New Guidance from the American Heart Association
The diet advice isn't new. Meanwhile, women are still more likely to have their heart attacks missed.
The Advice Is Clear, and It Works
Diets with more fruits, vegetables, whole grains, and plant-based proteins are associated with a lower risk of heart disease. Whole grains include whole wheat, brown rice, barley, and quinoa. Plant-based proteins include beans and lentils, nuts and seeds, and soy foods like tofu.
You don’t have to go fully vegetarian. Even just a few plant-based meals a week can make a big difference. What you eat affects your blood pressure, cholesterol, and blood sugar. Over time, that can lead to plaque building up in your arteries, and that can reduce your risk of heart disease.
The patients we still miss
Meanwhile, a lot of people are getting this wrong: heart attacks don’t just happen to older men.
We’re seeing a real pattern: younger women, especially premenopausal women, are being misdiagnosed or diagnosed late when they come in with heart attack symptoms.
Part of the problem is a long-standing assumption that they’re “low risk.” But that’s not actually true, and it’s creating a care blind spot.
These women often show up with symptoms doctors think are due to anxiety, acid reflux, or muscle pain, and they get sent home.
But more commonly, women come in with classic symptoms of a heart attack, like chest pain, jaw pain, nausea, and shortness of breath, and even then, doctors don’t always think “heart attack,” especially in younger women. They don’t fit the stereotype of an older man. When doctors do not expect heart attacks in younger women, diagnosis slows down. Testing and treatment may be delayed. Some patients are sent home. Time is muscle. The longer someone waits to get treatment for a heart attack, the more the heart muscle is damaged.
And it’s not just missed diagnoses. Younger women are actually more likely to die from their first heart attack than men the same age.
Not all heart attacks look the same
There’s more. Women’s heart attacks may have different causes from men’s heart attacks. About half are caused by the usual buildup of plaque, which can block the arteries feeding the heart muscle. The rest come from other problems, like artery tears or spasms. That makes diagnosis harder.
Doctors may diagnose her with “MINOCA” — myocardial infarction with non-obstructive coronary arteries — meaning she had a heart attack, but her arteries don’t show the a major blockage. But MINOCA isn’t a final diagnosis. It’s a starting point.
As one cardiologist put it: As Dr. Harmony Reynolds, MD told the Journal of the Medical Association: “You’d never just stop and say, ‘Oh, you’ve got a fever.’ You’d figure out what it’s from.”
These types are more common in younger women, especially during or after pregnancy, when hormones are shifting.
If you’re old enough to get pregnant, you’re old enough to have a heart attack. Yet in younger women, heart attack symptoms are still often missed or misdiagnosed. Women with these symptoms should always be taken seriously, especially during and after pregnancy.