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Heart attack remains as the leading cause of death among men and women in developed countries, with an estimated 770,000 people in the U.S. expected to suffer a coronary attack each year, according to statistics complied by the American Heart Association. Despite that approximately 555,000 men and 365,000 women will suffer a heart attack each year, women account for nearly half of the 452,000 annual deaths in the U.S. from heart attack. A recent study published in the Journal of the American Medical Association may finally shed some light on this disproportionate number.

According to researchers, women have a higher chance of suffering a heart attack without feeling the crushing chest pain often associated with an attack. While chest pain and discomfort are the often the warning signs that get the most attention, they’re not always present. Shortness of breath, sudden numbness or weakness in the face, arms or legs, loss of vision, and severe headache with no known cause can also signal a heart attack.

While previous research drew some preliminary finding about the gender difference in heart attack symptoms, this current study finds the most conclusive evidence yet. By examining the medical records of over a million heart attack patients between 1994 and 2006, researchers concluded that the number of myocardial infraction patients who presented without chest pain was significantly higher for women (42 percent) than men (30 percent). The mortality rate was also higher for women (15 percent) than men (10 percent) in patients who died in the hospital after being admitted for a heart attack.

The fact that women exhibited fewer obvious signs of a heart attack becomes more evidently dangerous after examining the statistics associated with early treatment. The average heart attack victim waits nearly four hours before seeking treatment, even though time is at a premium, and several worldwide studies suggest that life-saving therapies are most affective when started early during the course of a heart attack. Annually, 225,000 people die within the first hour of suffering a heart attack, and never even reach the hospital for treatment.

Age also plays a predominate role in the discussion, as younger women were much more likely to die from a heart attack than men of the same age. Researchers are unsure of why this discrepancy occurs, but have a few theories. Some evidence suggests that estrogen helps to protect women from heart disease, and that any heart attack suffered by a younger woman must be severe enough to overcome her natural defenses. Estrogen levels fall after menopause, and not so coincidently, heart disease is the leading killer of women over the age of 65.

While the researchers involved in the study admit their findings merit further investigation, the study will hopefully start the conversation about informing younger women of the chance they could suffer a heart attack without experiencing any of the classic warning signs.

Timothy Lemke is a freelance writer living in Portland who contributes regularly to the blog of Dr. Justin Marostica,a dentist in Tigard OR.ong