Differences between Men and Women in Risk for Death after a Heart Attack

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The summary below is from the full report titled "Sex Differences in 2-Year Mortality after Hospital Discharge for Myocardial Infarction." It is in the 6 February 2001 issue of Annals of Internal Medicine (volume 134, pages 173-181). The authors are V Vaccarino, HM Krumholz, J Yarzebski, JM Gore, and RJ Goldberg.

What is the problem and what is known about it so far?

Acute myocardial infarction, more commonly known as heart attack, is a condition in which the blood vessels that supply blood to the heart muscle become blocked. If blood flow is blocked for long enough, a part of the heart muscle dies and is replaced by scar tissue. When large areas of the heart or special areas that control heart rhythms are involved, heart attacks can be deadly. Women younger than 60 years of age are more likely than men younger than 60 years of age to die while in the hospital after suffering a heart attack. This sex difference in death in the hospital following heart attacks does not exist in older patients. It is not known, however, whether women who have had heart attacks do better or worse than men during the years after they leave the hospital.

Why did the researchers do this particular study?

To find out how women do compared with men during the 2 years following hospitalization for a heart attack.

Who was studied?

6826 patients who were hospitalized for a heart attack in 16 hospitals in Worcester, Massachusetts, between 1975 and 1995 and lived long enough to leave the hospital.

How was the study done?

The researchers reviewed hospital records and death certificates to see which patients died during the 2 years following hospital discharge after a heart attack.

What did the researchers find?

Overall, about 30% of the women and about 20% of the men died during the 2 years of follow-up after hospitalization for a heart attack. However, death rates for women were higher than those for men only among patients younger than 60 years of age. Death rates were similar in men and women aged 60 to 79. Among patients older than 80 years, women were less likely to have died than men.

What were the limitations of the study?

This study does not tell us why younger women have worse outcomes than men. The researchers did not have information on other potentially important risk factors, such as smoking or types of cardiac treatments during the 2 years of follow-up, that might explain the differences between men and women in risk for death. Also, the results might be different today because different therapies are now available.

What are the implications of the study?

Younger women who have a heart attack do worse than men. Further studies are needed to explain the reason for this and to develop ways to improve outcomes in younger women after heart attacks.