Heartwarming Moment: New heart attack guidelines correct decades of under-diagnosis in women

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Quick summary: This story highlights recent developments related to gender, showing how constructive action can lead to meaningful results.

The world’s four leading cardiovascular health organizations just agreed on a universal heart attack definition for the first time. The announcement came at the European Society of Cardiology congress in Munich and includes two changes that matter especially for women: an upgrade to three heart attack types that are up to ten times more common in women, and a lower threshold on the blood test that had been missing heart attacks in female patients for years.

What the old system missed

Some heart attack types had been classified as lower priority than the clot-caused variety most people picture when they hear “heart attack.” The types that got downgraded were the ones that disproportionately affect women.

Three specifically: coronary artery spasm, coronary embolism, and spontaneous coronary artery dissection (SCAD). Coronary artery spasm is a tightening of the artery that cuts off blood and oxygen; it can be triggered by emotional stress, exercise, or extreme cold. Coronary embolism is when a clot or fatty deposit travels to a coronary artery and blocks it. SCAD is a tear in the artery wall. About 80 percent of cases are in women, and it often happens during or shortly after pregnancy.

Because these types ranked lower, women who had them often got worse care. Sometimes treatment didn’t match the actual cause. In some cases, care made them more unwell.

Then there was the blood test. The main diagnostic tool for heart attacks worldwide measures troponin, a protein the heart releases when it’s injured. It was set to a single threshold for all patients, one that catches all men having a heart attack but misses some women. Prof. Nicholas Mills of the University of Edinburgh, who led the international task force, called this “unintended systematic bias against women.”

The fix

The three heart attack types most common in women now sit in the same classification tier as the clot-caused attacks that have long set the terms for cardiac care. Emergency departments will apply sex-specific troponin thresholds going forward.

“For decades, women have missed out on accurate diagnoses and treatment,” said Prof. Bryan Williams, chief scientific and medical officer of the British Heart Foundation. “This focus on finding less common causes of heart attacks, which predominantly affect women, should help to change that. It could be life-changing for huge numbers of women in the UK and worldwide.”

Mills said it was “the first time that we’ve had a truly global approach to aligning how we diagnose what is probably the most important diagnosis there is.” Getting the ESC, the American College of Cardiology, the American Heart Association, and the World Heart Federation onto the same document was its own challenge. The guidelines are published in the European Heart Journal.

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