Health for life

Chest pain is not a frequent early warning symptom of a heart attack in women.

But what is?

In a study funded by the NIH that appeared in the journal Circulation in 2003,¹ the most frequent early warning symptom of heart attack in women was unusual fatigue ... not a tiredness that you might link to overwork or stress, but a fatigue so severe some women gave the example of not being able to make a bed without resting.

Most Women Have Early Warning Symptoms

Of the 515 women studied, 95% of them reported experiencing symptoms a month or more before a heart attack.

The most frequent symptoms reported were:

• unusual fatigue (70.7% of women experienced)
  
• sleep disturbances (47.8%)
  
• shortness of breath (42.1%)
  
• indigestion (39.4%)
  
• anxiousness (35.5%)

The minority of women who did report chest discomfort in the weeks leading up to a heart attack "used descriptors such as aching, tightness, or pressure, not pain" to explain it.

Even during a heart attack, 43% of women in this study "did not experience any type of chest discomfort."

The lead author of the study, Jean C. McSweeney, PhD:²

"McSweeney said her best advice is for women who have risk factors for heart disease such as smoking, high blood pressure, high cholesterol, diabetes or a family history of heart disease and who are experiencing [early warning] symptoms should contact their doctor before seeking emergency treatment."

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¹ For the study (full free access):
Women’s Early Warning Symptoms of Acute Myocardial Infarction

² For a summary, provided by Yale-New Haven Health:
Signs Of Impending Heart Attacks Among Women

On the heels of Avandias new safety warning addressing a potential increased risk for heart attack (see previous post), Takeda, maker of Actos (pioglitazone), plans to launch a big advertising campaign using the headline:

"If you have type 2 diabetes, Actos has been shown to lower blood sugar without increasing your risk of having a heart attack or stroke."

The FDA reviewed cardiovascular data from Takedas PROactive study and approved this claim.

Avandia and Actos are the only drugs in the class of diabetes medications known as thiazolidinediones. They work by increasing insulin sensitivity.

Both drugs, however, may worsen heart failure, a condition in which the heart does not adequately pump blood, and are labeled as such. Below is Actos boxed warning regarding heart failure:

Thiazolidinediones (TZDs), including ACTOS, cause or exacerbate congestive heart failure (CHF) in some patients. After initiation of ACTOS and after dose increases, observe patients caully for signs and symptoms of heart failure (including excessive rapid weight gain, dyspnea, and/or edema). If these signs and symptoms develop, the heart failure should be managed according to current standards of care. Furthermore, discontinuation or dose reduction of ACTOS must be considered.

ACTOS is not recommended in patients with symptomatic heart failure. Initiation of ACTOS in patients with established NYHA Class III or IV heart failure is contraindicated.

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Takedas press release responding to Avandias new safety warning:
Re. U.S. Food and Drug Administration Decision Summary