After Heart Attack, Men And Women Face More-Similar Cardiovascular Risks

The well-known sex differences in cardiovascular-disease risk and all-cause mortality are strongly attenuated among heart-attack survivors, researchers have found.

"Women have a biological advantage over men in terms of heart disease: they get it less frequently and at an older age," Dr. Mark Woodward of Imperial College London told Reuters Health by email. "This study shows that, in the US, this natural advantage is considerably less amongst people who survive a heart attack: the rates of recurrent heart attack are much more similar between the sexes."

Dr. Woodward and his colleagues examined US health-insurance data from 2015 and 2016 and identified more than 171,000 women and close to 168,000 men who were hospitalized for myocardial infarction (MI).

These patients were frequency-matched by age and calendar year to more than 1.3 million beneficiaries without coronary heart disease (CHD). During follow-up until 2017, there were 21,052 CHD events in the control cohort (38% among women) and 40,878 recurrent CHD events in the MI cohort (46% among women).

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Age-standardized rates of MI per 1,000 person-years were 4.5 in women and 5.7 in men without CHD (hazard ratio, 0.64; 95% confidence interval, 0.62 to 0.67). For those with an MI, the rates were 60.2 and 59.8, respectively, (HR, 0.94; 95% CI, 0.92 to 0.96), the researchers report in the Journal of the American College of Cardiology.

CHD rates in women compared with men were 6.3 versus 10.7 among those without a history of CHD and 84.5 versus 99.3 among those with an MI. The women-to-men hazard ratio for all-cause mortality was 0.72 in those with no history of CHD and 0.90 in those with a history of MI.

The increased similarity in rates between the sexes after an MI, Dr. Woodward concluded, "may be explained by the traditional medical 'male model' for heart attacks, such that treatment might be delayed, or be less comprehensive, in women."

In an accompanying editorial, Dr. Nanette K. Wenger of Emory University School of Medicine, in Atlanta, notes, "Over the decades, women have been substantially under-represented in the diagnostic and therapeutic randomized clinical trials of coronary heart disease, resulting in a far less robust evidence base for women than for men."

She added in an email to Reuters Health, "Myocardial infarction selectively disadvantages women. Approaches to remediation include education that the female heart is vulnerable to coronary disease and advocacy for a heart-healthy lifestyle. Next is early identification of (those) at risk—often younger women—and implementation of coronary risk reduction."

—David Douglas

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