Mortality Differences Between Men and Women Following First Myocardial Infarction

Marrugat, Jaume; Sala, Joan; Masiá, Rafel; Pavesi, Marco; Sanz, Ginés; Valle, Vicente; Molina, Lluís; Serés, Luis

doi:10.1097/00132586-199912000-00011

Cited by 31 publications

(34 citation statements)

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“…Consistent with previous studies, [10][11][12][13][14][15][16][17] we found that women had a higher risk of early death after AMI than men. The fact that women were older than men in our study population can explain this finding.…”

Section: Discussionsupporting

confidence: 92%

“…Multiple studies [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] have shown that women with AMI tend to be older than men and are more likely to have a history of hypertension, diabetes, hypercholesetrolemia and congestive heart failure. Women on the other hand are less likely to be smokers.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Most studies have reported higher mortality among women, [10][11][12][13][14][15][16][17] while others have reported similar mortality rates among men and women. 2,[18][19][20][21] It is unclear whether the noticed gender differences in treatment and outcome following AMI are related to differences in baseline clinical characteristics, gender-bias in treatment administration, or to pathophysiological differences between women and men.…”

mentioning

confidence: 99%

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Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Zubaid

Rashed²,

Thalib

et al. 2001

Jpn Heart J

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SUMMARYThere is evidence for gender differences in the treatment and outcome of acute myocardial infarction (AMI). However, little data exist about these differences in patients from the Arab Middle East. Therefore, we studied the influence of patient gender on the presentation, the use of thrombolytic therapy, and in-hospital mortality after AMI in Kuwaiti nationals. This is a retrospective study of all consecutive Kuwaiti patients admitted to the coronary care unit of a university hospital with the diagnosis of AMI between June 1994 and May 1997. A total of 89 women and 267 men were included. Women were older than men and had significantly higher rates of diabetes (72% vs 46%), hypertension (58% vs 33%) and hypercholesterolemia (80% vs 53%). Women were less likely to receive thrombolytic therapy (40% vs 62%, p=0.001). Fewer women were eligible for thrombolytic therapy (50% vs 66%, p<0.05). Of those who were eligible for thrombolysis there was no sex difference in receiving such treatment. The in-hospital mortality among women younger than 70 years was 2.5 times higher than among men in the same age group; while there was no difference in mortality between women and men aged 70 years and older. We conclude that women and men with AMI have different clinical characteristics and outcomes following AMI. There was no gender bias for the use of thrombolytic therapy. The higher in-hospital mortality in younger women, i.e. less than 70 years, compared to younger men, indicates that younger women with AMI should be considered as a high-risk group. (Jpn Heart J 2001; 42: 669-676) Key words: Myocardial infarction, Gender, Thrombolytic therapy, Outcome, Middle East HEART disease is a leading cause of death in Kuwait. In 1995, coronary artery disease was responsible for 15.4% of all deaths among Kuwaitis and 23.6% of all deaths among expatriates. 1) Although coronary artery disease is more prevalent in men, it is the leading cause of death in women as in men. Several studies have assessed sex-based differences in treatment and mortality following AMI. It has From the

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Zubaid

Rashed²,

Thalib

et al. 2001

Jpn Heart J

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“…These two studies were, however, conducted on either mixed or male samples, therefore paid less or no attention to women patients. Women's socioeconomic position [32], cardiovascular risk factors [33], the pattern of the development and prognosis of CHD [33,34] are known to differ from that of men; consequently, explanatory factors of the socioeconomic differential in prognosis in CHD might, as well, be different for the two genders. Therefore, our purpose was two-fold.…”

Section: Introductionmentioning

confidence: 99%

Income and recurrent events after a coronary event in women

2008

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Strong evidence supports the existence of a social gradient in poor prognosis in patients with coronary heart disease (CHD). However, knowledge regarding what factors may explain this relationship is limited. We aimed to analyze in women CHD patients the association between personal income and recurrent events and to determine whether lifestyle, biological and psychosocial factors contribute to the explanation of this relationship. Altogether 188 women hospitalized for a cardiac event were assessed for personal income, demographic factors, lipids, inflammatory markers, cortisol, creatinine, lifestyle and psychosocial factors, i.e. alcohol consumption, smoking habits, body-mass index, depressive symptoms, anxiety, vital exhaustion, availability of social interaction, hostility and anger-related characteristics and were followed for cardiovascular death and recurrent acute myocardial infarction (AMI). During the 6-year follow-up 18 patients deceased and 31 experienced cardiovascular death or nonfatal AMI. After adjustment for confounders, patients with medium and high income had lower risk for recurrent events relative to those with low income (HR (95% CI): 0.38 (0.15-0.97) and 0.39 (0.17-0.93), respectively). Controlling for smoking reduced by 12.8% the risk for recurrent events associated with high versus low income, while adjusting for depression decreased the risk for middle versus low income by 13.5%. Anger symptoms explained 16.7% of the risk for recurrent events associated with middle versus low income and 10.2% of the risk for high versus low income. We suggest that in women with CHD low income is associated with recurrent events and that smoking, depressive symptomatology and anger symptoms may contribute to the explanation of this relationship.

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“…With this data they have added important information on the influence of sex hormones on cardiac electrophysiology under pathophysiological conditions. (2006) Keywords: cardiac arrhythmia; myocardial infarction; gender; sex hormones; ion channels Coronary artery disease, the most common cause of ventricular tachyarrhythmias, is the leading cause of death in both men and women (Cahndra et al, 1998;Marrugat et al, 1998). However, the incidence of sudden cardiac death at all age groups is significantly lower in women (Kannel et al, 1998;Kim et al, 2001) and traditional risk factors do not seem to predict sudden death to the same extent in women as they do in men (Lerner and Kannel, 1986;Kannel et al, 1998).…”

mentioning

confidence: 99%

Sex hormones and arrhythmia in myocardial ischemia

Korte

Grohé

2006

British J Pharmacology

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The mechanisms by which gender affects cardiac electrophysiological parameters and alters the predisposition to certain arrhythmias are not well understood, although differences in the expression and function of ion channels and in the activation of the autonomic nervous system may contribute. In their study Philp and coworkers address the issue of the effect of 17b-estradiol on ventricular vulnerability in a rat model of ischemia. Their data show that there is a dose-dependent antiarrhythmic activity of 17b-estradiol administration with suppression ventricular premature beats, ventricular tachycardia and ventricular fibrillation during ischemia. Furthermore they show a dose-dependent blockage of I CaL by 17b-estradiol which is again stronger in female than in male mice. They postulate that the shown gender-selective, concentration-dependent inhibition of I CaL is sufficient to account for the reduction in ischaemia-induced arrhythmia. With this data they have added important information on the influence of sex hormones on cardiac electrophysiology under pathophysiological conditions. (2006) Keywords: cardiac arrhythmia; myocardial infarction; gender; sex hormones; ion channels Coronary artery disease, the most common cause of ventricular tachyarrhythmias, is the leading cause of death in both men and women (Cahndra et al., 1998;Marrugat et al., 1998). However, the incidence of sudden cardiac death at all age groups is significantly lower in women (Kannel et al., 1998;Kim et al., 2001) and traditional risk factors do not seem to predict sudden death to the same extent in women as they do in men (Lerner and Kannel, 1986;Kannel et al., 1998). British Journal of PharmacologyThe mechanisms by which gender affects cardiac electrophysiological parameters and alters the predisposition to certain arrhythmias are not well understood, although differences in the expression and function of ion channels (Katsube et al., 1998;Leblanc et al., 1998;Trepanier-Boulay et al., 2001) and in the activation of the autonomic nervous system (Burke et al., 1997;Airaksinen et al., 1998;Cahndler and DiCarlo, 1998; Umetani et al., 1998) may contribute. Furthermore, gender has an influence on certain electrophysiological parameters, such as the corrected quantitative transmission (QT) interval, ventricular refractoriness and action potential duration (Burke et al., 1997; TrepanierBoulay et al., 2001;Saba et al., 2002). However, to date the exact mechanisms that underlie sex hormone-based differences in cardiac electrophysiology after myocardial infarction have not been established. Female sex hormones, in particular estrogen, may play a role in this process. The myocardium contains both functional estrogen receptor a (ERa) and estrogen receptor b (ERb) (Grohé et al., 1998). These transcription factors can activate downstream target genes such as the endothelial/inducible isoforms of the nitric oxide (NO) synthase as well as connexin 43 in the heart (Strehlow et al., 2003).In their study, Philp et al. (2006) address the issue of the effect ...

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Mortality Differences Between Men and Women Following First Myocardial Infarction

Cited by 31 publications

References 0 publications

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Income and recurrent events after a coronary event in women

Sex hormones and arrhythmia in myocardial ischemia

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