Sex differences in acute myocardial infarction: Is it only the age?

Valero‐Masa, María Jesús; Velásquez‐Rodríguez, Jesús; Díez-Delhoyo, Felipe; Devesa, Carolina; Juárez, Míriam; Sousa‐Casasnovas, Iago; Angulo-Llanos, Rocío; Fernández-Avilés, Francisco; Martínez‐Sellés, Manuel

doi:10.1016/j.ijcard.2016.11.010

Cited by 29 publications

(14 citation statements)

References 30 publications

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“…The characteristics of the patients in our study are comparable with those of other Australian and international studies that have found that women present with ACS later in life than men, and have more comorbid conditions, especially diabetes and hypertension; 3 , 4 , 8 , 9 , 11 , 13 , 17 ‐ 21 several of these studies also found that women were less likely to undergo invasive coronary angiography and revascularisation 4 , 9 , 11 , 13 , 17 , 18 . Three studies have reported rates of primary PCI in patients with STEMI.…”

Section: Discussionsupporting

confidence: 84%

“…A study by the Malaysian National Cardiovascular Disease–Acute Coronary Syndrome Registry (6378 patients) found much lower rates of primary PCI (women, 6.2%; men, 6.7%), and the rates of thrombolysis were also lower for women (64.4%; men, 74.6%) 9 . It is not clear whether these differences in management are associated with poorer clinical outcomes for women; some registries from middle (upper and lower) and high income countries have found no sex difference in adjusted rates of in‐hospital mortality 4 , 9 , 13 , 17 , 18 . An analysis of data in the Global Registry of Acute Coronary Events (14 Western countries; 26 755 patients) found higher adjusted 6‐month major adverse cardiac event rates, but not higher mortality among women than men 3 …”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found that the higher mortality rates for women than for men with ACS in hospital, 4 , 6 , 9 , 10 , 13 at 30 days, 7 , 14 and at 6 months 3 , 13 are attenuated after adjusting for age and comorbid conditions, but others have found that differences persist despite adjustment 8 …”

mentioning

confidence: 99%

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Differences in management and outcomes for men and women with ST‐elevation myocardial infarction

Khan

Brieger

Amerena

et al. 2018

Medical Journal of Australia

112

113

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The known Sex differences in the management and outcomes of patients with acute coronary syndromes have been reported, but many reported analyses were not adjusted for confounding covariates.The new Despite broader awareness of STEMI protocols, revascularisation rates for women with STEMI are lower than for men. In hospital, rates of major adverse cardiovascular events and mortality were similar, but at 6 months were significantly higher for women. Women were less frequently referred for cardiac rehabilitation or prescribed preventive medications on discharge.The implications Clinicians should consider potential barriers to equity for women in the management of STEMI. C ardiovascular disease is the leading cause of morbidity and mortality in both sexes, but an extensive literature has described differences between men and women in clinical presentation and pathophysiology that may influence management and outcomes.1,2 Observational studies have found that women with acute coronary syndromes (ACS) more frequently present with atypical symptoms, 3 with more comorbidities, 4 and at an older age, and that plaque rupture 5 and high risk features 3,6,7 are less likely to be identified during angiography than in men.Large hospital registry studies have found that women with ACS are less likely to receive evidence-based management, including coronary angiography and appropriate medications in hospital and at discharge. 4,6,[8][9][10] Australian data similarly indicate that women with ACS are underinvestigated and that evidence-based therapies are less often prescribed than for male patients. [10][11][12] Some studies have found that the higher mortality rates for women than for men with ACS in hospital, 4,6,9,10,13 at 30 days, 7,14 and at 6 months 3,13 are attenuated after adjusting for age and comorbid conditions, but others have found that differences persist despite adjustment. 8 In our investigation, we wanted to avoid confounding by the significant interactions between sex and type of ACS identified in earlier studies. 7,14 We therefore focused on patients with STEMI, as the clinical presentation and diagnosis of this condition is relatively consistent and the patients receive a largely standardised management plan. We hypothesised that management and outcomes for men and women with STEMI should be similar after adjusting for risk level.Our specific aims were to identify sex differences in the characteristics and outcomes of patients presenting with STEMI; to examine associations between sex and outcomes (morbidity and mortality) after adjusting for relevant covariates; and to explore whether there with differences in the prescribing of preventive medications for men and women after STEMI. MethodsWe analysed data from the CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) registry, an ongoing prospective ACS registry Main outcome measures: Rates of revascularisation (percutaneous coronary intervention [PCI], thrombolysis, coronary artery bypass grafting [CAB...

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Differences in management and outcomes for men and women with ST‐elevation myocardial infarction

Khan

Brieger

Amerena

et al. 2018

Medical Journal of Australia

112

113

View full text Add to dashboard Cite

show abstract

“…With regard to socio-demographic characteristics, the proportion of men and women in our study is not balanced (28.7% of women) and it is similar to previous studies. [13,14,24,25] We found that women were older, had greater comorbidity at baseline and received more comedications after the study event than men, probably because they were older when had the rst ACS, as described in a similar cohort by Ribas et al [25] In agreement with similar studies, we found a higher prevalence of comorbidities in women, [26][27][28] while men had a higher prevalence of peripheral artery disease, [29] possibly related with the higher frequency of smoking habit.…”

Section: Discussionsupporting

confidence: 88%

Pharmacological Treatment After Acute Coronary Syndrome: Baseline Clinical Characteristics and Sex Differences in a Population-Based Cohort Study.

Sotorra-Figuerola

Ouchi

García-Sangenís

et al. 2020

Preprint

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Background: Cardiovascular disease remains the most common cause of death worldwide. Some differences between sexes in secondary prevention pharmacological therapies after an acute coronary syndrome (ACS) have been described, being women less likely to be treated. The aim was to to describe baseline socio-demographic and clinical characteristics and drugs prescribed for secondary prevention after a first episode of ACS in a Primary Health Care cohort population in Catalonia (Spain) and to assess differences between sexes.Methods: Population-based observational cohort study of patients with a first episode of ACS during 2009-2016. Data source: Information System for Research in Primary Care (SIDIAP) database. Results: There were 8,071 patients included, 71.3% of them were men and 80.2% had an acute myocardial infarction (AMI). Their mean age was 65.3, being older the women than the men. The most frequent comorbidities were hypertension, dyslipidaemia and diabetes and they were more common in women. Antiplatelets (91.3%) and statins (85.7%) were the study drugs most prescribed. The uses of all comedications were significantly higher in women, except for nitrates. The combination of four study groups was initially prescribed in 47.7% of patients and combination of beta-blockers, statins and antiplatelets was prescribed in 18.4%. More men than women received all recommended pharmacological groups.Conclusion: Women were older, had more comorbidities and received more comedication. Most patients were treated with a combination of four or three study drugs for secondary prevention. Men initiated more treatments for secondary prevention and dual antiplatelet therapy than women.

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“…1 Depending on the country, the mean age of male and female patients indexing with ACS is approximately 51-59 years, of female patients 70-74 years. 2,3 Thus, in general CAD is a disease of middle and advanced aged patients, nevertheless a relevant number of patients are at working age. Independent of the initial treatment strategy, return to work (RTW) rates within 12 months after ACS is about 67-93%.…”

Section: Introductionmentioning

confidence: 99%

The importance of return to work: How to achieve optimal reintegration in ACS patients

Reibis

Salzwedel

Abreu

et al. 2019

Eur J Prev Cardiolog

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The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action.

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Sex differences in acute myocardial infarction: Is it only the age?

Cited by 29 publications

References 30 publications

Differences in management and outcomes for men and women with ST‐elevation myocardial infarction

Differences in management and outcomes for men and women with ST‐elevation myocardial infarction

Pharmacological Treatment After Acute Coronary Syndrome: Baseline Clinical Characteristics and Sex Differences in a Population-Based Cohort Study.

The importance of return to work: How to achieve optimal reintegration in ACS patients

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