This article appears in Nov.-December 2019 Family magazine.

A heart attack gender gap exists, and it’s killing women.

“Absolutely, there’s a gender gap,” said Dr. John Osborne, an American Heart Association spokesman and director of cardiology at State of the Heart Cardiology in Dallas. Reasons for the disparity in awareness, diagnosis and treatment include symptoms that are misunderstood or ignored as well as medical bias, Osborne said.

Recently released research from the British Heart Foundation estimated that more than 8,200 women in England and Wales died between 2003 and 2013 as a result of receiving worse treatment than their male counterparts for heart attacks. While the research focused on women in another country, the gender gap affects women in the United States, too, Osborne said.

Common killer

Cardiovascular disease is so common that it kills 40% of Americans, Osborne said. It is the leading cause of death in America and in most developed countries.

“Cardiovascular death kills more Americans than the next seven causes of death combined — and that includes cancer. Not to say one disease is worse than another, but more women with breast cancer die from cardiovascular disease than from breast cancer,” Osborne said.

The common symptoms of a heart attack include crushing pressure, tightness or squeezing in the chest or arms that may radiate to the neck or throat, nausea and sweating.

“Two-thirds of men suffer what I call the ‘Hollywood heart attack’ with these classic, textbook heart attack symptoms,” Osborne said.

However, only one-third of women who have a heart attack exhibit these symptoms, Osborne said. Instead of the chest grab, the symptoms women experience are often a little “suspicious,” he said.

“They can be very non-specific. It can feel like fatigue, feeling tired, shortness of breath. In other words, it can feel like everyday life. The symptoms are less in your face. It makes diagnosis much more difficult,” Osborne said.

Women can easily mistake these more subtle symptoms for the cold, flu or a virus, he said.

“There’s also systematic bias,” Osborne said. Instead of diagnosing a possible heart attack, doctors may ask women experiencing these symptoms if they feel panicked, stressed or upset.

Age factor

Tobacco use, high blood pressure, high cholesterol and diabetes/prediabetes are all risk factors of cardiovascular disease that can be controlled. Age cannot.

“Age is the biggest, most powerful risk factor and it’s not fixable,” Osborne said.

The age factor also contributes to the heart attack gender gap. The risk of heart attack in men spikes around 55, Osborne said.

On the other hand, the risk of heart attack for women doesn’t increase sharply until 65, possibly because of hormonal changes, he said.

“Women are protected for about 10 extra years. The way people think about it is, there’s a sort of adverse bias. When a man of 45 experiences symptoms doctors are more likely to diagnose a heart attack than with a woman of 45,” Osborne said.

Over time, the risk evens out, and by 65 the risk of heart attack is equal for men and women, he said.

“Women should have a very low threshold. If you feel something you think may be a heart attack, get it checked out,” said Osborne, who has examined numerous female patients who thought they had a cold or the flu but an EKG test revealed they had suffered a heart attack.