Tear in aorta more deadly for women than men

A sudden tear in the inner lining of the aorta is always a medical emergency, but for women it's especially dangerous.

Women are more likely than men to die of the condition - called acute aortic dissection - possibly because of belated recognition of the problem, according to a report in the American Heart Association's journal Circulation.

There are 2000 new cases of acute aortic dissection each year in the U.S. and 3000 new cases in Europe, the authors explain, but little is known about possible differences between men and women in this highly lethal condition and its outcomes.

To investigate, Dr. Christoph A. Nienaber from Rostock School of Medicine, Germany, and colleagues studied 732 men and 346 women with acute aortic dissection.

Similar proportions of men and women were diagnosed within four hours of onset of symptom, the authors report. However, in significantly more women than men the condition was not recognized until more than 24 hours had passed.

Women were less likely than men to experience abrupt onset of pain, the report indicates, and the picture was further muddied because women often also had heart failure or were in a coma.

"Thus, there are various reasons that may all interfere with a clear-cut early suspicion of dissection in women," Nienaber told Reuters Health, and consequently the diagnosis is delayed. "This chain of events may finally end up in later treatment with an impact on prognosis and outcome."

Signs that the tear could rupture completely at any moment were more frequent among women. Nonetheless, women were less often taken to surgery than men, the team found. Even when patients were treated surgically, death rates were substantially higher for women (32 percent) than men (22 percent).

Overall, women had a 40 percent higher mortality rate than men.

"There is a need to educate doctors and the public (especially women) that the symptoms of acute aortic syndrome (aortic dissection and its precursors) may not be as typical as described in textbooks or as is the common perception," Nienaber said. "Chest pain of any kind needs to be taken seriously and should undergo swift evaluation."

SOURCE: Circulation, rapid access issue, June 14, 2004.