The findings underscore the urgent need to raise public awareness about heart attacks in young women, emphasizing the unique symptoms they may experience and the importance of tailored post-heart attack care.
A comprehensive study published in the Journal of the American College of Cardiology sheds light on the heightened risk of hospital readmissions for young women following a heart attack.
The research reveals that young women who suffer a heart attack face a higher likelihood of adverse outcomes and subsequent hospital readmissions compared to men of similar age groups within the first year after discharge.
The leading causes of readmission include second heart attacks and chest pain resulting from cardiac complications. However, it is notable that non-cardiac hospitalizations display the most substantial discrepancy in readmission rates.
The study’s findings highlight the critical importance of early detection and intervention for young women at risk of heart attacks. Recognizing the unique symptoms experienced by this demographic, such as fatigue, shortness of breath, and atypical chest pain, is crucial for prompt medical attention. Moreover, healthcare professionals need to provide sex-specific care, ensuring young women receive appropriate treatments and interventions tailored to their specific needs.
“People need to be aware that heart attacks occur in young women as well and they can present with atypical symptoms,” remarks lead author Mitsuaki Sawano.
“After experiencing a heart attack, young women will be more likely to need a 360-level approach.”
In this study, researchers utilized data from the VIRGO study, which focuses on examining the presentation, treatment, and outcomes of young women and men who have experienced a heart attack between the ages of 18 and 55. The study included a total of 2,985 patients from the United States, comprising 2,009 women and 976 men, all of whom were hospitalized due to a heart attack. After excluding in-hospital deaths, the final cohort consisted of 2,979 patients, with 2,007 women and 972 men.
The objective of the study was to investigate acute events requiring hospitalization, both for all causes and specific causes, within one year after discharge following a heart attack. For the purpose of this research, hospitalization was defined as a stay in a hospital or observation unit lasting longer than 24 hours. The identified events were classified into the following categories:
- Coronary-related hospitalization: This category included hospitalizations resulting from recurrent heart attacks or stable/unstable angina (chest pain caused by heart-related issues).
- Other cardiac or stroke hospitalization: This category encompassed hospitalizations related to heart failure, arrhythmias, valvular diseases, and strokes.
- Non-cardiac hospitalization: Here, any hospitalization not attributed to cardiac problems was included. This encompassed hospitalizations for chest pain unrelated to the heart, gastrointestinal issues, bleeding, psychiatric conditions, and so on.
“We think young women who present with heart attacks tend to have a greater burden of cardiovascular risk factors compared with men,” adds the author.
“In general, young, premenopausal women are protected by their own estrogen hormone to have lower incidence of heart attacks. Thus, to overcome this physiological protection, we think a higher accumulation of risk factors, such as obesity, high blood pressure, high cholesterol, cigarette smoking, etc., is needed to cause a ‘breakthrough’ effect.”
According to the study, the study participants had an average age of 47 years, with 70% identifying as non-Hispanic White. A greater proportion of women self-identified as non-Hispanic Black than men. Moreover, women were found to have a higher prevalence of comorbidities, such as obesity, congestive heart failure, prior stroke, and renal disease. Among the patient cohort, young women were more likely to be low-income, have a history of depression, and experience significantly worse health status compared to men in the study.
“For women, this greater number of risk factors are likely to cause difficulty controlling them after discharge,” Sawano adds. “Worse control of risk factors is associated with worse outcomes, including recurrence of heart attacks, chest pain due to the heart, as well as other atherosclerotic diseases like stroke.”
According to the study, women exhibit different patterns when it comes to seeking medical care for chest pain compared to men. The study revealed that women were less likely to promptly present themselves to the hospital upon experiencing chest pain. In fact, they tended to arrive more than six hours after the onset of symptoms. Additionally, women were more prone to a specific type of heart attack known as non ST-elevated myocardial infarction or myocardial infarction with nonobstructive coronary arteries (MINOCA).
The study further indicated that women who experienced MINOCA were typically younger and had a higher representation of non-Hispanic Black patients. They were more likely to be smokers, have lower education levels, and had a lower prevalence of previous coronary artery disease. Interestingly, these patients reported lower satisfaction with their treatment compared to both men and women who presented with myocardial infarction with obstructive coronary artery disease (MI-CAD). It was also observed that, on average, women stayed in the hospital for longer durations and received lower rates of guideline-recommended medical therapies, including aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors (ACE inhibitors).
Within one year of discharge, the study found that women had higher all-cause hospitalization rates compared to men, with rates of 34.8% for women and 23% for men. The primary reason for hospitalization among women was coronary-related issues, followed by non-cardiac conditions, and then other cardiac and stroke-related complications. Women diagnosed with MINOCA had lower rates of adverse outcomes within one year compared to women who experienced MI-CAD. Furthermore, the study revealed a significant disparity between women and men in terms of non-cardiac hospitalizations, with rates of 145.8 per 1,000 person-years for women and 69.6 per 1,000 person-years for men.
The authors “think that the accumulation of risk factors seen in the MI-CAD population is associated with the high incidence of hospitalization one year after heart attack.
“We must emphasize, however, that does not mean that MINOCA patients are ‘low risk.’ We know from recent studies that MINOCA is not a benign disease compared with similarly aged women and these cases warrant further evaluation to understand the underlying mechanism and treatment of certain conditions.”
Based on the researchers’ analysis, the results underscore the importance of ongoing endeavors to enhance secondary preventive measures in order to diminish hospitalizations related to coronary issues.
Additionally, the findings emphasize the necessity for additional investigations into the factors and mechanisms behind non-cardiac hospitalizations, particularly considering the notable differences observed between genders.
These outcomes emphasize the significance of continued efforts to optimize strategies for preventing secondary coronary-related hospitalizations, while also calling for further research to explore the causes and mechanisms of non-cardiac hospitalizations, particularly in light of the significant disparity between sexes.
Source: 10.1016/j.jacc.2023.03.383
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