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Sex Differences in Long-Term Mortality after Myocardial Infarction
- Viola Vaccarino, MD, PhD; and
- Robert J. Goldberg, PhD
- Emory University School of Medicine; Atlanta, GA 30306 University of Massachusetts Medical School; Worcester, MA 01655
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•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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.
Viola Vaccarino, MD, PhD
Emory University School of Medicine; Atlanta, GA 30306
Robert J. Goldberg, PhD
University of Massachusetts Medical School; Worcester, MA 01655
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
