Women are more than twice as likely to die after a heart attack

In a striking revelation from Heart Failure 2023, a scientific congress organized by the European Society of Cardiology (ESC), experts have revealed that women are over twice as likely to die post-heart attack than men. This significant finding highlights the vulnerability of women who have undergone a myocardial infarction.

Dr. Mariana Martinho from the Hospital Garcia de Orta expressed concern about this alarming trend. “Women of all ages who experience a myocardial infarction are at particularly high risk of a poor prognosis,” she said. 

Dr. Martinho emphasized the need for consistent monitoring of these women, calling for strict control of their blood pressure, cholesterol levels, and diabetes, and suggested referrals to cardiac rehabilitation. She also highlighted the concerning rise in smoking levels among young women, advocating for a focus on physical activity and healthy living.

Building on previous research

The study’s results build upon previous research which established that women suffering from ST-elevation myocardial infarction (STEMI) face worse outcomes during their hospital stay compared to men. 

This unfavorable prognosis was attributed to the fact that women are typically older when they experience STEMI, often deal with more underlying health conditions, and are less likely to receive stents to open blocked arteries.

In this new research, outcomes for women and men after STEMI were compared in both the short- and long-term. The study delved deeper to understand if there were differences in outcomes between premenopausal women (55 years and under) and postmenopausal women (over 55).

Dr. Martinho’s team conducted a retrospective observational study that enrolled patients admitted with STEMI who were treated with percutaneous coronary intervention (PCI) within 48 hours of symptom onset between 2010 and 2015. 

The researchers defined adverse outcomes as 30-day all-cause mortality, five-year all-cause mortality, and five-year major adverse cardiovascular events (MACE; a composite of all-cause death, reinfarction, hospitalization for heart failure, and ischemic stroke).

What the researchers discovered

Of the 884 patients included, the average age was 62 years and women accounted for 27%. Women, with an average age of 67, were older than the men, who averaged 60 years. Moreover, women exhibited higher rates of high blood pressure, diabetes, and prior stroke. In contrast, men were more often smokers and had a higher prevalence of coronary artery disease.

The treatment delay after arriving at the hospital was notably longer for women aged 55 and below, standing at 95 minutes versus the 80 minutes for their male counterparts. However, the time gap between symptoms and PCI treatment did not significantly differ between women and men overall.

Taking into consideration factors like diabetes, high cholesterol, hypertension, coronary artery disease, heart failure, chronic kidney disease, peripheral artery disease, stroke, and family history of coronary artery disease, the team adjusted the risk of adverse outcomes between women and men. The results were startling.

Within 30 days of the heart attack, 11.8% of women had died, in comparison to 4.6% of men, yielding a hazard ratio of 2.76. The five-year picture was equally concerning, with nearly a third of women (32.1%) dying as compared to 16.9% of men. Moreover, over a third of women (34.2%) experienced MACE within five years, contrasting with 19.8% of men.

“Women had a two to three times higher likelihood of adverse outcomes than men in the short- and long-term, even after adjusting for other conditions and despite receiving PCI within the same timeframe as men,” said Dr. Martinho.

Searching for causes

The team conducted further analysis, matching men and women according to risk factors for cardiovascular disease, including hypertension, diabetes, high cholesterol, and smoking. They then compared adverse outcomes between these matched pairs, categorized into two age groups: those aged 55 years and under, and those over 55 years old.

There were 435 patients included in this matched analysis. Among the group aged over 55, it was seen that women suffered from more adverse outcomes than men. Some 11.3% of women died within 30 days compared to a mere 3.0% of men, which led to a hazard ratio of 3.85.

Over the course of five years, the gap persisted, with one-third of women (32.9%) dying compared to 15.8% of men. More than one-third of women (34.1%) experienced MACE within five years, as opposed to 17.6% of men.

However, in the group aged 55 years and below, the picture was slightly different. Here, one in five women (20.0%) experienced MACE within five years compared to just 5.8% of men. Interestingly, the all-cause mortality at 30 days or five years showed no significant difference between women and men.

Paying closer attention to women’s health

This groundbreaking study underscores the urgent need for the medical community to pay closer attention to women’s heart health, particularly following a heart attack. 

It underlines the importance of regular monitoring, control of various risk factors, and the promotion of a healthy lifestyle, including quitting smoking. In doing so, it hopes to bridge the gap and improve the prognosis for women who experience myocardial infarctions.

“Postmenopausal women had worse short- and long-term outcomes after myocardial infarction than men of similar age. Premenopausal women had similar short-term mortality but a poorer prognosis in the long-term compared with their male counterparts,” noted Dr. Martinho.

“While our study did not examine the reasons for these differences, atypical symptoms of myocardial infarction in women and genetic predisposition may play a role. We did not find any differences in the use of medications to lower blood pressure or lipid levels between women and men.”

“The findings are another reminder of the need for greater awareness of the risks of heart disease in women. More research is required to understand why there is gender disparity in prognosis after myocardial infarction so that steps can be taken to close the gap in outcomes.”

More about heart attacks and heart health

Heart health is a crucial aspect of overall wellness, and heart disease is the leading cause of death for both men and women worldwide. One of the most severe events related to heart disease is a heart attack or myocardial infarction.

A heart attack occurs when the blood supply to a part of the heart gets blocked, most often by a blood clot. This typically happens when coronary arteries that supply the heart with blood slowly narrow from a buildup of fat, cholesterol, and other substances, a condition known as atherosclerosis.

The blockage can lead to parts of the heart muscle becoming damaged or dying, leading to chest pain or discomfort, shortness of breath, and potentially more serious outcomes if not treated immediately.

Symptoms of a heart attack can include discomfort in the chest (often described as pressure, squeezing, fullness, or pain), discomfort in other areas of the upper body (such as the arms, back, neck, jaw, or stomach), shortness of breath, nausea, lightheadedness, and cold sweats.

Maintaining a healthy heart to prevent heart attacks 

Heart health is influenced by both genetic and lifestyle factors. Some people are more prone to heart disease due to their family history, but many risk factors can be controlled. 

Lifestyle changes, such as eating a heart-healthy diet, regular exercise, maintaining a healthy weight, and avoiding tobacco, can significantly reduce the risk of heart disease. It’s also important to manage other health conditions that can increase the risk of heart disease, like high blood pressure, high cholesterol, and diabetes.

Treatment for heart attacks has improved dramatically over the years. Procedures like angioplasty and stenting can open blocked arteries and restore blood flow to the heart. Medications can also help to break up clots, reduce the workload on the heart, and lower the risk of a future heart attack.

Despite these advancements, it’s crucial to focus on prevention. Regular check-ups can help detect problems before they become serious, and knowing the signs of a heart attack can lead to faster treatment and better outcomes. Heart health is a lifelong commitment, but the benefits of taking care of your heart are worth the effort.

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