Each year, 435,000 American women have heart attacks. Nearly 20% of them are under age 65. In fact, heart attacks kill six times as many women as breast cancer does.
However, women are not always evaluated and treated appropriately for their heart attacks, especially compared to men, research shows.
One study, for example, found that women were less likely to receive beta blockers and other common medications and therapies to manage their heart attacks or undergo certain standard procedures such as angiography.
"Women are not getting the same care as men," says Suzanne Steinbaum, a cardiologist at The Mount Sinai Hospital in New York City and a volunteer medical expert for the American Heart Association's Go Red for Women campaign.
"It may be because heart disease is not a woman's disease, but that's not true," she says. "Heart disease kills more women than all cancers combined."
Women can take solid steps to improve their odds of getting the right treatment for heart attacks.
1. Advocate for yourself
A 2018 study published in Circulation, the journal of the American Heart Association, found that with similar symptoms, 53% of women said their doctor did not think their symptoms were heart-related; 37% of men.
"The most powerful thing a woman can say is, 'I think I'm having a heart attack.'" Steinbaum says. "When she says, she sets off a train of activity and thought processes in the team that cares for her. That simple statement can be a lifesaving measure. "
2. You may not be sure it's a heart attack-seek help anyway
Women wait 30% longer than men-about another half hour-before seeking care, on average, according to an August 2018 study published in Current Cardiology Reports.
"One of the reasons why women are getting treatment is that they are concerned about appearing silly if their symptoms are not due to heart attack," says Nieca Goldberg, medical director of the NYU Langone Medical Joan H. Tisch Center for Women's Health Center.
These slowdowns can snowball. Once they arrive at the hospital, women wait 20% longer than men to receive care, according to the same study.
"When women reach out for help, they have delays in whether they are EMTs out in the field or doctors seeing women in the emergency room," Steinbaum says.
3. Get on the phone, not on the internet
Women who suspect they may have a heart attack often take an aspirin and go online to check their symptoms. says Goldberg
"If you're thinking about taking aspirin because you may be having a heart attack, call 911 at the same time," Goldberg says.
4. Describe-but do not interpret-your symptoms
When did the symptoms start? How long did they last? Were you at rest or asleep when you experienced them? What do they feel like?
Do not discount symptoms by assuming they stem from anxiety, stress, indigestion, or insomnia. One study found that 21% of women attributed their symptoms to stress or anxiety compared to 12% of men.
5. Talk about your risk factors
Do not assume your health care team has reviewed your records. Let them know if you have high blood pressure, abnormal cholesterol levels, diabetes, or a family history of heart disease, says Goldberg.
If you have not been to the doctor for a while, she adds, say that you do not know if you have risk factors because you have not been evaluated recently.
6. Talk about gender bias
Women are more likely to survive a heart attack if their doctor is female.
Goldberg would not go so far as to recommend a female doctor, but you can draw attention to the possibility of gender bias.
You can ask your doctor what the recommended treatment plan would be if a man presented with your symptoms.
And ask about stenting and bypass. These lifesaving procedures are more often recommended for men than for women.
"I tell all women they need to have a relationship with a doctor," says Steinbaum. "They need to feel heard and understood. It does not matter if it's a man or a woman, but it has to be someone who really understands and gets them. If they are not heard or taken seriously, they should get another doctor. "
7. Watch for a range of symptoms
More than 85% of women and men who have a heart attack notice, chest pain, pressure, tightness, or discomfort. But women are more likely to have three or more additional symptoms such as shortness of breath, nausea, or abdominal, shoulder, jaw, or neck pain.
"Women can be more difficult to diagnose because their symptoms are so esoteric," Steinbaum says.
Do not think you're too young
"Age is not something that rules in or out of a heart attack," Goldberg says.
Assuming you are too young to have one you can keep from you that you need to survive. A large study of over 28,000 people hospitalized for heart attack included both men and women starting at age 35.