MI rates remain stable in middle-aged women

LAS VEGAS — The rate of MI has declined in recent years among men and elderly adults, but has remained stable in women younger than 55 years.

Using the Nationwide Inpatient Sample database, Luke Kim, MD, FSCAI, assistant professor of medicine at Weill Cornell Medical College, New York, and colleagues analyzed patients younger than 55 years who were hospitalized for MI between 2007 and 2011. The cohort included 13,009 women and 42,444 men.

The researchers analyzed by sex temporal trends, as well as rates of adverse in-hospital outcomes such as death, stroke, bleeding, vascular complications and acute renal failure.

Luke Kim

During the years studied, the number of MI decreased from 20,150 to 15,419 in women aged at least 55 years and from 26,562 to 23,571 in men aged at least 55 years. However, among women younger than 55 years, the number of MI decreased from only 3,435 to 2,988, with most of the decline occurring between 2007 and 2009, Kim and colleagues found.

Although the rate of STEMI declined in those aged at least 55 years, it remained steady in those younger than 55 years, especially women, according to the researchers.

“We know that it’s harder to recognize the signs of heart attack in women, and that women tend to receive less-aggressive treatment than men,” Kim said in a press release. “What’s troubling is that we still aren’t doing a great a job of preventing heart attack in younger women. This is especially important, since they have worse clinical outcomes.”

Compared with men younger than 55 years with MI, women of the same age with MI were more likely to have diabetes, hypertension, chronic renal insufficiency, peripheral vascular disease, congestive HF and obesity. These women were also more likely to have non-STEMI than STEMI and to develop shock during MI, but less likely to undergo PCI or CABG, the researchers found.

Among those younger than 55 years with MI, women had a higher unadjusted risk for death (5.2% vs. 3.7%; P<.001), higher incidence of stroke (0.5% vs. 0.3%; P<.001), higher rates of bleeding (4.9% vs. 3%; P<.001), higher rates of vascular complication (0.6% vs. 0.4%; P<.001) and higher rates of acute renal failure (11.6% vs. 9.6; P<.001) compared with men.

After adjustment, the following events were higher for women with MI younger than 55 years compared with men of the same age with MI:

Death (OR=1.1; 95% CI, 1.04-1.17).
Stroke (OR=1.31; 95% CI, 1.1-1.55).
Bleeding (OR=1.3, 95% CI, 1.22-1.37).
Vascular complications (OR=1.33; 95% CI, 1.15-1.55).

“It may be that we’re still treating men and older people more aggressively with preventive medical therapy than we are younger women,” Kim said in the press release. “We need to improve our efforts. We have more work to do in order to optimize outcomes in this group of patients.” – by Erik Swain

For more information:

Kim L. Abstract A-042. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 28-31, 2014; Las Vegas.

Disclosure: Kim reports no relevant financial disclosures.