Recurrent events post-MI falling overall, risk varies by age, sex
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From 2008 to 2017, overall rates of recurrent MI declined among men and women in the U.S. in the 365 days after discharge, according to research published in Circulation.
However, incidence of outcomes such as CHD events and HF hospitalization varied by sex and age group.
“We expected to see a decline in the rate of events; however, we did not expect the rates to differ between the sexes,” Sanne A. E. Peters, PhD, senior lecturer at The George Institute for Global Health in collaboration with Imperial College London, U.K., said in a press release. “It may be that the improvements in men were achieved before our study period, leaving less room for improvement in the most recent decade. It could also be that the attention paid to heart disease in women over recent years has resulted in the greater gains. However, regardless of the improvements, the rates of recurrent events in people who survived a heart attack are still very high in both sexes. Patients should speak with their doctors to ensure that the get the right treatments to prevent secondary events and must make sure that they adopt or maintain a healthy lifestyle.”
For this analysis that included 770,408 women and 700,477 men in the U.S. who had an MI hospitalization from 2008 to 2017, investigators accessed the rates of decline of recurrent MI, CHD event, HF hospitalization and all-cause mortality compared between sexes and age groups.
Decline in recurrent events
Overall, the age-standardized rate of recurrent MI declined from 89.2 to 72.3 per 1,000 person-years among women and from 94.2 to 81.3 per 1,000 person-years in men. After adjustment, researchers observed that, by 2017, women experienced similar or lower rates of recurrent MI (RR = 0.9; 95% CI, 0.86-0.93).
“Improvements in the emergency treatment of heart attacks and better treatment options for people who survive a heart attack may explain the overall decline,” Peters said in the release.
However, researchers reported that women aged 21 to 54 years did not experience this same decline in recurrent MI.
“In women, it could be that younger women and their treating physicians may be more likely to miss signs of worsening heart disease,” Peters said in the release.
From 2008 to 2017, the age-standardized rates of recurrent CHD events in 1 year after discharge decreased from 166.3 to 133.3 per 1,000 person-years for women and from 198.1 to 176.8 per 1,000 person-years among men. Investigators found that each year, women were less likely to experience a recurrent CHD event compared with men (RR = 0.8; 95% CI, 0.78-0.82).
For HF hospitalization, the age-standardized rates declined from 177.4 to 158.1 per 1,000 person-years for women and from 162.9 to 156.1 per 1,000 person-years in men. Overall, women experienced similar or greater incidence of HF hospitalization each year (RR = 0.99; 95% CI, 0.96-1.01).
Among patients hospitalized for MI from 2008 to 2017, the age-standardized rate of all-cause mortality decreased from 403.2 to 389.5 per 1,000 person-years among women and from 436.1 to 417.9 per 1,000 person-years among men. Investigators observed that women were overall less likely to die in the 1-year period after discharge compared with men (RR = 0.82; 95% CI, 0.8-0.83).
Some therapies remain ‘suboptimal’
“Although high-intensity statins and antihypertensive medications reduce the risk of recurrent events, and generic versions are available, the use of these therapies remains suboptimal and many high-risk patients do not initiate or continue taking guideline-recommended treatments,” Peters and colleagues wrote in the study. “Women continue to be less likely than men to fill a prescription for high-intensity statins following hospitalization for MI, suggesting that interventions to improve medication use may have to be sex-specific. In addition to patient characteristics, quality improvement programs should focus on health systems and consider regional variation, as there are substantial disparities across regions in the use of guideline-directed medical therapy.”
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