Younger age potentiates post myocardial infarction survival disadvantage of women
Introduction
Despite recently developed preventive strategies as well as advances in treatment, the burden of cardiovascular disease among women remains high. In contrast to the traditional notion that coronary events are uncommon in this population, cardiovascular disease deaths among women have exceeded those among men [1]. Although there is general agreement that women exhibit higher unadjusted mortality rates after acute MI [2], [3], [4], conflicting evidence exist concerning the female-to-male relative risks after adjustment for age, diabetes mellitus, hypertension and other prognostic factors [2], [5]. Recent studies, trying to obtain further insight on the issue, have also demonstrated a varying effect of gender on post-MI short-term prognosis in relation to age [6], [7].
The present study is a secondary analysis of the Hellenic multicenter study for acute MI, which aimed to estimate the incidence of acute MI in the Greek population and to evaluate the in-hospital mortality of consecutively hospitalized patients with acute MI, on a countrywide basis. The study patients were derived from a relatively low coronary risk, homogeneous, in terms of ethnic and cultural background, population [8].
Section snippets
Patient population
This study aimed to record the total of patients hospitalized for AMI on a countrywide basis, in order to estimate the incidence and management of the disease in the Greek population. Patients were enrolled if they were admitted in the hospital within 24 h from the onset of symptoms. The diagnosis was established on the basis of the presence of typical pain lasting at least for 30 min, temporal rise and fall of serially obtained values of serum levels of cardiac enzymes and dynamic
Baseline characteristics and in-hospital mortality rates
The main baseline characteristics of the study population in relation to gender are presented in Table 1. Unadjusted in-hospital mortality rates of female patients were significantly higher compared to male patients (17.7 vs. 8.6, p < 0.001). Based on univariate analysis, female gender [relative risk (RR) = 2.05, 95% confidence interval (CI) = 1.94–2.66, p < 0.001], older age (RR = 1.08, 95% CI = 1.07–1.09, p < 0.001), smoking status (RR = 2.14, 95% CI = 1.77–2.58, p < 0.001), hypertension (RR = 1.52, 95% CI =
Discussion
This study, based on a countrywide survey of consecutive unselected patients, demonstrated that female gender was an independent predictor of poor short-term outcome following acute MI. Moreover, the adverse effect of gender on early post infarction outcome was exaggerated among younger women. In addition, despite their worse early prognosis, women were less likely to receive a vigorous in-hospital treatment.
Acknowledgements
The Hellenic Study of Acute Myocardial Infarction was supported and supervised by the Hellenic Cardiological Society and was also supported by Servier Hellas S.A. The authors are indebted to all the cardiologists and to all the directors of the Cardiac departments who participated in the study. The complete list of study investigators and coordinators, and the list of the 76 hospitals that have participated in this study, has been published previously [9].
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2016, Brain, Behavior, and ImmunityCitation Excerpt :Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the United States (Go et al., 2014). Substantial differences exist in the outcome of CAD by sex and age, as numerous studies have demonstrated that young and middle-aged women (<50 years) who experience an acute myocardial infarction (AMI), have poorer outcomes than men of the same age (Andrikopoulos et al., 2006; Koek et al., 2006; Vaccarino et al., 1999, 2009). This is in spite of the fact that women have less severe CAD and are more likely to have preserved systolic function and smaller infarcts when compared with their male counterparts (Rosengren et al., 2001; Vaccarino et al., 1999).
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2014, Canadian Journal of CardiologyCitation Excerpt :Based on the National Registry of Myocardial Infarction (NRMI), the mortality rate during hospitalization in younger patients (< 50 years) was more than twice as high in women than in men (6.1% vs 2.9%), but this difference decreased with increasing age and was no longer significant for patients ≥ 74 years (age-sex interaction P < 0.001).5 This survival disadvantage in younger women compared with their male counterparts was later confirmed in several other studies of AMI populations.9,10 Although the evidence for a sex gap in short-term mortality is compelling, there is considerable debate regarding the evidence for a sex gap in long-term mortality.
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