Sex differences and heart attack: "A matter of life or death"

“Being unaware of these sex differences may be a matter of life and death. There is a risk that women will not be admitted [to hospital] in time or die at home,” says Karin Schenck-Gustafsson, consultant cardiologist and senior professor of cardiology at the Department of Medicine in Solna, referring to the differing symptoms of heart attack experienced by women and men respectively.

Karin Schenck-Gustafsson, Photo: Ulf Sirborn

In women, symptoms such as shortness of breathe, nausea and general malaise are more common, while men are more likely to display the classic symptoms of chest pains, possibly radiating out into the arm. However, some women may also display characteristic chest pains while men might have atypical pain or discomfort.

There are sex differences associated with most types of cardiovascular disease. Women have smaller hearts with narrower coronary arteries and are more likely to suffer from issues such as coronary artery spasm and myocardial infarction without any narrowing of the coronary arteries, with the arteries appearing normal in x-rays despite changes to the small vessels. Women and men also suffer different types of congestive heart failure.

Swedish register data has shown that older women in general have not received the recommended treatment to the same extent as men and therefore do not survive for as long after a heart attack; however, according to Karin Schenck-Gustafsson, knowledge of sex differences in cardiovascular disease has increased over recent decades.

“Although initially I encountered a great deal of resistance and suspicion, these days it is taken for granted that there are differences between women and men. That said, we are not there yet; women remain underrepresented in clinical trials and a large amount of research is conducted without any sex perspective. It is still rare to find sex differences reported in major heart studies, even when women have been included in the studies,” she says.

She also emphasises the importance of teaching sex and gender.

Text: Sara Nilsson, first published in Medicinsk Vetenskap nr 3 2020