First year after a myocardial infarction poses more risks for women

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Woman patientA team at the Technical University of Munich (TUM) has determined that in the first year after a myocardial infarction, women are subject to a significantly higher mortality risk than men with similar case histories.

Studies in recent years have shown that women have a higher incidence of death from myocardial infarction and their consequences. One reason for this is that women suffer “different” heart attacks—statistically, they tend to be 10 years older at the time of the infarct and are more likely to have accompanying conditions such as diabetes. Moreover, it is less common for myocardial infarction in women to be triggered by a local narrowing of blood vessels that can be widened relatively easily. Instead they suffer more often from diffuse coronary artery disease. In these cases, local ablation procedures have less chance of success.

Romy Ubrich, the first author of the paper (published in PLoS One) comments: “We wanted to find out whether the mortality risk of female patients after a heart attack is still higher after adjusting for those factors.” Therefore, she and her colleagues drew on patient data collected in two studies (ISAR-RISK and ART) with a total of 4,100 participants. “If we look at the full five-year investigation period after the myocardial infarction, there are no unusually large gender-specific differences if we adjust for factors such as age, accompanying conditions and type of treatment. But we were surprised by the data for the first 365 days after the event: during that time, women were 1.5 times as likely to die as men,” Ubrich comments.

Conclusions

There are a number of possible reasons for this. The last author of the study, Georg Schmidt believes that societal and psychological causes play an important role. “In everyday life, women often face different expectations after a heart attack than men. They are expected to start ‘functioning’ again sooner, which means that they are subject to bigger stresses.” Another important factor is the prevalence of depressive conditions. Studies have shown that such conditions are not only dangerous in themselves, but are also a risk factor in combination with other illnesses.

The studies providing the data for the current investigation did not cover psychosocial factors, however. Future studies would have to consider whether they represent the main cause of the differences, or whether there are other reasons, possibly biological in nature, says Schmidt. In any case, he says, the spotlight now shifts to the doctors of women recovering from heart attacks and notes: “Our study shows that it is important to pay close attention to female patients especially in the first year after the event.”


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