Heart Attacks: Care is NOT One-Size-Fits-All




A recent study from the European Society of Cardiology (ESC) suggests women are more than twice as likely to die after a heart attack than men. The study included 884 patients, and 27% of them were women with an average age of 67. The average age of men in the study was 60.

Sridhar Sampath Kumar, MD, an Interventional Cardiologist at OSF HealthCare, says more studies need to be done before making too much out of this.

“The study said that despite women being treated in the same way that men are for heart attacks, using stents and percutaneous coronary intervention (PCI), the mortality seems to be worse in women. This is irrespective of the fact that the medical management of those patients was exactly the same. There were age-related changes, but these are unexplained by the current data that’s available,” Dr. Kumar says.

Dr. Kumar says whether you’re a man or a woman, environmental factors play a huge role in our overall health.

“We have clear data from the past, looking at populations that migrated from Japan to the United States. In Japan, they had a higher risk of cancer or malignancies, but much lower rate of cardiovascular disease. But when they migrated to the U.S. they had a much lower rate of cancer but much higher of cardiovascular disease,” Dr. Kumar says.

According to The Centers for Disease Control and Prevention (CDC), someone has a heart attack every 40 seconds in the U.S. Over 314,000 women died from heart disease in 2020 in the United States, or about one in every five female deaths. Dr. Kumar says misdiagnosing women’s heart problems has been an issue for decades.

“For generations, we’ve been treating men and women in the same ballpark. Saying, well if you don’t have any blockages, then the chest pain you have is probably not related to any heart arteries or angina. The same thing happened years ago, where predominantly men had labeled women who have chest pain either as hysterical chest pain, or it is related to mitral valve prolapse,” Dr. Kumar says. “A lot of women patients come to me today and have come with a diagnosis of having mitral valve prolapse in the 80s and 90s.”

Dr. Kumar says educating his patients that these past diagnoses are wrong has been a challenge.

“It’s taken awhile for me to educate them that they don’t have mitral valve prolapse, so you don’t have to have that crutch to hang on. Women tend to have more microvascular disease than macrovascular disease. This means we may not see clear blockages in the arteries, but they may have microvascular dysfunction. But it’s only now that people seem to be getting the message out that we need to be treating those people like they have angina.”

Angina pectoris, commonly known as angina, is chest pain or discomfort that happens when a part of your heart doesn’t get enough blood and oxygen. It can be a symptom of coronary artery disease (CAD), but it can have other causes.

Another universal truth, Dr. Kumar says, is that smoking has a negative impact on any heart disease patient.

“It’s very clear that smoking is bad for you. We know that women tend to smoke more and that younger women are beginning to smoke more. This started from marketing campaigns back in the 70s and 80s,” Dr. Kumar says. “Subsequently when regulation was brought into the U.S. to reduce tobacco use, tobacco companies very quickly jumped into southeast Asia with their marketing strategy saying, “’Smoking is cool.’”

And treatment is not a “one size fits all.” Dr. Kumar says different populations across the globe may need different treatment plans than others.

“If you look at the Asian population, with people from India, Vietnam and Thailand, they have completely different body makeup compared to a western population. But we seem to use the same generalizations from a white Caucasian background to a Thai or Vietnamese background,” Dr. Kumar says. “But when you speak to the physicians who are actually from there, they will tell you that the arteries are not the same. The complications and medical issues we deal with are not the same.”

Dr. Kumar says this point just proves you cannot paint with a wide brush, transcending populations, when it comes to treatment and data.

He adds that maintaining an active life, changing your dietary habits, seeing your medical provider and being more attuned with how you’re feeling are proactive steps you can take for a heart healthy lifestyle.


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