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Sex Differences in Long-Term Mortality after Myocardial Infarction
Viola Vaccarino, MD, PhD, and
Robert J. Goldberg, PhD
18 December 2001 | Volume 135 Issue 12 | Pages 1090-1091
IN RESPONSE:
Drs. Ayus and Arieff, Dr. Franco-Bronson and coworkers, and Dr. Friedman present interesting hypotheses regarding possible underlying mechanisms for the higher mortality risk in younger women compared with men. Drs. Ayus and Arieff hypothesize that the effects of sex hormones on the regulation of the myocardial circulation, possibly mediated by vasopressin, may lead to increased coronary vasoconstriction. Although, as they note, these effects have been described in the cerebral circulation in the setting of hyponatremic encephalopathy, it is unknown whether similar effects apply to the coronary circulation. There is some evidence, however, that women are more subject to coronary vasospasm than men (1); therefore, this hypothesis is worth exploring in future studies.
We agree with Dr. Franco-Bronson and coworkers and Dr. Friedman that behavioral, psychological, and neurobiological factors might play an important role in the higher mortality rate after myocardial infarction in women younger than 60 years of age compared with men. In particular, the higher rate of depression and anxiety in women could significantly contribute to an explanation of our findings. The evaluation of these factors in future studies could help us to understand sex differences in outcome after myocardial infarction, as well as improve treatment in this patient group.
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Author and Article Information
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Emory University School of Medicine; Atlanta, GA 30306
University of Massachusetts Medical School; Worcester, MA 01655
1. Kimball BP, LiPreti V, Aldridge HE. Quantitative arteriographic responses to ergonovine provocation in subjects with atypical chest pain Am J Cardiol. 1989;64:778-82. [PMID: 2801529].[Medline]
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