“Women of all ages who experience a myocardial infarction are at particularly high risk of a poor prognosis,” said study author Dr. Mariana Martinho of Hospital Garcia de Orta, Almada, Portugal. “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.”
Previous research showed that women with ST-elevation myocardial infarction (STEMI) have worsened prognosis during hospital stays than men, this current retrospective observational study compared both short and long-term outcomes after STEMI in men and women to examine whether any gender differences were apparent in both pre (under 55 years old) and postmenopausal (aged 55+) women. Adverse outcomes were defined as 30 days all-cause mortality, 5 year all-cause mortality, and 5-year major adverse cardiovascular events.
884 patients were involved in this study with an average age of 62 years old, and the interval between symptoms and treatment with PCI did not differ between sexes overall however, women under the age of 55 had significantly lower treatment delay after hospital arrival than their male peers. The researchers compared the risks of adverse outcomes between the sexes and adjusted for possible influencing factors such as diabetes cholesterol, hypertension, and family history among other factors
The researchers reported that at 30 days 11.8% of the women had died compared to 4.6% of the men, and 34.2% of women experienced MACE within 5 years compared to 19.8% of men. MACE is a composite of all-cause death, reinfarction, hospitalization for heart failure, and ischaemic stroke.
Dr. Martinho said: “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.”
Further analysis matched the sexes for risk factors for cardiovascular disease and compared between matching ages identifying 435 matched participants. In those matched over the age of 55 all adverse outcomes were found to be more common among women with 11.3% of the women dying within 30 days compared to 3% of men, at five years 32.9% of the women had died compared to 15.8% of men, and 34.1% of women had experienced MACE compared to 17.6% of men. In those matched under the age of 55, 20% of the women experienced MACE within 5 years compared to 5.8% of men, and there were no differences found between all-cause mortality at 30 days or at 5 years between the sexes.
Dr. Martinho said: “Postmenopausal women had worse short- and long-term outcomes after myocardial infarction than men of similar age. Premenopausal women had similar short-term mortality 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.”
She concluded: “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.”
