Women are twice as likely to die after a heart attack as men. The data are from a new study presented this Monday (22) at the scientific congress of the European Society of Cardiology.
“Women of all ages who suffer a myocardial infarction are at particularly high risk of a poor prognosis,” said study author Mariana Martinho of Garcia de Orta Hospital in Almada, Portugal, in a statement.
The expert points out that women need regular follow-up after the cardiac event, with strict control of blood pressure, cholesterol levels and diabetes, in addition to referral to cardiac rehabilitation.
“Smoking levels are increasing in young women and this must be combated, together with the promotion of physical activity and healthy living”, he advises.
Substances present in cigarettes can cause addiction in addition to causing narrowing of the arteries, inflammation and the appearance of fatty plaques in the arteries. Also associated with smoking are harmful effects on blood pressure and blood vessels, on coronary arteries and cerebral arteries.
Differences between men and women
Women who suffer a myocardial infarction have a worse prognosis during hospitalization compared to men, studies show. This context may be due to advanced age, an increase in the number of other health conditions, and less use of stents to open blocked arteries.
This study compared short-term and long-term outcomes after infarction in women and men, and examined whether any sex differences were apparent in both premenopausal (age 55 and younger) and postmenopausal (over 55) men. The analysis included patients treated with percutaneous coronary intervention (PCI), non-surgical treatment of coronary artery obstructions via a balloon catheter, within 48 hours of symptom onset, between 2010 and 2015.
Adverse outcomes were defined as 30-day all-cause mortality, 5-year all-cause mortality, and five major adverse cardiovascular events (MACE; a composite of all-cause death, new heart attacks, hospitalization for heart failure, and accident ischemic stroke).
The study included 884 patients. The average age was 62 years and 27% were women. Women were older than men (mean age 67 vs. 60 years) and had higher rates of high blood pressure, diabetes, and previous stroke. Men were more likely to be smokers and have coronary artery disease. The interval between symptoms and treatment did not differ between women and men overall, but women aged 55 and younger had a significantly longer delay in treatment after arriving at the hospital than their male peers (95 vs. 80 minutes). .
The researchers compared the risk of adverse outcomes between women and men after adjusting for factors that could influence the relationship, including diabetes, high cholesterol, hypertension, coronary artery disease, heart failure, chronic kidney disease, peripheral artery disease, stroke, and family history of coronary disease.
At 30 days, 11.8% of women died compared with 4.6% of men, for a hazard ratio of 2.76. By age five, almost a third of women (32.1%) had died versus 16.9% of men. More than a third of women (34.2%) had experienced a major adverse cardiovascular event within five years compared with 19.8% of men.
“Women were two to three times more likely to have adverse outcomes than men in the short and long term, even after adjusting for other conditions and despite receiving PCI within the same period of time as men,” says Mariana.
The researchers conducted a further analysis in which they compared men and women according to risk factors for cardiovascular disease, including hypertension, diabetes, high cholesterol and smoking. Adverse outcomes were then compared between matched men and women age 55 and younger, and between matched men and women age 55 and older. In all, 435 patients were included in the paired analysis.
In subjects over 55 years of age, all adverse outcomes measured were more common in women than in men. About 11.3% of women died within 30 days compared to 3% of men. At five years, one-third of women (32.9%) had died compared with 15.8% of men, and over a third of women (34.1%) had experienced a major cardiovascular event compared with 17.6% of men.
In matched patients aged 55 years and younger, one in five women (20%) had a major cardiovascular event at five years, compared with 5.8% of men, while there were no differences between women and men in all-cause mortality in 30 days or five years.
“Postmenopausal women had worse short- and long-term outcomes after myocardial infarction than age-matched men. Premenopausal women had similar short-term mortality but a worse long-term prognosis compared with their male peers. Although our study did not examine the reasons for these differences, atypical symptoms of myocardial infarction in women and genetic predisposition may play an important role”, details the researcher.
For the researchers, the findings highlight the need for greater awareness of the risks of heart disease in women.
“Further research is needed to understand why there is a gender disparity in prognosis after myocardial infarction, so that steps can be taken to close the gap in outcomes,” he concluded.
Source: CNN Brasil
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