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Young women who survive MI, stroke at elevated long-term risk for death, CV events
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Compared with young women in the general population, young women who survive MI or stroke are at higher long-term risk for death or CV events, according to a research letter published in JAMA Internal Medicine.
Researchers analyzed 226 women with MI (mean age, 42 years), 160 women with ischemic stroke (mean age, 40 years) and 782 women without either (mean age, 48 years) from the RATIO study of arterial thrombosis and oral contraceptives.
The women were followed for a median of 18.7 years until the end of 2012. Outcomes of interest were all-cause mortality, mortality related to vascular events, and fatal or nonfatal MI or stroke.
During the study period, compared with controls, the rate of mortality was 3.7 (95% CI, 2.5-5.4) times higher in women with MI and 1.8 times higher in those with ischemic stroke (95% CI, 1-3.5). The incidence rate for mortality were 8.8 per 1,000 person-years (95% CI, 6.2-12.3) in those with MI, 4.4 per 1,000 person years (95% CI, 2.4-7.6) in those with ischemic stroke and 2.4 per 1,000 person-years (95% CI, 1.7-3.4) in controls.
The mortality curves began to separate at approximately 4 years and got wider over time, according to Alberto Maino, MD, from the department of clinical epidemiology at Leiden University Medical Center, Leiden, the Netherlands, and colleagues.
The mortality figures were driven by deaths from acute vascular events, which were 3.5 per 1,000 person-years (95% CI, 1.9-5.9) in those with MI, 2.1 per 1,000 person-years (95% CI, 0.8-4.5) in those with ischemic stroke and 0.3 per 1,000 person-years (95% CI, 0.1-0.7) in controls.
The incidence rates of any CV event, fatal or nonfatal, were 14.1 per 1,000 person-years (95% CI, 9.9-19.4; adjusted HR compared with controls = 13; 95% CI, 6.7-25) for those with ischemic stroke, 12 per 1,000 person-years (95% CI, 8.7-16.2; adjusted HR compared with controls = 9.8; 95% CI, 5-19.4) and 0.9 per 1,000 person-years (95% CI, 0.5-1.5) for controls, they found.
For fatal or nonfatal MI or other cardiac event, the incidence rates were 10 per 1,000 person-years in women with MI (95% CI, 7.1-13.1; adjusted HR compared with controls = 19.6; 95% CI, 8-51), 2.7 per 1,000 person-years in women with stroke (95% CI, 1.2-5.4; adjusted HR compared with controls = 5.6; 95% CI, 1.9-16.8) and 0.4 per 1,000 person-years (95% CI, 0.2-0.9) in controls.
For fatal/nonfatal stroke or other cerebral event, the incidence rates were 11.1 per 1,000 person-years in women with ischemic stroke (95% CI, 7.5-15.8; adjusted HR compared with controls = 17.9; 95% CI, 7.6-42.2), 1.9 per 1,000 person-years in women with MI (95% CI, 0.8-3.8; adjusted HR compared with controls = 2.7; 95% CI, 0.9-8.1) and 0.5 per 1,000 person-years (95% CI, 0.2-1) in controls.
“Our findings provide direct insight into the consequences of [CV] diseases in young women, which persist for decades after the initial event, stressing the importance of lifelong prevention strategies,” Maino and colleagues wrote. – by Erik Swain
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Carl J. Pepine, MD, MACC
I believe that this is a very important message that supports data documenting that while rates of CVD, in general, are declining, they have plateaued in younger women. An important part of that problem is that patients, providers, and the public at large continue to believe that younger women are protected. This notion contributes to major delays in younger women recognizing that their own symptoms could be related to serious CVD, delays in seeking care and delays receiving appropriate care.
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