A recent study found that the number of young women who are hospitalized from a heart attack is increasing, and these women are less likely than men to receive the right treatment.
This aligns with what Jennifer Lewey, MD, Director of the Penn Women’s Cardiovascular Center, has observed in recent years: “I’m seeing an increasing number of premenopausal women coming in with heart attacks,” she says.
Ultimately, heart attacks can be especially dangerous for this population because they may be unexpected—by both the person having the heart attack and her health care providers.
What’s behind it?
According to Dr. Lewey, most young women who have heart attacks fall into two main groups.
Women in the first group have a number of risk factors, including obesity, prediabetes, diabetes, and high blood pressure. “They’ve had an early onset of all these factors that we know lead to heart disease, which may or may not be under control,” Dr. Lewey says.
Obesity is one of the strongest risk factors for diabetes, and diabetes is one of the strongest risk factors for heart disease. That’s why the recent increase in obesity among women of reproductive age and black women is especially concerning.
“Targeting the increase in these risk factors is important,” Dr. Lewey says, “and that may mean intervening at the level of the individual, community, or health care system to improve diagnosis and treatment.”
The second group of young women who have heart attacks is harder to define. These women don’t have or aren’t aware that they have one of the typical risk factors. Their first sign of cardiac trouble is the heart attack itself.
“I think some of these women have traditional atherosclerosis, or plaque build-up,” Dr. Lewey explains. “But it might stem from a family history or another risk factor they aren’t aware of, like pregnancy, which doesn’t get a lot of attention as a risk factor for heart disease.”
The rise of SCAD
Besides these two groups, there’s a smaller population that Dr. Lewey also sees: young women with a spontaneous coronary artery dissection, or SCAD.
SCAD tears the inner lining of the coronary artery, allowing blood to flow between the artery’s layers. In time, a hematoma (a collection of blood) forms, which blocks blood flow to the artery as it gets bigger. Untreated, SCAD can eventually lead to a heart attack.
The cause remains unknown, but nine out of 10 people who develop SCAD are women in their forties.
“It’s younger women having these kinds of heart attacks, and 1 to 3 percent of all heart attacks are caused by SCAD rather than traditional plaque build-up,” Lewey says. “It’s an underappreciated cause of heart disease in younger women.”
Early education and treatment
Regardless of age, awareness and appropriate treatment is key to preventing these heart attacks.
A 2012 survey by the American Heart Association found that just over half of the women surveyed knew that heart disease is the leading cause of death among women. Among black and Hispanic women, it was closer to a third.
Dr. Lewey explains that a couple things create this gap. Individual awareness is one concern, but the health care system is also partly to blame.
“Heart disease is still seen as affecting predominantly men and older women, so women’s providers aren’t always talking to them at younger ages about heart disease,” she says. “The other part is that women tend to take care of a lot of other people and don’t necessarily take care of themselves all the time. They may seek care when they have active issues, but they may not ask about cholesterol and blood pressure.”
In some cases, women who do take their symptoms seriously aren’t always tested for a heart attack in the emergency room. “That bias about who is a typical heart attack patient definitely persists in the health care system,” Dr. Lewey says.
Dr. Lewey adds that this is complicated by a lack of sex-specific research into the risk factors of heart disease. “We know that the main risk factors for heart disease carry different weights for men and women,” she explains. “It may be that obesity and diabetes are higher risks for women than they are for men. Which begs the question: have we studied these issues appropriately?”