A new study has revealed that men are more likely to die from "Broken Heart Syndrome," even though the condition is more commonly diagnosed in women.
Published in the Journal of the American Heart Association, the study analyzed nearly 200,000 hospital admissions in the United States between 2016 and 2020 and found significant differences in outcomes between men and women.
The condition, known medically as Takotsubo cardiomyopathy, is often triggered by intense physical or emotional stress. Its symptoms resemble those of a heart attack — such as chest pain and shortness of breath — but without arterial blockages.
Although most patients recover, a small percentage may experience serious complications such as heart failure or death.
The study found that around 11% of men hospitalized with the syndrome died during the study period, compared to just 5% of women.
These findings align with previous research suggesting that while men are less frequently diagnosed with the condition, they face a higher risk of severe outcomes when it does occur.
Dr. Harmony Reynolds, a cardiologist at NYU Langone Medical Center who was not involved in the study, commented: “Men develop Takotsubo syndrome less frequently than women, but when they do, their condition tends to be worse.”
Different Triggers, Different Outcomes
Experts believe that the nature of the stressor triggering the syndrome may explain the gender disparity. Emotional stress — such as grief or job loss — is more commonly linked to cases in women, while physical stressors like surgeries, strokes, or infections are more often the cause in men.
“People who develop the syndrome due to emotional stress tend to have better outcomes,” said Dr. Ilan Wittstein, a cardiologist at Johns Hopkins Hospital. “Men may be more likely to die because their cases typically involve more severe physical triggers.”
Lead author Dr. Mohammad Mouhied, a cardiologist at the Sarver Heart Center at the University of Arizona, added that lower levels of social support among men may also hinder recovery.
“If the psychological stress persists, it can continue to damage the heart or reduce the chances of recovery,” he said.
Unanswered Questions About the Cause
Despite decades of research, the precise biological mechanisms behind the syndrome remain unclear. It is believed that a sudden surge in stress hormones like adrenaline can temporarily weaken heart function, but stress alone doesn't account for all cases.
Dr. Reynolds noted that some instances have followed relatively minor stressors, such as nausea or everyday irritations. Dr. Wittstein pointed out that biological predispositions — such as high blood pressure or cholesterol — may impair blood flow in the heart’s microvessels, increasing susceptibility.
Postmenopausal women remain the most affected demographic, prompting some researchers to suspect a link between declining estrogen levels and vulnerability to the syndrome, given the hormone's role in widening blood vessels.
However, Reynolds cautioned that the link remains unproven: “It’s clear that sex hormones play a role, but a direct connection hasn’t been definitively established.”
Prevention and Treatment Remain Challenging
Takotsubo syndrome poses challenges in both prevention and treatment. While medications like beta-blockers are sometimes prescribed, no drug has yet proven effective in reducing complications or mortality.
“We haven’t found a treatment that lowers the death rate,” said Dr. Mouhied, noting that mortality rates remained steady over the four-year study, highlighting the limited therapeutic options available.
Complicating matters further is the difficulty in diagnosing the syndrome accurately, especially in patients with other health conditions like strokes. Wittstein explained that some deaths attributed to the syndrome may, in fact, result from unrelated complications.
Cardiologists emphasize the importance of seeking immediate medical attention when experiencing chest pain or shortness of breath, as only hospital tests can distinguish between Takotsubo syndrome and a conventional heart attack.
“You can’t tell the difference without medical tests,” said Reynolds. “It’s not safe to stay home if you’re having chest pain.”
As researchers continue to explore the physiological roots of the syndrome, they stress the importance of managing both psychological and physical stress, recognizing that in rare cases, emotional pain can be life-threatening.
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