Women's heart attacks kill more often 

 Heart attacks typically hit men at an earlier age than they do women, but women may not hold the ultimate advantage. Among people stricken during middle age, women are much more likely than men to die in the hospital, new findings indicate.

 Using data from 1,658 hospitals around the United States, researchers led by Viola Vaccarino of Yale University studied almost 400,000 men and women between the ages of 30 and 89 who were hospitalized for heart attacks.

 The team found that the male patients were on average almost 7 years younger than the female patients. However, 16.7 percent of women but only 11.5 percent of men died in the hospital, although about the same number of men and women died. For patients under age 50, women were more than twice as likely as men to die in the hospital, the group reports in the July 22 New England Journal of Medicine. That gap steadily narrowed as patients got older, closing at age 74.

 Seeking an explanation for this striking pattern, Vaccarino's group uncovered several notable sex differences among younger patients, none of which emerged in elderly patients.

 Women under age 70 were more likely than their male counterparts to have diabetes, congestive heart failure, or stroke, lessening their odds of surviving a heart attack. Younger women also tended to wait longer than men before going to the emergency room and were more often misdiagnosed. The researchers report that the crushing chest pain and other warning signs that typify men's heart attacks are less common for women, making their symptoms tougher to evaluate.

 Finally, younger women tended to have heart attacks that were more severe and were accompanied by more complications than their male peers did. Even so, physicians were slightly less likely to give these women aspirin, beta-blockers, clot-busting drugs, and other crucial early remedies for heart attacks.

 Together, sex differences in all these risk factors explain only about one-third of the difference in death rate between women and men, the researchers calculate.

"The bottom line is that women who have a heart attack may not all be the same," says Vaccarino. "There may be some subgroups that are susceptible to a particularly aggressive disease for reasons we don't yet understand."

 In an editorial accompanying the report, Laura F. Wexler of the University of Cincinnati Medical Center underscores the apparent severity of heart attacks in younger women. Noting that many sex differences in coronary artery disease lessen after menopause, she speculates that genetic variations in the regulation of estrogen may make some younger women more vulnerable to heart disease.

 Charles Maynard of the University of Washington in Seattle says the new study is important because it highlights the danger of heart attacks in women, a threat that has long been underappreciated. Further research, he suggests, should scrutinize habits and treatments that might promote women's long-term health after heart attacks.