Sex Differences in Patient-Reported Symptoms Associated With Myocardial Infarction (from the Population-Based MONICA/KORA Myocardial Infarction Registry)

      Many studies have examined gender-related differences in symptoms of acute myocardial infarction (AMI). However, findings have been inconsistent, largely because of different study populations and different methods of symptom assessment and data analysis. This study was based on 568 women and 1,710 men 25 to 74 years old hospitalized with a first-ever AMI from January 2001 through December 2006 recruited from a population-based AMI registry. Occurrence of 13 AMI symptoms was recorded using standardized patient interview. After controlling for age, migration status, body mass index, smoking, some co-morbidities including diabetes, and type and location of AMI through logistic regression modeling, women were significantly more likely to complain of pain in the left shoulder/arm/hand (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.10 to 1.69), pain in the throat/jaw (OR 1.78, 95% CI 1.43 to 2.21), pain in the upper abdomen (OR 1.39, 95% CI 1.02 to 1.91), pain between the shoulder blades (OR 2.22, 95% CI 1.78 to 2.77), vomiting (OR 2.23, 95% CI 1.67 to 2.97), nausea (OR 1.94, 95% CI 1.56 to 2.39), dyspnea (OR 1.45, 95% CI 1.17 to 1.78), fear of death (OR 2.17, 95% CI 1.73 to 2.72), and dizziness (OR 1.49, 95% CI 1.16 to 1.91) than men. Furthermore, women were more likely to report >4 symptoms (OR 2.14, 95% CI 1.72 to 2.66). No significant gender differences were found in chest pain, feelings of pressure or tightness, diaphoresis, pain in the right shoulder/arm/hand, and syncope. In conclusion, women and men did not differ regarding the chief AMI symptoms of chest pain or feelings of tightness or pressure and diaphoresis. However, women were more likely to have additional symptoms.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Meisinger C.
        • Hörmann A.
        • Heier M.
        • Kuch B.
        • Löwel H.
        Admission blood glucose and adverse outcomes in non-diabetic patients with myocardial infarction in the reperfusion era.
        Int J Cardiol. 2006; 113: 229-235
        • Kuch B.
        • Heier M.
        • von Scheidt W.
        • Kling B.
        • Hoermann A.
        • Meisinger C.
        Characteristics and outcome of patients with acute myocardial infarction according to presenting electrocardiogram (from the MONICA/KORA Augsburg Myocardial Infarction Registry).
        Am J Cardiol. 2007; 100: 1056-1060
        • Alpert J.S.
        • Thygesen K.
        • Antman E.
        • Bassand J.P.
        Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction.
        J Am Coll Cardiol. 2000; 36: 959-969
        • Canto J.G.
        • Goldberg R.J.
        • Hand M.M.
        • Bonow R.O.
        • Sopko G.
        • Pepine C.J.
        • Long T.
        Symptom presentation of women with acute coronary syndromes: myth vs reality.
        Arch Intern Med. 2007; 167: 2405-2413
        • DeVon H.A.
        • Zerwic J.J.
        Symptoms of acute coronary syndromes: are there gender differences?.
        Heart Lung. 2002; 31: 235-245
        • Chen W.
        • Woods S.L.
        • Puntillo K.A.
        Gender differences in symptoms associated with acute myocardial infarction: a review of the research.
        Heart Lung. 2005; 34: 240-247
        • Shin J.Y.
        • Martin R.
        • Suls J.
        Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes.
        Heart Lung. 2010; 39: 283-295
        • Culić V.
        • Eterović D.
        • Mirić D.
        • Silić N.
        Symptom presentation of acute myocardial infarction: influence of sex, age, and risk factors.
        Am Heart J. 2002; 144: 1012-1017
        • Arslanian-Engoren C.
        • Patel A.
        • Fang J.
        • Armstrong D.
        • Kline-Rogers E.
        • Duvernoy C.S.
        • Eagle K.A.
        Symptoms of men and women presenting with acute coronary syndromes.
        Am J Cardiol. 2006; 98: 1177-1181
        • Goldberg R.J.
        • O'Donnell C.
        • Yarzebski J.
        • Bigelow C.
        • Savageau J.
        • Gore J.M.
        Sex differences in symptom presentation associated with acute myocardial infarction: a population-based perspective.
        Am Heart J. 1998; 136: 189-195
        • Meischke H.
        • Larsen M.P.
        • Eisenberg M.S.
        Gender differences in reported symptoms for acute myocardial infarction: impact on prehospital delay time interval.
        Am J Emerg Med. 1998; 16: 363-366
        • Meshack A.F.
        • Goff D.C.
        • Chan W.
        • Ramsey D.
        • Linares A.
        • Reyna R.
        • Pandey D.
        Comparison of reported symptoms of acute myocardial infarction in Mexican Americans versus non-Hispanic whites (the Corpus Christi Heart Project).
        Am J Cardiol. 1998; 82: 1329-1332
        • Løvlien M.
        • Schei B.
        • Hole T.
        Women with myocardial infarction are less likely than men to experience chest symptoms.
        Scand Cardiovasc J. 2006; 40: 342-347
        • Berg J.
        • Björck L.
        • Dudas K.
        • Lappas G.
        • Rosengren A.
        Symptoms of a first acute myocardial infarction in women and men.
        Gend Med. 2009; 6: 454-462
        • Maynard C.
        • Beshansky J.R.
        • Griffith J.L.
        • Selker H.P.
        Influence of sex on the use of cardiac procedures in patients presenting to the emergency department.
        Circulation. 1996; 94: II93-II98
        • Cunningham M.A.
        • Lee T.H.
        • Cook E.F.
        • Brand D.A.
        • Rouan G.W.
        • Weisberg M.C.
        • Goldman L.
        The effect of gender on the probability of myocardial infarction among emergency department patients with acute chest pain: a report from the Multicenter Chest Pain Study Group.
        J Gen Intern Med. 1989; 4: 392-398
        • Whitehead D.L.
        • Strike P.
        • Perkins-Porras L.
        • Steptoe A.
        Frequency of distress and fear of dying during acute coronary syndromes and consequences for adaptation.
        Am J Cardiol. 2005; 96: 1512-1516
        • Everts B.
        • Karlson B.W.
        • Währborg P.
        • Hedner T.
        • Herlitz J.
        Localization of pain in suspected acute myocardial infarction in relation to final diagnosis, age and sex, and site and type of infarction.
        Heart Lung. 1996; 25: 430-437
        • Thuresson M.
        • Jarlöv M.B.
        • Lindahl B.
        • Svensson L.
        • Zedigh C.
        • Herlitz J.
        Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age, and a history of diabetes.
        Am Heart J. 2005; 150: 234-242
        • Milner K.A.
        • Funk M.
        • Richards S.
        • Wilmes R.M.
        • Vaccarino V.
        • Krumholz H.M.
        Gender differences in symptom presentation associated with coronary heart disease.
        Am J Cardiol. 1999; 84: 396-399
        • King K.B.
        • McGuire M.A.
        Symptom presentation and time to seek care in women and men with acute myocardial infarction.
        Heart Lung. 2007; 36: 235-243
        • DeVon H.A.
        • Ryan C.J.
        • Ochs A.L.
        • Shapiro M.
        Symptoms across the continuum of acute coronary syndromes: differences between women and men.
        Am J Crit Care. 2008; 17: 14-24
        • Kroenke K.
        • Spitzer R.L.
        Gender differences in the reporting of physical and somatoform symptoms.
        Psychosom Med. 1998; 60: 150-155
        • Herlitz A.
        • Nielsson L.
        • Backman L.
        Gender differences in episodic memory.
        Mem Cogn. 1997; 25: 801-811
        • Martin R.
        • Lemos C.
        • Rothrock N.
        • Bellman S.B.
        • Russell D.
        • Tripp-Reimer T.
        • Lounsbury P.
        • Gordon E.
        Gender disparities in common sense models of illness among myocardial infarction victims.
        Health Psychol. 2004; 23: 345-353