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Vice President Dick Cheney Hunting Accident - Silent Heart Attacks Go Undiagnosed in Women More than Men

February 15th 2006

Vice President Dick Cheney Hunting Accident - Silent Heart Attacks Go Undiagnosed in Women More than Men

Dick Cheney

A Dutch study concerning silent heart attacks came out about the same time that Vice President Cheney’s hunting buddy, Harry Whittington, suffered a “minor heart attack.”  According to the Dutch study, four in 10 heart attacks go “unrecognized.”

Whittington did not even know he was having a heart attack.  He experienced no pain or symptoms.  The doctors picked up on it because he had an irregular heart beat.   Evidently one of the pellets migrated to the heart causing a temporary blockage of blood flow.

Whittington was lucky, but the Dutch research found that heart attacks in women go unrecognized more often than they do in men.  Senior author of the Dutch study, Dr Jacqueline Witteman, Associate Professor of Epidemiology, said “Overall, 43% of the total heart attacks had been clinically unrecognized – a third of the male heart attacks and more than a half of the female heart attacks. This is a significant proportion of all the MIs."


The researchers used participants from the Rotterdam Study, a prospective population study investigating chronic disabling diseases.  According to the journal of the European Society of Cardiology, a total of 5,148 participants over the age of 55 with no evidence of prevalent myocardial infarction (MI) were enrolled from 1990-93. 

Of the original pool, 4,197 of the men and women underwent a repeat ECG (electrocardiogram) between 1993-96 and 1997-99.  They were analyzed for clinical unrecognized MI.  Unrecognized MIs are heart attacks that are not diagnosed at the time of occurrence. 

Dr. Witteman found that “Over our median follow up time of more than 6 years, we found an incidence rate of nine heart attacks per 1,000 person years. There were around 12 heart attacks per 1,000 person years in men (8.4 recognised and 4.2 unrecognised) and around seven per 1,000 person years in women (3.1 recognised and 3.6 unrecognised). Additionally, in men as well as in women, there was one sudden death per 1,000 person years.”


Men and women experience heart attacks in different ways.  According to co-author Dr Eric Boersma, Associate Professor of Clinical Cardiovascular Epidemiology, "There are likely to have been multiple factors. Men and women experience chest pain in different ways. MIs can occur without typical symptoms in women (also in people with diabetes and the elderly). They may sense shoulder pain instead of chest pain, they may think they have severe flu that is taken a long time to recover from, and those with an inferior-wall infarction may complain of stomach pain. So women may hold back from reporting symptoms and doctors may also be in doubt whether or not to consider heart disease as a source of the complaints. It is also a problem that women and their doctors have traditionally worried more about death from breast and gynecological cancer, than from heart disease."

The authors suggest that the role of ECGs in existing cardiovascular prevention programs should be evaluated.  "Patients with a history of MI are at increased risk of repeat cardiovascular complications, irrespective of their awareness. Therefore, people with unrecognised infarctions may also benefit from effective preventive treatment. By that I mean preventive drugs, including aspirin, beta-blockers and statins, and specific lifestyle advice. In most developed countries cardiovascular prevention programmes are installed, which aim to identify high-risk individuals on the basis of classical risk factors, including smoking and obesity, and co- conditions, such as diabetes mellitus. Our findings indicate that these programmes might be enriched with an ECG." The researchers acknowledge that cost benefit studies are needed to determine the “role of ECGs in prevention programmes.”

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