More than 15,000 women younger than 55 die of heart disease in the United States every year, making it the leading cause of death for women in this age group. But among that group, women are nearly twice as likely as men to die after suffering from a heart attack, and research published Tuesday in the journal Circulation: Cardiovascular Quality and Outcomes may help explain why.

Scientists at Yale University surveyed women ages 30 to 55 who were hospitalized for heart attack. They asked the women specifically about their response to initial heart attack symptoms, and when they chose to seek medical help, according to a news release. Researchers did not compare the women’s responses to men’s.

In women, they found that patients commonly failed to identify their heart disease risk, allowed work and family to interfere with seeking medical care, and did not receive a complete health assessment in a timely manner after experiencing initial heart attack symptoms. Patients also did not receive routine primary care, including preventative care for heart disease.

“Young women with multiple risk factors and a strong family history of cardiac disease should not assume they are too young to have a heart attack,” lead study author Judith Lichtman, associate professor and chair of the department of chronic disease epidemiology at Yale University, said in the news release.

“Participants in our study said they were concerned about initiating a false alarm in case their symptoms were due to something other than a heart attack,” she added. “Identifying strategies to empower women to recognize symptoms and seek prompt care without stigma or perceived judgment may be particularly critical for young women at increased risk for heart disease.”

According to the Mayo Clinic, heart attack symptoms include pain in the chest, upper body or stomach, shortness of breath, anxiety, lightheadedness, cold sweats, and nausea and vomiting.