Heart attacks, the leading cause of death for both men and women in the U.S., can strike at any time. According to the Centers for Disease Control, about 735,000 people are affected annually.

The data also reveals that although women tend to have their first heart attacks later in life than men, they tend to have lower survival rates.

Why?

“Classically, women develop coronary disease 10 years later than men; on average, they’re in their 60s,” says Dr. Anne E. Mani, a board certified noninvasive cardiologist with St. Luke’s Cardiology Associates. “It’s possible that estrogen is a protective factor which disappears as menopause develops. And older people often have additional medical issues that can complicate treatment.”

Women sometimes display different symptoms from men. “The classic heart attack symptom is severe chest pain that can radiate down into your arm, usually the left, and profuse sweating,” Dr. Mani says. “Women usually experience that too, but sometimes those symptoms are absent. Instead, they report having a feeling of indigestion or problems with gas. They might have shortness of breath, or severe sweating with no chest pain at all. Others will say their jaw or throat feels full.”  Nausea, dizziness, and fatigue are other atypical signs.

In other words, it’s possible to experience a heart attack with no obvious indicators—making the episode easy to ignore. “Also, women tend to have the role of caring for other people—their children, aging parents, spouses—spending less time maintaining their own health,” Dr. Mani said.

Other evidence suggests that women are more reluctant than men to seek treatment when they aren’t feeling well. For example, one study looked at heart attack patients to determine how long they waited before seeking treatment. The median delay time for men was 16 hours; for women, it was 54 hours.

All of the above drives Dr. Mani’s recommendations. “Women can reduce their heart attack risk by following the usual suggestions—eat right and exercise. If you have other risk factors, such as hypertension, high cholesterol, or diabetes, be sure to treat them.”

“And if you experience any heart attack symptoms, even the unusual ones, call 9-1-1 immediately. If it is a heart attack, the sooner you’re evaluated and treated, the better your chances are for a good outcome. And that’s always a good thing!”