The new “findings are another reminder of the need for greater awareness of the risks of heart disease in women.”
New findings unveiled today at Heart Failure 2023, a distinguished scientific congress of the European Society of Cardiology (ESC), reveal a concerning disparity in post-heart attack mortality rates between women and men.
“Women of all ages who experience a myocardial infarction are at particularly high risk of a poor prognosis,” warns study author Dr. Mariana Martinho. “These women need regular monitoring after their heart event, with strict control of blood pressure, cholesterol levels and diabetes, and referral to cardiac rehabilitation. Smoking levels are rising in young women and this should be tackled, along with promoting physical activity and healthy living.”
Several earlier studies have consistently shown that women diagnosed with ST-elevation myocardial infarction (STEMI) tend to have a poorer prognosis during their hospital stay compared to men.
Factors such as advanced age, comorbidities, and underutilization of stents (percutaneous coronary intervention; PCI) have been attributed to this discrepancy.
In order to further investigate the disparities in outcomes between genders, this study examined short- and long-term prognoses following STEMI in both premenopausal (55 years and under) and postmenopausal (over 55) women.
This retrospective observational study enrolled consecutive patients who were admitted with STEMI and received PCI within 48 hours of symptom onset between 2010 and 2015. Adverse outcomes were defined as 30-day all-cause mortality, five-year all-cause mortality, and five-year major adverse cardiovascular events (MACE) comprising all-cause death, reinfarction, hospitalization for heart failure, and ischemic stroke.
A total of 884 patients were included in the study, with an average age of 62 years. Among them, 27% were women. Notably, women were found to be older than men, with an average age of 67 compared to 60 years for men. Additionally, women exhibited higher rates of high blood pressure, diabetes, and prior stroke, whereas men were more likely to be smokers and have pre-existing coronary artery disease. Although the overall time interval between symptom onset and PCI treatment did not differ significantly between genders, it was observed that women aged 55 and below experienced a longer delay in treatment after arriving at the hospital, averaging 95 minutes compared to 80 minutes for men.
After adjusting for potential confounding factors including diabetes, high cholesterol, hypertension, coronary artery disease, heart failure, chronic kidney disease, peripheral artery disease, stroke, and family history of coronary artery disease, the researchers compared the risk of adverse outcomes between women and men. At 30 days, the mortality rate for women stood at 11.8%, compared to 4.6% for men, resulting in a hazard ratio (HR) of 2.76. Over a span of five years, approximately one-third of women (32.1%) succumbed to their condition, while 16.9% of men met the same fate (HR 2.33). Furthermore, within a five-year period, MACE affected 34.2% of women and 19.8% of men (HR 2.10).
“Women had a two to three times higher likelihood of adverse outcomes than men in the short- and long-term even after adjusting for other conditions and despite receiving PCI within the same timeframe as men,” adds Dr. Martinho.
Researchers conducted an additional analysis by matching men and women based on risk factors for cardiovascular disease, such as hypertension, diabetes, high cholesterol, and smoking. The purpose was to compare adverse outcomes between matched men and women who were 55 years old or younger, and those who were over 55 years old.
The matched analysis included 435 patients. Among matched patients over 55 years old, women had a higher prevalence of all adverse outcomes compared to men. Within 30 days, 11.3% of women died, while only 3.0% of men died, resulting in a hazard ratio (HR) of 3.85. At the five-year mark, one-third of women (32.9%) had passed away in comparison to 15.8% of men (HR 2.35). Additionally, over one-third of women (34.1%) experienced major adverse cardiovascular events (MACE), whereas 17.6% of men experienced the same (HR 2.15).
In the matched analysis of patients aged 55 years and below, 20.0% of women experienced MACE within five years, while only 5.8% of men did (HR 3.91). However, there were no significant differences between women and men in terms of all-cause mortality at 30 days or at the five-year mark.
“Postmenopausal women had worse short- and long-term outcomes after myocardial infarction than men of similar age,” points out the author.
“Premenopausal women had similar short-term mortality,” according to her, “but a poorer prognosis in the long-term compared with their male counterparts.
“While our study did not examine the reasons for these differences, atypical symptoms of myocardial infarction in women and genetic predisposition may play a role. We did not find any differences in the use of medications to lower blood pressure or lipid levels between women and men.
“The findings are another reminder of the need for greater awareness of the risks of heart disease in women. More research is required to understand why there is gender disparity in prognosis after myocardial infarction so that steps can be taken to close the gap in outcomes.”
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