News Roundup [abridged Versions Appear In The Paper Journal]

Middle aged women more likely to die after heart attack than men

BMJ 2001; 322 doi: (Published 17 February 2001) Cite this as: BMJ 2001;322:384
  1. Scott Gottlieb
  1. New York

    Middle aged women are more likely than their male peers to die after a heart attack, the results of a new study have shown.

    Women younger than age 50 were nearly three times more likely to die than men of the same age regardless of their medical history, the severity of their condition, when they were admitted to hospital, and the hospital treatment they were given, the study's results showed (Annals of Internal Medicine 2001;134:173-81).

    Most previous studies, which have examined long term outcome, have generally found no differences in mortality between men and women, and some have found that women have a more favourable outcome. These studies, however, have not looked at the question of whether the association between sex and mortality changes according to age.

    The researchers looked at two year mortality in 6826 patients who survived admittance to hospital for acute myocardial infarction between 1975 and 1995. Overall, two year mortality was higher in women (28.9%) than in men (19.6%).

    When the patients were examined according to age group, however, only women younger than age 60 had a higher mortality than men of a similar age. Older women were less likely to die after a heart attack than men were. The results were based on an examination of medical records at 16 different hospitals.

    These findings show that middle aged women, in addition to very elderly men, should be targeted to receive state of the art treatment for heart disease, said Dr John Ayanian from Harvard Medical School in Boston, Massachusetts, in an accompanying editorial in the same issue of the journal (pp 239-41).

    There were “surprisingly few sex disparities in the use of cardiac drugs and procedures while patients were hospitalised. Thus, the initial treatment of women and men was unlikely to have explained their age-specific differences in mortality,” Dr Ayanian wrote.

    The study, led by Dr Viola Vaccarino from Emory University in Atlanta, Georgia, could not isolate a cause of the increased risk of death among younger women. Because the sex based differences in mortality were independent of clinical severity and other clinical characteristics, Dr Vaccarino said that non-biological factors might be implicated.

    Factors such as depression, lack of support, and stress might put women at greater risk of dying, she said, or the younger women in the study might have had more severe heart attacks than the men. The researchers noted that heart attacks in middle aged women are much less common than those in men. As a result, milder heart attacks in women may go undiagnosed and therefore might have been excluded from the study.

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