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Younger women at risk: Heart attack under age 50

Question: Which of the following statements about heart disease are true?

  • It’s the leading killer of women in this country.
  • It can strike the young as well as the old.
  • Younger women are more likely to die of a heart attack than their male counterparts while still in the hospital.

Answer: All of the above.

And if the very last statement surprises you, you’re not alone: Yale researchers were struck by it, too. In their study of nearly 400,000 heart attack victims, ages 30 to 89, they found that women under age 50 were twice as likely to die following a heart attack as men under age 50. What’s more, the younger a female heart attack victim, the higher her risk of death compared to that of a man the same age. Why? Doctors aren’t sure, but they have some theories:

  • A serious delay. Instead of crushing pain, women sometimes feel only a slight pressure or a burning sensation during heart attack. The result? They often put off seeking help—sometimes for hours. It’s a delay that can be extra damaging, if not deadly.
  • More risk factors. Young women who suffer heart attack may be more likely than their young male counterparts to have other health problems, such as high blood pressure, heart failure, heartbeat irregularities, valve problems and diabetes. And consider that while having diabetes doubles a man’s risk for heart disease, women who have diabetes are three to four times more likely to develop heart disease than women who don’t.
  • Smoking worse for women. This bad habit, it turns out, causes more heart disease in women than in men. In one study, smoking increased the risk of heart attack 57 percent more in women than in men. More than 70 percent of women age 45 or younger who have heart disease are smokers.
  • Estrogen less effective. Although the hormone estrogen shields most women from heart disease, researchers suspect that heart disease in young female heart attack victims may be so aggressive that estrogen doesn’t offer adequate protection.
  • Less aggressive treatment. Research suggests that women who seek medical attention for a heart attack are often treated less aggressively than men. For example, young female victims may not be given clot-busting medications as readily as men are, even though these drugs are extremely effective for both sexes.
  • A woman’s body. The Yale researchers found that young women who have heart attacks are less likely than men or older women to have narrowing of the arteries, or atherosclerosis. Instead, heart attacks in young women are more often the result of blood clots and spasms in arteries. This means traditional diagnostic tests that look for atherosclerosis, such as angiography, are not necessarily helpful when it comes to detecting early-stage heart disease in younger women. Doctors are looking for the ways heart disease manifests itself in younger women in order to develop more effective diagnostic techniques.

Protect yourself

If you’re a woman, young or old, you can protect your heart health by taking these steps:

  • Don’t smoke.
  • Exercise regularly and maintain a healthy body weight.
  • Enjoy a diet low in saturated fat and high in fruits, vegetables, whole grains, legumes and fiber.
  • Talk to your doctor about taking a regular dose of aspirin: One study showed that women over age 50 who took one to six aspirins per week slashed their heart-attack risk by 32 percent.
  • Take control of high blood pressure and diabetes.
  • Remember your vitamins. The B vitamins, for example, lower levels of homocysteine, an amino acid that’s been linked to increased risk of heart disease.
  • Monitor triglycerides. In women, these blood fats predict heart disease risk better than total cholesterol. Your levels should be less than 150 mg/dL.
  • If you are on hormone replacement therapy, talk to your doctor about stopping.
  • Ask your doctor if wine is wise for you: Three to six glasses of red or white wine per week can help lower the risk of heart disease. But more than that can damage the heart, raise your blood pressure and cholesterol levels and increase your risk for breast cancer and other illnesses.