Women's Heart Attack Symptoms Differ from Men's

Goldberg et al. conducted a population-based, observational study of differences in heart attack symptoms between 810 men and 550 women with diagnosed acute myocardial infarction (AMI) from 16 hospitals in the Worcester, Massachusetts, area. They controlled for age, medical history, and characteristics of AMI by regression modeling. They found that chest pain, diaphoresis, and shortness of breath were the most commonly reported symptoms in both women and men. However, compared to men, women were significantly more likely to present with:

• Neck Pain (adjusted odds ratio (OR)=0.52; 95% confidence interval (CI): 0.35, 0.78);
• Back Pain (OR=0.38; 95% CI: 0.26, 0.56);
• Jaw Pain (OR=0.50; 95% CI: 0.31, 0.81); and
• Nausea (OR=0.58); 95% CI: 0.45, 0.75).

Goldberg's team also observed that:

• At the time of their heart attack, women were older than men "and were more likely to include those with a history of angina, diabetes, and hypertension (p<0.05);"
• An anterior and non-Q wave AMI was more likely to occur in women (p<0.001).

"The present results," they wrote, "suggest that non-chest pain symptoms frequently occur in women; these symptoms may be mistaken as being musculoskeletal or neurologic in origin, or atypical, and therefore inconsistent with onset of AMI, thereby delaying or preventing access to early receipt of medical care."

They continued, "One possible explanation as to why women are less likely to believe they are having a heart attack ... is that their symptoms of AMI may be perceived as different or less typical than those reported by men or there may be sex differences in pain thresholds. That being the case," Goldberg et al. wrote, "the seriousness of these symptoms may be misinterpreted by themselves or their health care providers."

Data such as those revealed in the current study are needed, they said, "to familiarize clinicians with these variations [in women's heart attack symptoms] so that proper education, identification, diagnostic evaluation, and timely management can be carried out."

They emphasized that the traditionally described symptoms of heart attack do not apply universally. "Women need to be told that they may be more likely to experience nausea or back, jaw, or neck pain than men, whereas men need to be made aware that they may be more likely to experience diaphoresis."

Excerpted from Women's Health Weekly: October 12, 1998

Goldberg, RJ et al. "Sex Differences in Symptom Presentation Associated with Acute Myocardial Infarction: A Population-Based Perspective," Am Heart J, 1998;136(2):189-195.

Women at Special Risk of Hepatitis C

Hepatitis C is a blood-borne disease that attacks the liver and quietly damages other vital health functions. Often it can take 20 years for the symptoms to appear. People with hepatitis C can also develop cirrhosis, liver cancer, and other diseases causing severe symptoms. Those infected can spread the disease through blood-to-blood contact and during birth.

Before 1992, when a reliable screening process for the disease was available, an estimated 7-10 percent of all people who received blood transfusions became infected with the hepatitis C virus (HCV). This included a large number of women who received blood transfusions - often while under sedation and without their knowledge - during cesarean section childbirth.

A 1993 study published in the Journal of Reproductive Medicine indicated that only 25 percent of women who received blood during a C-section realized they had been transfused. It is estimated that 250,000 women may have contacted the virus in this way. "If these women don't know about the virus or do not realize they received transfusions, they may not be tested until severe liver damage becomes evident," says Phyllis Greenberger, executive director of the Society for the Advancement of Women's Health Research, who has called hepatitis C "the next major health crisis women are facing." She is urging the federal government to take a stronger lead in educating and alerting women to the potentially fatal consequences of hepatitis C.

"Four million Americans are infected with the life-threatening virus, and only 5 percent know they have it," she said. "Women have special risk factors for this disease, and because the symptoms are mostly silent, the [U.S.] government has a particular responsibility to alert women at risk." Greenberger is joined in the call to action by former U.S. Surgeon General C. Everett Koop. "We stand at the precipice of a grave threat to our public health ... it affects people from all walks of life, in every state, in every country. And unless we do something about hepatitis C soon, it will kill more people than AIDS," Koop warned.

Both Greenberger and Koop said that a national program to notify those who received blood transfusions between 1988 and 1992 is a step in the right direction. But Greenberger urged government officials to create a greater public awareness effort to reach those who were transfused before 1988 or those who received blood from infected donors who were never traced.

Greenberger urges women who had a C-section before 1992 to have their blood tested for the disease. "The good news is that there is treatment available, including Rebetron, a new drug recently approved by the FDA [U.S. Food and Drug Administration], to help fight the disease. "The federal government should not wait to start alerting the public to this women's health crisis," she says.

Excerpted from Women's Health Weekly: November 2 & 9, 1998

Women and Systemic Sclerosis

In a study published in the April 23rd, 1998 issue of The New England Journal of Medicine, authors Artlett, Smith and Jimenez write about the "Identification of Fetal DNA and Cells in Skin Lesions from Women with Systemic Sclerosis".

Systemic sclerosis is a disease that affects women past their childbearing years but who have had children. It is a disease of unknown origin similar to that of the graft-versus-host-disease that occurs in recipients of donated organs. Some studies have shown that fetal cells can remain in the mother's bloodstream and tissues for many years after she has given birth to the baby. This study found that many women who have systemic sclerosis have these fetal cells in the affected skin. This could mean that the disease is a reaction of the body to these foreign cells.

New England Journal of Medicine 1998;338:1186-91

CWH Journal Watch: January 1999