Racial Differences in Women's Prodromal and Acute Symptoms of Myocardial Infarction

Abstract

Background Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority women's symptoms of coronary heart disease may contribute to these disparities. Objective To compare black, Hispanic, and white women's prodromal and acute symptoms of myocardial infarction. Methods In total, 545 black, 539 white, and 186 Hispanic women without cognitive impairment at 15 sites were retrospectively surveyed by telephone after myocardial infarction. With general linear models and controls for cardiovascular risk factors, symptom severity and frequency were compared among racial groups. Logistic regression models were used to examine individual prodromal or acute symptoms by race, with adjustments for cardiovascular risk factors. Results Among the women, 96% reported prodromal symptoms. Unusual fatigue (73%) and sleep disturbance (50%) were the most frequent. Eighteen symptoms differed significantly by race (P <.01); blacks reported higher frequencies of 10 symptoms than did Hispanics or whites. Thirty-six percent reported prodromal chest discomfort; Hispanics reported more pain/discomfort symptoms than did black or white women. Minority women reported more acute symptoms (P < .01). The most frequent symptom, regardless of race, was shortness of breath (63%); 22 symptoms differed by race (P < .01). In total, 28% of Hispanic, 38% of black, and 42% of white women reported no chest pain/discomfort. Conclusions Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of women's prodromal and acute symptoms should assist providers in interpreting women's symptoms.

Acute Myocardial Infarction in Women

“…[189][190][191][192][193] Ischemic symptoms in young black women include unusual fatigue, shortness of breath, chest discomfort, or frequent indigestion, with older white women displaying fewer symptoms. 188,194 Shoulder pain and arm pain are twice as predictive of an ACS diagnosis in women compared with men. 195 Among young patients in the Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome (GENESIS PRAXY) study, chest pain was the most prevalent symptom in both sexes, regardless of the type of ACS.…”

Predicting Coronary Heart Disease Events in Women

“…10,11 The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) assesses the presence of a broad range of prodromal symptoms (PS) among women. However, although the MAPMISS has been used in several studies 10,12,13 all have been retrospective. As a result, we know little about the predictive utility of symptoms in the PS section of the MAPMISS.…”

Anginal Symptoms, Coronary Artery Disease, and Adverse Outcomes in Black and White Women: The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study

“…Our finding that black women with CAD checked a greater number and variety of symptoms than white women with CAD are consistent with other studies. 25,26 These differences may be explained in part by cultural differences in symptom expression, as the majority of the black women in this cohort were from the south. Studies have documented that regional differences may affect the description and experience of pain, which may result in misleading portrayals of CAD in southern U.S. populations.…”

“…13,26,29,30 Public campaigns to date have focused on typical chest pain presentations 8,10 and significantly lower rates of awareness of heart disease risks have been documented in black women than white women.…”