Women face a 20% increased risk of developing heart failure (HF) or dying within 5 years after their first severe heart attack vs men, according to a new study published November 30, 2020 in the American Heart Association (AHA) journal Circulation.
Previous studies examining sex differences in heart health have often focused on recurrent heart attack or mortality, but the differences in vulnerability to HF between men and women after a heart attack is unclear.
“Close enough is not good enough...there are gaps across diagnosis, access, quality of care and follow-up for all patients, so we need to be vigilant, pay attention to our own biases and to those most vulnerable to ensure that we have done everything possible in providing the best treatment"
-Padma Kaul, PhD, study co-author
For this reason, researchers analyzed data on 45 064 patients (30.8% women) hospitalized for a first myocardial infarction (MI) between 2002 and 2016 in Alberta, Canada. Researchers focused on 2 types of heart attacks: ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI).
There were 20 327 patients in the STEMI group (26.5% women, 73.5% men) and 24 737 patients in the NSTEMI group (34.3% women, 65.7% men). Patients were followed for an average of 6.2 years.
In addition to the increased risk of developing HF among women, results showed women were older (median age, 72 vs 61 years), had more comorbidities, and had lower rates of diagnostic angiography vs men (74% vs 87%).
Also, results showed:
- The development of HF either in the hospital or after discharge remained higher for women vs men for both STEMI and NSTEMI groups.
- Women had a higher unadjusted rate of mortality in the hospital vs men in both the STEMI (9.4% vs 4.5%) and NSTEMI (4.7% vs 2.9%) groups, but this gap narrowed considerably for those in NSTEMI group after confounder adjustments.
- Women had more complicated medical histories at the time of their first heart attacks, including hypertension, diabetes, atrial fibrillation, and chronic obstructive pulmonary disease.
- Women were seen less frequently in the hospital by a cardiovascular specialist compared to men (72.8% vs 84%).
- Regardless of whether their heart attacks were severe or less severe, few women were prescribed medications such as β-blockers or cholesterol-lowering drugs.
“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,” said lead study author Justin A. Ezekowitz, MBBCh, MSc, a cardiologist and co-director of the Canadian VIGOUR Centre, University of Alberta, Canada, in a AHA 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 next step—according to co-author Padma Kaul, PhD—is to further examine if all patients, particularly women, are receiving proper care and where interventions can address oversights.
“Close enough is not good enough,” said Kaul, co-director, Canadian VIGOUR Centre, professor, department of medicine, University of Alberta, in the same press release. “There are gaps across diagnosis, access, quality of care and follow-up for all patients, so we need to be vigilant, pay attention to our own biases and to those most vulnerable to ensure that we have done everything possible in providing the best treatment.”
