Recurrent event rates after early-onset MI lower in women vs. men
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Women with early-onset MI had fewer recurrent major CV events during long-term follow-up compared with men, despite sex differences regarding disease burden and preventive treatments, researchers found.
“Men had a greater burden of angiographically detected atherosclerotic disease at the time of index burden,” Diego Ardissino, MD, director of the cardio-thoracic-vascular department at University Hospital of Parma in Italy, said during a presentation at the European Society of Cardiology Congress. “Women received fewer preventive treatments during follow-up. Despite this, they enjoyed better long-term outcomes.”
In the Italian Genetic Study on Early-onset Myocardial Infarction, researchers assessed data from 2,000 patients younger than 45 years with MI who underwent coronary angiography and 2,000 blood donors. Patients were matched by sex, age and geographic origin. Patients in this study included 1,778 men (median age, 41 years) and 222 women (median age, 40 years).
Each patient completed a case report form to collect detailed information on CVD history in each member of the family, CV risk factors, medications and lifestyle. These patients were followed up via outpatient visits and telephone calls for subsequent hospital admissions for CV events.
This cross-sectional part of the study was then followed by a prospective, longitudinal cohort which aimed to describe the characteristics and long-term outcomes of patients with MI. This portion of the study was conducted for a median of 19.9 years.
The primary endpoint was cumulative incidence of nonfatal myocardial reinfarction, nonfatal ischemic stroke and CV death. The secondary endpoint included cumulative incidence of hospitalization requiring bypass surgery or PCI. Primary and secondary endpoints were analyzed as time to first event and time to all events.
Compared with men, women were more often undertreated with aspirin (86.5% vs. 93.8%; P < .001), beta-blockers (74.8% vs. 82.3%; P < .02), ACE inhibitors or angiotensin II receptor antagonists (32.9% vs. 44.5%; P < .001) and P2Y12 inhibitors (43.2% vs. 51.3%; P < .02). This was not observed for statin therapy (women, 96.4%; men, 97.6%).
During 25 years of follow-up, the first occurrence of the primary endpoint was lower in women compared with men (HR = 0.67; 95% CI, 0.51-0.88). This was also observed regarding the first occurrence of the secondary endpoint (HR = 0.58; 95% CI, 0.41-0.81).
Total occurrences of the primary endpoint occurred less often in women than men (HR = 0.72; 95% CI, 0.57-0.92). The cumulative incidence of all secondary endpoints was also lower in women compared with men (HR = 0.75; 95% CI, 0.57-0.99), although it was borderline statistically significant.
“In early-onset myocardial infarction, more than one-third of the patients experienced a major cardiovascular event during long-term follow-up, and nearly one-fifth of these experienced two or more,” Ardissino said during the presentation.
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Ardissino D, et al. Late-Breaking Science in Cardiovascular Disease in Women. Presented at: European Society of Cardiology Congress; Aug. 29-Sept. 1, 2020 (virtual meeting).
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