A groundbreaking 15-year study has revealed that more than half of heart attacks in younger women are caused by factors other than blocked arteries, challenging long-held assumptions in medical practice. Published on September 15, 2025, in the Journal of the American College of Cardiology, the research highlights the need for new approaches to diagnosing and treating heart attacks in women under 65. This discovery could save lives by ensuring younger women receive the right care. Here’s a detailed look at the study’s findings and their implications for heart health.
1. A New Understanding of Heart Attacks
Traditionally, doctors assume heart attacks in younger people are caused by blocked arteries due to cholesterol buildup, as is common in older patients. However, the OCTOPUS study (Olmsted Cardiac Troponin in Persons Under Sixty-six) shows this is often not the case, especially for women. Key points include:
- Study Scope: Conducted from 2003 to 2018 in Olmsted County, Minnesota, the study tracked nearly 3,000 people aged 65 and under with elevated troponin levels, a marker of heart muscle damage.
- Comprehensive Approach: Unlike previous studies that focused only on patients with classic chest pain, this research included all troponin-positive cases, capturing heart attacks that might otherwise be missed.
- Key Finding: While 75% of heart attacks in younger men were due to traditional artery blockages, only 47% of heart attacks in women had this cause. The remaining 53% were linked to other mechanisms.
This finding challenges the one-size-fits-all approach to heart attack diagnosis and treatment, particularly for younger women.
2. Different Causes of Heart Attacks in Women
The study classified heart attacks into six categories based on their cause: traditional artery blockages (atherothrombosis), spontaneous coronary artery dissection (SCAD), blood clots from elsewhere (embolism), artery spasms, supply-demand mismatches, and unexplained cases. Notable differences in women include:
- Spontaneous Coronary Artery Dissection (SCAD): This condition, where an artery wall tears spontaneously, caused 11% of heart attacks in women but less than 1% in men. SCAD was often misdiagnosed, with 55% of cases initially mistaken for traditional blockages or unexplained heart attacks.
- Lower Rates of Blockages: Only 23 per 100,000 women had heart attacks due to artery blockages, compared to 105 per 100,000 men.
- Higher Risk Factors: Women with traditional heart attacks had higher rates of diabetes and high blood pressure, suggesting they may need more risk factors than men to develop similar heart disease.
These differences highlight the need for tailored diagnostic and treatment approaches for women.
3. Risks of Misdiagnosis
Misdiagnosing the cause of a heart attack can have serious consequences, especially for conditions like SCAD. Key issues include:
- Wrong Treatments: Procedures like angioplasty, used to unblock arteries, can worsen SCAD by damaging torn artery walls, potentially leading to complications.
- Missed Diagnoses: The study found that non-traditional heart attack causes often mimic classic blockages on initial tests, making accurate diagnosis challenging without advanced imaging like coronary angiograms.
- Higher Death Rates for Secondary Causes: Heart attacks triggered by other medical emergencies, such as severe anemia or low blood pressure, had a 33% five-year mortality rate, the highest among all causes. In contrast, SCAD patients had no deaths during the study period.
These findings underscore the importance of correctly identifying the cause of a heart attack to ensure proper treatment.
4. Symptoms to Watch For
Women often experience heart attack symptoms differently than men, which can lead to delayed or missed diagnoses. Bradley Serwer, MD, an interventional cardiologist, emphasized the importance of recognizing these signs:
- Classic Symptoms: Chest pain, jaw pain (especially on the left side), neck or arm pain, shortness of breath, sweating, or clammy skin, particularly during moderate exercise that subsides with rest.
- Atypical Symptoms in Women: Nausea, indigestion, upper abdominal pain, dizziness, or passing out may indicate a heart attack in women, even without chest pain.
- Risk Factors: Smoking, diabetes, high blood pressure, high cholesterol, or a family history of heart disease increase the likelihood of a heart attack.
Serwer advised, “If you experience new onset chest pain, shortness of breath, or severe exertional fatigue, seek medical attention immediately. Do not ignore the symptoms because you may be considered low risk for a heart attack.”
5. Advice for Seeking Care
The study’s findings highlight the need for better communication between patients and doctors to ensure accurate diagnoses. Michael Doney, MD, executive medical director at Biograph, offered practical advice:
- Be Clear and Direct: When describing symptoms, use concise language. For example: “I’m experiencing aching pain in my neck and jaw, and I feel sick to my stomach and dizzy. These symptoms came on suddenly, and I have never experienced anything like this before.”
- Know Your Tests: Request an electrocardiogram (ECG) and blood tests to assess heart muscle damage. These tools are critical for identifying heart attacks, especially in younger women.
- Advocate for Yourself: If a doctor dismisses your concerns, seek a second opinion or bring a trusted family member or friend to advocate for you.
Doney stressed, “Being direct helps your doctor focus on your specific symptoms and concerns, making sure they don’t mistake your symptoms for something less serious.”
6. Implications for Emergency Medicine
The OCTOPUS study calls for a shift in how emergency rooms approach heart attacks in younger patients, particularly women:
- New Diagnostic Protocols: Doctors may need to use advanced imaging, like coronary angiograms, more frequently to identify non-traditional causes like SCAD.
- Gender-Specific Approaches: Emergency departments should adapt protocols to account for the higher prevalence of non-traditional heart attack causes in women.
- Increased Awareness: Educating healthcare providers about atypical symptoms and causes can reduce misdiagnoses and improve outcomes.
Bradley Serwer noted, “Being young, healthy, and female does not guarantee immunity from heart attack,” urging both patients and doctors to remain vigilant.
7. Why This Matters
This study is a wake-up call for the medical community and younger women alike. By revealing that over half of heart attacks in women under 65 are caused by factors other than blocked arteries, it challenges outdated assumptions and highlights the need for personalized care. Misdiagnosis can lead to ineffective or harmful treatments, while correct identification of causes like SCAD can save lives. As heart attack rates in younger women rise, these findings could reshape emergency medicine and improve survival rates.
Looking Ahead
The OCTOPUS study is a critical step toward understanding heart attacks in younger women and ensuring they receive the right care. By raising awareness of non-traditional causes like SCAD and advocating for better diagnostic tools, the medical community can reduce misdiagnoses and save lives. For younger women, the message is clear: listen to your body, seek immediate care for concerning symptoms, and advocate for thorough testing to ensure your heart health is protected.
