Research introduced on the Heart Failure 2023 Congress signifies that girls are greater than twice as more likely to die after a coronary heart assault in comparison with males. The examine, performed by Dr. Mariana Martinho, tracked outcomes for sufferers handled for ST-elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI) inside 48 hours of symptom onset between 2010 and 2015. Despite the similarity in remedy occasions, girls had the next chance of hostile outcomes, with practically a 3rd dying inside 5 years.
According to a examine introduced at Heart Failure 2023, girls are over twice as more likely to die after a coronary heart assault in comparison with males. This distinction persists even when controlling for different well being elements and remedy occasions, with older girls experiencing even greater charges of hostile outcomes. The causes for this disparity stay unknown, necessitating additional analysis.
Women are greater than twice as more likely to die after a coronary heart assault than males, in response to analysis introduced right now at Heart Failure 2023, a scientific congress of the European Society of Cardiology (ESC).[1]
“Women of all ages who experience a myocardial infarction are at particularly high risk of a poor prognosis,” stated examine writer 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 have discovered that girls with ST-elevation myocardial infarction (STEMI) have a worse prognosis throughout their hospital keep in comparison with males, and that this can be resulting from their older age, elevated numbers of different situations, and fewer use of stents (percutaneous coronary intervention; PCI) to open blocked arteries.[2] This examine in contrast short- and long-term outcomes after STEMI in ladies and men, and examined whether or not any intercourse variations had been obvious in each premenopausal (55 years and underneath) and postmenopausal (over 55) girls.
This was a retrospective observational examine that enrolled consecutive sufferers admitted with STEMI and handled with PCI inside 48 hours of symptom onset between 2010 and 2015. Adverse outcomes had been outlined as 30-day all-cause mortality, five-year all-cause mortality, and five-year main hostile cardiovascular occasions (MACE; a composite of all-cause dying, reinfarction, hospitalization for coronary heart failure, and ischaemic stroke).
The examine included 884 sufferers. The common age was 62 years and 27% had been girls. Women had been older than males (common age 67 vs. 60 years) and had greater charges of hypertension, diabetes, and prior stroke. Men had been extra more likely to be people who smoke and have coronary artery illness. The interval between signs and remedy with PCI didn’t differ between ladies and men total, however girls aged 55 and under had a considerably longer remedy delay after arriving on the hospital than their male friends (95 vs. 80 minutes).
The researchers in contrast the chance of hostile outcomes between ladies and men after adjusting for elements that would affect the connection together with diabetes, excessive ldl cholesterol, hypertension, coronary artery illness, coronary heart failure, continual kidney illness, peripheral artery illness, stroke and household historical past of coronary artery illness. At 30 days, 11.8% of ladies had died in comparison with 4.6% of males, for a hazard ratio (HR) of two.76. At 5 years, practically one-third of ladies (32.1%) had died versus 16.9% of males (HR 2.33). More than one-third of ladies (34.2%) skilled MACE inside 5 years in contrast with 19.8% of males (HR 2.10).
Dr. Martinho stated: “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.”
The researchers performed an additional evaluation by which they matched women and men in response to danger elements for cardiovascular disease including hypertension, diabetes, high cholesterol, and smoking. Adverse outcomes were then compared between matched men and women aged 55 years and under, and between matched men and women over 55 years old.
There were 435 patients in the matched analysis. In matched patients over 55 years of age, all adverse outcomes measured were more common in women than men. Some 11.3% of women died within 30 days compared with 3.0% of men, for an HR of 3.85. At five years, one-third of women (32.9%) had died compared with 15.8% of men (HR 2.35) and more than one-third of women (34.1%) had experienced MACE compared with 17.6% of men (HR 2.15). In matched patients aged 55 years and below, one in five women (20.0%) experienced MACE within five years compared to 5.8% of men (HR 3.91), while there were no differences between women and men in all-cause mortality at 30 days or five years.
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.”
References and notes
- The abstract ‘Ladies first: awareness for the risk of adverse outcomes of female patients after ST-segment elevation acute coronary syndrome’ was presented during the session ‘Coronary Artery Disease / Chronic Coronary Syndromes’ on May 22, 2023, at Moderated ePosters 1.
- “The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030″ by Birgit Vogel, MD; Prof Monica Acevedo, MD; Yolande Appelman, MD; Prof C Noel Bairey Merz, MD; Alaide Chieffo, MD; Prof Gemma A Figtree, MD; Prof Mayra Guerrero, MD; Vijay Kunadian, MBBS; Prof Carolyn S P Lam, MBBS; Prof Angela H E M Maas, MD; Anastasia S Mihailidou, PhD; Agnieszka Olszanecka, MD; Prof Jeanne E Poole, MD; Clara Saldarriaga, MD; Prof Jacqueline Saw, MD; Prof Liesl Zühlke, PhD and Prof Roxana Mehran, MD, 16 May 2021, The Lancet.
DOI: 10.1016/S0140-6736(21)00684-X
