Research finds intercourse variations amongst younger people who are suffering a coronary heart assault

According to a new study published today (Wednesday) in the European Heart Journal, women aged 50 or younger who have a heart attack are more likely to die than men over the next 11 years.

The study found that women were less likely to undergo therapeutic invasive procedures or were treated with certain medical therapies such as aspirin, beta-blockers, ACE inhibitors, and statins on discharge, compared to men after hospital admission with a heart attack.

The researchers, led by Ron Blankstein, professor of medicine at Harvard Medical School and preventive cardiologist at Brigham and Women’s Hospital in Boston, USA, found no statistically significant differences between men and women in hospital deaths or in cardiac-related deaths during an average Follow-up time of more than 11 years. However, women had a 1.6-fold increased risk of dying from other causes during the follow-up period.

It is important to note that most heart attacks in people under the age of 50 occur in men. Only 19% of the people in this study were women. However, women who have a heart attack at a young age often have symptoms similar to men, are more likely to have diabetes, lower socioeconomic status, and ultimately die longer. “

Ron Blankstein, Professor of Medicine at Harvard Medical School

The researchers looked at 404 women and 1,693 men who had a first heart attack (a myocardial infarction) between 2000 and 2016 and were treated at Brigham and Women’s Hospital and Massachusetts General Hospital in the United States. During a myocardial infarction, the blood supply to the heart becomes suddenly blocked, usually by a clot, and the lack of blood can cause serious damage to the heart muscle. Treatments may include coronary angiography, where a catheter is inserted into a blood vessel to inject dye so an X-ray can show if blood vessels are narrowed or blocked, and coronary revascularization, where blood flow is restored by inserting a Stent to keep the blood vessel open or to bypass the blocked segment during surgery.

The mean age (mean age) was 45 years and 53% (1121) had ST segment elevation myocardial infarction (STEMI), a type of heart attack in which the blood supply is long interrupted by a complete blockage of the coronary artery. Despite the similar age, women had fewer STEMIs than men (46.3% versus 55.2%) but more likely to have non-obstructive coronary disease. The most common symptom for both sexes was chest pain, which occurred in almost 90% of patients. However, women were also more likely to experience other symptoms, such as difficulty breathing, palpitations, and fatigue.

Prof. Blankstein said, “For patients who survived hospital discharge, there was no significant difference in deaths from cardiovascular problems between men and women. Cardiovascular deaths occurred in 73 men and 21 women , 4.4% versus 5.3% over a mean follow-up time of 11.2 years, but excluding hospital deaths, there were 157 deaths in men and 54 deaths in women from all reasons during the follow-up period : 9.5% versus 13.5%, which is a significant difference and a greater proportion of women died from causes other than cardiovascular problems, 8.4% versus 5.4% in 30 women and 68 men Adjusting for factors that could affect the results, this translates to a 1.6-fold increased risk of death in women. “

Women were less likely to have invasive coronary angiography (93.5% versus 96.7%) or coronary vascularization (82.1% versus 92.6%). They were less likely to be using aspirin (92.2% versus 95%), beta blockers (86.6% versus 90.3%), angiotensin converting enzyme inhibitors (ACE inhibitors), or angiotensin receptor blockers (53.4% ​​versus 63.7%) and statins were discharged (82.4% versus 88.4%).

The study is the first to look at results after a heart attack in young men and women over such a long follow-up period. It turns out that even after adjusting for differences in risk factors and treatments, women are more likely to die for any reason in the longer term. The researchers aren’t sure why this could be. Although they don’t see a significant difference in the total number of risk factors, they wonder if some factors, such as smoking, diabetes, and psychosocial risk factors, could have more adverse effects in women than men, overcoming the protective effects of the estrogen hormone in women.

Prof. Blankstein added, “Because fewer women have had STEMI and more have had non-obstructive myocardial infarction, they are less likely to undergo coronary revascularization or receive medication such as dual platelet inhibition, which is essential after invasive heart surgery and the absence of obstructive disease coronary arteries can lead to uncertainty about the diagnosis and whether these people have actually had a myocardial infarction or have elevated enzymes from other causes.

“While more studies will be needed to evaluate the underlying reasons for these differences, clinicians need to assess and, if possible, treat any modifiable risk factors that may affect deaths from cardiovascular and non-cardiovascular events. This could lead to improved prevention. ” Ideally before, but in some cases after, a heart attack. We plan to do more research to assess the underlying gender risk factors that may explain the higher risk for women in this group and that may help us understand why they had a heart attack at a young age. “

In an accompanying editorial, Dr. Marysia Tweet, Assistant Professor of Medicine at the Mayo Clinic College of Medicine and Science in Minnesota, USA, that “it is important to aggressively address traditional cardiovascular risk factors in young AMIs [acute myocardial infarction] Patients, especially in young women with AMI and high exposure to comorbidities. Assessment of clinical risk and implementation of primary prevention are imperative, and non-traditional risk factors require attention, although they are not always considered. Women in this study compared to men: “Young women with depression are six times more likely to have coronary artery disease than women without depression “.

It concludes, “This study … demonstrates the continuing need – and commitment – to study and improve the incidence and mortality of cardiovascular disease in young people, especially women. We can all rely on this Work towards a goal by raising awareness of heart disease and heart disease “heart healthy” lifestyles in our communities, working with local policy makers, promoting primary or secondary prevention efforts in our clinical practices, designing studies that take into account gender differences, facilitating recruitment of women for clinical trials, requesting gender-specific data when reviewing manuscripts, and reporting gender differences in published research. “

Research limitations include: The researchers were unable to consider some potential factors that might be related to the patient’s outcomes or management, such as: B. patient preferences or psychosocial factors. There were no data on whether patients continued to take their prescribed medication or gender-specific risk factors such as problems related to pregnancy. The small number of women in the study may have influenced the results. and deaths before reaching the hospital were not counted.

Source:

European Society of Cardiology

Journal references:

  • DeFilippis, EM, et al. (2020) Women who suffer from a myocardial infarction at a young age have worse results compared to men: the YOUNG-MI partner registry. European heart journal. doi.org/10.1093/eurheartj/ehaa662.
  • Tweet, MS (2020) Gender differences among young people with myocardial infarction. European heart journal. doi.org/10.1093/eurheartj/ehaa682.

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