Doctors have long known that women are nearly twice as likely as men to die in the first month after a heart attack. But a new study published in the Journal of the American Medical Association looked behind this statistic to discover that gender may not directly influence survival outcomes after a heart attack heart attack outcomes.
Theresa Volpe, 40, barely survived a massive heart attack two years ago. She said despite ongoing symptoms of dizziness and fatigue, when her chest pains struck, many people thought she had indigestion.
"I was so dizzy and light headed -- my arms felt heavy and weighed down," said Volpe. "The paramedics came and looked me over and said, well your heart rate is not so high maybe it's just anxiety."
But once a cardiologist saw her, she was immediately airlifted to a specialist center where it was discovered one of Volpe's major arteries was 90 percent blocked by plaque.
"I was lucky because a lot of women don't survive a heart attack," said Volpe, who is now a spokeswoman for the Go Red for Women campaign of the American Heart Association.
To discover more about the difference in heart attack survival rates between the sexes, Dr. Jeffrey Berger and his colleagues at the New York University School of Medicine analyzed the medical records of more than 130,000 heart attack patients (72 percent men and 28 percent women) that were part of 11 international studies between 1993 and 2006.
Among all the studies, women died at a 9.6 percent rate compared with a 5.3 percent rate for men in the first month after a heart attack. Yet the study pointed out key differences between men and women in these statistics.
Women were having heart attacks at an older age than the men. Women were also more likely to have diabetes, high blood pressure and heart failure while men were more likely to smoke, to have had a previous heart attack and have a previous bypass surgery.
Once the researchers compared men and women of the same age and health status, then the gender difference in survival rate disappeared.
"[In our study] you see that women have almost a twofold increase risk for death after 30 days, which was found before, but the beauty of our study is we're able to look at reasons why this is," said Berger. "If you account for age, clinical risk factors that differ like hypertension, high cholesterol and numbers of arteries are blocked, there is not a difference."
"It's not being a man or woman that puts you at higher risk, it's these other factors," said Berger. Rather than focus on treating men and differently, Berger hoped doctors would start looking at treating older heart attack victims with specific health complications differently than other heart attack victims.
Indeed, Berger's study led some cardiologists to wonder if some of the differences between men and women in heart disease have been overblown.
"The so-called 'gender differences' in heart disease have been hyped to a large extent," said Dr. Steven Nissen, director of the Joseph J. Jacobs Center for Thrombosis and Vascular Biology at the Cleveland Clinic Foundation in Cleveland, Ohio.
"The primary conclusion of this study is that there is not a higher mortality in women than men following a heart attack (when adjusted for severity of disease and co-morbidities)," said Nissen. "Accordingly, the study does not suggest a different strategy in women with heart attack. It appears that 'what is good for the goose is also good for the gander.'"
Yet other doctors point out that the study couldn't explain why women had their heart attacks at an older age, and in worse health in the first place. Moreover, doctors wondered whether there are still important differences to note about men and women leading up to the heart attack, if not in the 30 days that follow.
"This study tells us that even in this era of highly sophisticated diagnostic and treatment modalities for heart attack that women's heart disease is different from that seen in men and that women still fare worse," said Dr. Malissa Wood, of the cardiac unit of Massachusetts General Hospital in Boston.
"I believe that the big differences start before the heart attack ever happens," said Wood. "Once a woman presents with a heart attack and is of advanced age with diabetes and high blood pressure and their associated complications (blood vessel disease, kidney disease) the horse is out of the barn."
Volpe was only 38 when she had a heart attack. Despite her young age, she experienced some of the worst troubles that seem to affect women who have heart disease. First nobody could recognize her symptoms, and then nobody believed it when she had a heart attack.
"I was very tired, I was very fatigued. I was so tired I thought I was pregnant," said Volpe.
Volpe also occasionally went into dizzy spells, she got out of breath and she would experience chest pain. Her primary care doctor performed some tests -- an EKG and an echocardiography -- but when those came up normal Volpe's doctor suggested anti-anxiety medication.
"She had thought that I was suffering from a generalized anxiety disorder -- I was thinking the only thing that I'm anxious about is that I'm having chest pains," said Volpe.
Another round of tests at a gastrointestinal specialist couldn't explain her chest pains, so Volpe tried to relax with the occasional chest pain.
Then, on March 31, 2007 at a family birthday party she had a heart attack.
"At the ER, the cardiologist said we need to get to her out of here, she's having a massive heart attack and my husband said 'are you kidding,'" said Volpe.
Volpe now lives with four stents and must take a variety of medications for life.
"I wish I had the guts to say I want to see a cardiologist earlier," said Volpe, a mother of two school-age children. "Being so young, I was afraid to say I'd like to see a cardiologist."
More, Volpe wishes she had taken better care of herself.
"That's the huge thing. I really wish that I had taken better care of myself. You always think you have time. I don't have to worry about that until I'm older, but you're back pedaling," she said. "Every time I get on the treadmill I think I don't feel like it but this is what I have to do."