Women face higher risk for HF, death following first MI vs. men
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Risk for subsequent HF or death in the 5 years after STEMI or non-STEMI remains higher in women, compared with men, researchers reported in Circulation.
Women were also more likely to be older at the time of hospitalization for first-time MI, had a greater comorbidity burden, and were less likely to see a CV specialist in-hospital and undergo coronary angiography or revascularization.
“Identifying when and how women may be at higher risk for heart failure after a heart attack can help providers develop more effective approaches for prevention,” Justin A. Ezekowitz, MBBCh, MSc, cardiologist and co-director of the Canadian VIGOUR Centre at the University of Alberta in Edmonton, Canada, said in a press release. “Better adherence to reducing cholesterol, controlling high blood pressure, getting more exercise, eating a healthy diet and stopping smoking, combined with recognition of these problems earlier in life would save thousands of lives of women — and men.”
The population-based cohort study included 45,064 patients with a first-time MI from 2002 to 2016 (31% women; 55% non-STEMI). The researchers’ goal was to evaluate between-sex differences in angiographic findings, treatment and clinical outcomes.
Differences between women, men
Overall, women were older (median age, 72 years vs. 61 years; P < .0001), had a greater prevalence of cerebrovascular disease, chronic obstructive pulmonary disease, hypertension and atrial fibrillation (P for all < .0001), and were seen less frequently by a CV specialist in-hospital (72.8% vs. 84%; P < .0001), compared with men.
Women were also less likely to undergo diagnostic coronary angiography during the index hospitalization for MI (74% vs. 87%; P < .0001) and revascularization (68.9% vs. 81.2%; P < .0001).
“It is worth noting that nearly half of the women in our cohort presenting with non-STEMI were > 75 years of age, and one-third of women with STEMI were > 75 years of age,” Ezekowitz and colleagues wrote. “Age alone may be a strong driver of the treatment choices as well as options for follow-up care (including access) and secondary prevention through cardiac rehabilitation, but choices are likely further modified by functional assessments.”
Risk difference in post-MI outcomes
Unadjusted rates of in-hospital mortality were higher for women compared with men for both STEMI (9.4% vs. 4.5%; P < .0001) and non-STEMI hospitalizations (4.7% vs. 2.9%; P < .0001). This difference remained significant after adjustment among women admitted for STEMI (adjusted OR = 1.42; 95% CI, 1.24-1.64) but not non-STEMI (aOR = 0.97; 95% CI, 0.83-1.13), according to the researchers.
At 1 year and 5 years after the index hospitalization, women remained at greater risk of developing HF compared with men, regardless of MI type:
- STEMI at 1 year (aHR = 1.21; 95% CI, 1.12-1.3);
- STEMI at 5 years (aHR = 1.18; 95% CI, 1.11-1.24);
- non-STEMI at 1 year (aHR = 1.18; 95% CI, 1.11-1.25); and
- non-STEMI at 5 years (aHR = 1.17; 95% CI, 1.1-1.25).
When the researchers analyzed development of HF in composition with death, women had greater risk compared with men at the index hospitalization and at 1 and 5 years, regardless of MI type, but this finding was attenuated over time:
- STEMI at index (aOR = 1.37; 95% CI, 1.24-1.5);
- STEMI at 1 year (aHR = 1.26; 95% CI, 1.19-1.35);
- STEMI at 5 years (aHR = 1.2; 95% CI, 1.13-1.27);
- non-STEMI at index (aOR = 1.16; 95% CI, 1.07-1.27);
- non-STEMI at 1 year (aHR = 1.13; 95% CI, 1.07-1.2); and
- non-STEMI at 5 years (aHR = 1.08; 95% CI, 1.03-1.13).
“We were somewhat pleasantly surprised by the narrowing of the gap between men and women over the last decade, but that the gap had not narrowed as much for STEMI in which there are clearer pathways for care,” Ezekowitz told Healio. “That allows for some focus of physicians, other clinicians and health systems on this key area.
Ezekowitz said there may be a “constellation of factors,” including biologic, therapeutic choices and environmental factors, underlying these differences.
“In the follow-up of patients after discharge from hospital, there are likely gaps in outpatient care that are an opportunity to explore how much of the gaps are also due to this area. Women were also substantially older and that adds in unaccounted confounders that could be part of the mechanism,” Ezekowitz said.
For more information:
Justin A. Ezekowitz, MBBCh, MSc, can be reached at jae2@ualberta.ca.
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