Research from the Mayo Clinic reveals that over half of heart attacks in younger women are not caused by the traditionally recognized culprit of clogged arteries. This significant finding challenges long-standing beliefs about heart health and underscores the need for a reassessment of risk factors in this demographic.
The study analyzed 1,474 heart attack events among individuals aged 65 or younger in Olmsted County, Minnesota, recorded from 2003 to 2018. Researchers meticulously reviewed medical records and imaging to determine the primary causes of these incidents. The results indicated that more than half of the heart attacks experienced by women were attributed to non-atherothrombotic causes, marking a crucial divergence from established understandings of heart attack triggers.
In men, atherothrombosis, which involves blood clots blocking arteries, accounted for approximately 75 percent of heart attacks. However, in women, this figure dropped to 47 percent. This discrepancy may have significant implications for both the prevention and treatment strategies employed by healthcare professionals.
Dr. Claire Raphael, a cardiologist involved in the study, emphasized the importance of recognizing these alternative causes. “This research shines a spotlight on heart attack causes that have historically been under-recognized, particularly in women,” she stated. “When the root cause of a heart attack is misunderstood, it can lead to treatments that are less effective – or even harmful.”
Among the notable findings, 34 percent of heart attacks in women were linked to supply/demand mismatch secondary myocardial infarctions (SSDMs). This condition arises from an imbalance between oxygen supply and the body’s demands due to various stressors, including anemia or infections. Other contributing factors included spontaneous coronary artery dissections (SCADs), which occur when tears in artery walls trap blood, and embolisms, where blood clots travel from other regions of the body.
The study pointed out that SSDMs were the most common cause of heart attacks in women aged 45 years or younger. The researchers noted that the acute non-atherothrombotic causes, including SCAD, embolism, spasm, and MINOCA (myocardial infarction not otherwise classified), were collectively as prevalent as atherothrombosis in this group.
The findings also indicated that individuals who experienced SSDMs had the highest mortality rates from any cause within five years following their heart attack. The authors suggested this may relate to a sicker population that is more vulnerable to non-cardiac diseases.
The study revealed that many SCAD-related heart attacks had initially been misattributed to atherothrombosis, especially among women, where SCAD was identified as the cause almost six times more frequently. Misdiagnosis of heart attack causes can lead to inappropriate preventive measures. Dr. Rajiv Gulati, a cardiologist involved in the research, noted, “Our research highlights the larger need to rethink how we approach heart attacks in this patient population, particularly younger adult women.” He encouraged clinicians to be more vigilant about conditions like SCAD and stress-related triggers and urged patients to advocate for themselves when they feel something is amiss.
While the study did not delve into the differences between men and women regarding heart attack causes, it raises questions about how risk factors may impact women differently and whether they are less likely to seek medical help. Future research could explore these dynamics, employing similar analytical techniques across larger and more diverse populations.
In the United States, a heart attack occurs approximately every 40 seconds, highlighting the urgency of understanding the risk factors involved. These factors range from urban living, dietary habits, to environmental influences such as air pollution.
Encouragingly, advancements in heart imaging technology have improved the ability to diagnose and prevent recurrent heart attacks. However, recent studies from the US and Canada reveal that current medical screening techniques may still fail to identify nearly half of those experiencing heart attacks.
Risk assessments in the US typically involve evaluating atherosclerotic cardiovascular disease (ASCVD) scores, which consider various factors linked to cardiovascular disease development. An analysis of health records for 465 individuals aged 65 and younger who experienced their first heart attack found that two days prior, ASCVD scores would have categorized 45 percent of them as low or borderline risk.
Both Dr. Raphael and Dr. Gulati stress the necessity of raising awareness about the alternative causes of heart attacks among healthcare professionals and the public. “Understanding why a heart attack happened is just as important as treating it,” Dr. Raphael remarked. “It can mean the difference between recovery and recurrence.”
This research was published in the Journal of the American College of Cardiology, offering vital insights that could potentially reshape approaches to heart health, particularly for younger women.
