Older age of American moms may be behind increase in cases, experts say
TUESDAY, July 8 (HealthDay News) -- Although heart attacks are rare among young women, becoming pregnant does double or triple a woman's risk, a new study finds.
"This is a unique phenomenon in the sense that these are young women who are not supposed to have [heart attacks]," said lead researcher Dr. Uri Elkayam, a professor of medicine at the University of Southern California in Los Angeles.
About 250 pregnant women in the United States each year suffer a heart attack, Elkayam said. However, mortality can be high in these cases, mainly because a diagnosis of heart problems is often missed or delayed. "These women are victims of a lack of awareness," Elkayam said.
Physicians should not dismiss symptoms of chest pain and young women as not being from a heart attack, he said. "If somebody had symptoms of what could be a heart attack, the physician needs to consider [it]."
One reason for the increase in the number of pregnant women having heart attacks is that women in the United States are becoming pregnant at much later ages, Elkayam said. "So, it is anticipated that the number of pregnant women who have heart attacks will increase," he said.
The report was published in the July 15 issue of the Journal of the American College of Cardiology.
In the study, Elkayam's team reviewed the cases of 103 women who had heart attacks during their pregnancy.
Women who had a heart attack in the 24 hours before or after delivery were twice as likely to die from heart attack compared with women who had a heart attack before labor or in the first day to three months after delivery, the team found.
Elkayam's group also found that older pregnant women were at greater risk for having a heart attack. In fact, 72 percent of the women who had heart attacks were older than 30, and one in four were older than 35.
One of the most common causes of heart attacks among pregnant women was coronary dissection, where the wall of the coronary arteries is weakened and separates. "This is a rare type of heart attack," Elkayam said.
Most women in this group did not have atherosclerosis or blocked arteries, the usual causes of heart attack, he noted.
Many women studied had standard risk factors for heart attack, Elkayam said. Among these women, 45 percent smoked, 24 percent had high cholesterol, 22 percent had a family history of heart attack, 15 percent had high blood pressure, and 11 percent had diabetes.
However, "early diagnosis and appropriate treatment can result in an improvement in outcome," Elkayam said. "Ten years ago, the mortality rate was 20 percent. Now, it's between 5 and 10 percent. So, we are making progress."
Dr. Jeffrey S. Berger, from the department of cardiovascular medicine at Duke University Medical Center, in Durham, N.C., said that "fortunately, this is not a very common experience."
However, internists and cardiologists should be aware of the increased risk of heart attack during pregnancy, he said. "Women who have risk factors for heart disease should take this into consideration and speak with their physicians about it," Berger added.
For more on women and heart disease, visit the American Heart Association.
SOURCES: Uri Elkayam, M.D., professor, medicine, University of Southern California, Los Angeles; Jeffrey S. Berger, M.D., department of cardiovascular medicine, Duke University Medical Center, Durham, N.C.; July 15, 2008, Journal of the American College of Cardiology
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