When you think of the signature symptom of a heart attack, chest pain probably comes to mind. But according to a new study, when some young and middle-aged women have a heart attack[1] , they won't experience this tell-tale sign.


"We need to move away from the image of an older man clutching his chest, when we think about acute coronary syndrome," which includes heart attacks and angina, study researcher Dr. Louise Pilote, director of the Division of General Internal Medicine at McGill University Health Centre, said in a statement. "The reality is that chest pain[2] , age and gender are no longer the definers of a heart attack."


The new study, published in the journal JAMA Internal Medicine[3] , is based on data from 1,000 young patients hospitalized for acute coronary syndrome. Even though chest pain was the most common symptom of heart attack in both sexes, researchers found that one in five women age 55 and younger didn't experience chest pain with their heart attack. Plus, women in general were less likely to experience chest pain from heart attack than men.


The researchers also didn't find an association between not experiencing chest pain and having a less severe heart attack.


"Our study demonstrates that young people and women who come into the emergency without chest pain, but other telltale ACS symptoms such as weakness, shortness of breath and/or rapid heartbeats, are in crisis," Pilote said in the statement. "We need to be able to recognize this and adapt to new standard assessments in previously unrecognized groups such as young women."


For women in particular, signs of a heart attack[4] include feeling pain in the arms, back, stomach or neck; feeling shortness of breath; feeling lightheaded or nauseous; and having a pressure or squeezing feeling in the chest, according to the American Heart Association. (Check out their PSA on the topic, starring Elizabeth Banks, here.[5] )


The Mayo Clinic explained why women may be more likely to experience all the other symptoms[6] besides chest pain:


These symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks. This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart -- a condition called small vessel heart disease or microvascular disease.


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  • 1. Not Smoking


    While not entirely surprising, it doesn't make the message any less important: <a href="http://www.nhlbi.nih.gov/health/health-topics/topics/smo/" target="_hplink">Smoking kills</a>. The habit is considered the No. 1 cause of preventable death and sickness in the U.S.

    Specifically, <a href="http://www.nhlbi.nih.gov/health/health-topics/topics/smo/" target="_hplink">smoking cigarettes harms the heart</a> in that it damages heart and blood vessel function, thereby upping the risk of atherosclerosis (where your arteries harden), according to the National Institutes of Health.




  • 2. Being Physically Active


    Aerobic exercise is good for the heart in that it makes you take in more oxygen, helps you <a href="http://www.mayoclinic.com/health/aerobic-exercise/EP00002/NSECTIONGROUP=2" target="_hplink">keep to a healthy weight</a>, reduces plaque buildup in the arteries and helps to lower blood pressure, according to the Mayo Clinic.

    According to the Centers for Disease Control and Prevention, adults are recommended to get at least <a href="http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html" target="_hplink">150 minutes of aerobic exercise</a> a week (moderate to intense level), and also do muscle-strengthening at least twice a week.




  • 3. Maintaining Normal Blood Pressure Levels


    <a href="http://www.nhlbi.nih.gov/hbp/bp/bp.htm" target="_hplink">Blood pressure measurements</a> are written in terms of systolic over diastolic. Systolic pressure is "as the heart beats," according to the National Institutes of Health, while diastolic pressure is the relaxation of the heart between heartbeats.

    A person with a normal blood pressure level has a systolic blood pressure reading of 120 millimeters of mercury or less, and a diastolic blood pressure reading of 80 millimeters of mercury or less.

    A person is <a href="http://www.nhlbi.nih.gov/hbp/detect/categ.htm" target="_hplink">considered hypertensive</a> (has high blood pressure) when the systolic blood pressure is between 140 and 159, and the diastolic blood pressure is between 90 and 99.




  • 4. Maintaining Normal Blood Glucose Levels


    Having chronically <a href="http://diabetes.webmd.com/blood-glucose" target="_hplink">high levels of glucose</a>, a kind of sugar, in the blood can lead kidney and blood vessel damage, according to WebMD.

    Insulin, a hormone in the body, is responsible for helping the body's cells to <a href="http://www.medicinenet.com/insulin/article.htm" target="_hplink">use glucose in the blood</a>. However, if the body doesn't have enough insulin or isn't able to use it properly, then <a href="http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html" target="_hplink">blood sugar levels may rise</a>, according to the American Diabetes Association. High blood sugar is considered a diabetes complication.

    Tests to check for high blood glucose can help show whether a person has diabetes, and are used to <a href="http://diabetes.webmd.com/blood-glucose" target="_hplink">monitor someone with diabetes</a> over time, WebMD reported.




  • 5. Maintaining Normal Total Cholesterol Levels


    <a href="http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm" target="_hplink">High cholesterol</a> is a known risk factor for heart disease, because it causes hardening of arteries going to the heart, according to the National Institutes of Health. When part of the heart is deprived of blood, it could trigger a heart attack.

    The <a href="http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm" target="_hplink">optimum total cholesterol level</a> is 200 or fewer milligrams of cholesterol per deciliter of blood, while having a total cholesterol level of 200 to 239 milligrams per deciliter is considered borderline high. High total cholesterol is having 240 milligrams of cholesterol per deciliter of blood, or more, according to the National Institutes of Health.




  • 6. Having A Healthy Weight


    Calculating your body mass index (BMI, a ratio of weight to height) is a good starting point for knowing if you're at a <a href="http://www.cdc.gov/healthyweight/assessing/index.html" target="_hplink">healthy weight</a>, according to the Centers for Disease Control and Prevention. According to the BMI chart, having a BMI of 18.5 or below is considered "underweight" and a BMI of 18.5 to 24.9 is considered "normal" or healthy weight. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 and above is considered obese.

    <a href="http://www.nhlbisupport.com/bmi/" target="_hplink">Click here to calculate your BMI</a>.

    <a href="http://www.cdc.gov/healthyweight/assessing/index.html" target="_hplink">Waist circumference</a> can also give clues to your weight; a man may be at risk for health problems from obesity if his waist circumference is more than 40 inches, the CDC reported. For a non-pregnant woman, it's more than 35 inches.




  • 7. Eating A Healthy Diet


    While there are obviously differences in opinion depending on who you ask as to what you should or shouldn't eat for optimal health, there are some <a href="http://www.mayoclinic.com/health/heart-healthy-diet/NU00196" target="_hplink">heart-healthy nutrition rules</a> that remain true across the board. The Mayo Clinic reports that eating a diet low in cholesterol and "bad" fats (saturated and trans fats), with low-fat proteins (like lean meats, fish and beans), whole grains (with lots of fiber), and little sodium is good for your heart.

    For more nutrition advice, <a href="http://www.mayoclinic.com/health/healthy-diet/NU00200" target="_hplink">click over to the Mayo Clinic</a>.




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    Follow a heart healthy diet to reduce your risk of coronary disease.