Unique female indicators of coronary heart disease: do they exist?

To the Editor: In the article “Women’s early warning symptoms of acute myocardial infarction,” Dr Jean McSweeney and coworkers1 renew the attention to prodromal symptoms of acute coronary events. In 1975, Alonzo et al2 observed that “unusual fatigue and weakness” were the most prevalent symptoms of myocardial infarction, followed by dyspnea and angina. Many authors replicated those findings and added loss of energy, increased irritability, and sleep disturbances to the list. According to McSweeney et al, “it is unknown whether prodromal symptoms themselves predict future [coronary heart disease] events.”1 This statement is in contrast with the fact that 6 epidemiological studies have shown that these prodromal symptoms increase the risk of coronary events in both healthy populations and those with heart disease.3,4 Pathophysiological mechanisms that …