In Younger Women, Heart Attacks Are Not Always Caused by Atherosclerosis

A study from the US has revealed that heart attacks in women under 65 can develop through mechanisms quite different from what was previously thought. The established belief is that the overwhelming majority of heart attacks occur when atherosclerotic plaques block the heart's arteries. The study showed that in younger women, only 47% of heart attacks were due to atherosclerotic plaques, while other causes together made up the majority. In men, by contrast, 75% of heart attack cases were due to the classic mechanism of blockage by atherosclerotic plaque. In particular, spontaneous coronary artery tearing (dissection) was strikingly more common in women (11% vs. 0.7%), and about 60% of these cases were misclassified at the initial evaluation.

The study also showed that secondary heart attacks caused by an increased oxygen demand were more common in women and that this group had the highest 5-year death rates. The study authors emphasized that cases of spontaneous coronary tearing, especially those involving distal segments or side branches, can easily be missed on angiography, and pointed out that the appearance of "normal or mildly diseased coronary arteries" in younger women can be misleading.

Conclusion: Viewing heart attacks in younger women solely as an atherosclerotic disease can lead to delayed diagnosis and inappropriate treatment.

Source
Lou, N. (2025, September 15). Heart attacks in younger women more often not an issue of atherosclerosis: Nonatherosclerotic etiologies dominate in this group, study finds. MedPage Today.