Young women fare worse than men after acute MI

Women aged 54 years or younger who have acute MI appear to have more comorbidities, a longer length of hospital stay and higher in-hospital mortality compared with men of the same age who have acute MI, according to a new report.

Data also demonstrate that hospitalization rates for young men and women with acute MI did not decline from 2001 to 2010, but there was a reduction in in-hospital mortality among women.

“This trend suggests we need to raise awareness of the importance of controlling [CV] risk factors like diabetes, high [BP] and smoking in younger patients,” Aakriti Gupta, MBBS, from the Center for Outcomes Research and Evaluation of Yale-New Haven Hospital and the department of internal medicine at Yale University School of Medicine, said in a press release.

Using the National Inpatient Sample database, the researchers compared clinical characteristics, hospitalization rates, length of stay and in-hospital mortality for men and women aged 30 to 54 years with acute MI from 2001 to 2010.

Gupta and colleagues analyzed 230,684 hospitalizations for acute MI in US adults aged 30 to 54 years (25.9% women) from 1.1 million hospitalizations reported in a national database from 2001 to 2010, according to the release.

Hospitalization rate unchanged

Hospitalization rates for acute MI among people aged 30 to 54 years did not change during the study period: men, 174 per 100,000 in 2001 vs. 171 per 100,000 in 2010 (P=.7); women, 56 per 100,000 in 2001 vs. 61 per 100,000 in 2010 (P=.4).

Compared with men, the women analyzed were more likely to have hypertension (51.1% vs. 48.5%), renal failure (9.5% vs. 6.7%), chronic obstructive pulmonary disease (11.4% vs. 7.7%), diabetes and related complications (32.6% vs. 22.7%) and congestive HF (18.8% vs. 13.7%). However, women were less likely than men to have dyslipidemia (11.5% vs. 14.1%). Black women had higher prevalence of hypertension, HF and diabetes than black men, white women or white men, the researchers found.

In-hospital mortality was higher in women (2001, 3.3%; 2010, 2.3%) than men (2001, 2%; 2010, 1.8), but declined during the study period for women (relative change, 30.5%; P<.0001). The same decline was not observed in men (relative change, 8.6%; P=.6), according to the researchers.

Mean length of stay was also longer for women than men: 4.4 days in 2001 vs. 4 days in 2010 (P<.01) compared with 4.1 days in 2001 vs. 3.8 days in 2010 (P=.1). For both sexes, length of stay was higher for blacks than for whites, the researchers found.

The absence of decline in acute MI hospitalization rates during the study period is in contrast to rates observed for the Medicare population, for which declines of more than 20% were observed from 2001 to 2010, the researchers wrote.

“One potential explanation for this difference could be a lack of awareness and poorer control of risk factors among the young population,” they wrote. “Moreover, it is possible that young persons who are more likely to survive a hospitalization for [acute MI], have more admissions for subsequent [acute MIs]. If the rate of these subsequent events is not declining, then it could be responsible for less prominent hospitalization rate declines in this age group.”

Although men in some age subgroups showed a decline in acute MI rates, the same was not observed in women, which could be related to the 10-year risk for incident CVD not declining the same rate in women as in men, or could “suggest inadequacy of screening and risk factor control (such as hypertension and elevated cholesterol) among women,” the researchers wrote.

Concerns for young black women

Javed Butler

The findings relating to young black women are particularly alarming, Leslee J. Shaw, PhD, and Javed Butler, MD, MPH, both from the Emory Center for Clinical Cardiovascular Research Institute, Emory University School of Medicine, wrote in an accompanying editorial.

“This higher hospitalization rate for younger black women may be the product of improved public awareness leading to greater rates of presentation to the health care system following symptom onset,” Shaw and Butler wrote. “Likely, a more disconcerting alternative is related to the increasing burden of risk factors in black women that escalates their coronary disease risk beyond that of white women and at a decidedly young age.”

Further, “the higher rate of [acute MI] hospitalization combined with the risk factor burden suggests that primary prevention efforts are less effective for young black female patients,” and that “an examination of policy models reveals that high-risk preventive approaches emphasizing costly drug and lifestyle interventions only widen socioeconomic inequalities,” they wrote.

For more information:
Gupta A. J Am Coll Cardiol. 2014;64:337-345.

Shaw LJ. J Am Coll Cardiol. 2014;64:346-348.

Disclosure: The study was funded by the NHLBI. Several researchers report financial ties with Eli Lilly, Genentech, Johnson & Johnson and UnitedHealthcare. Shaw and Butler report no relevant financial disclosures.