US Pharm. 2021;46(2):43-44.

In the United States, some 1.5 million heart attacks and strokes occur every year in men and women. Sex and age play a large part in who experiences a heart attack, the methods used to treat these heart attacks, and the eventual posthospital outcomes of the individuals who experience heart attacks. Mayo Clinic researchers discuss these sex and age differences in study findings published in Mayo Clinic Proceedings.

The scientists pored over more than 6.7 million hospitalization records for heart attacks. They categorized the information by sex and divided the patients into four age categories: younger than age 45 years, age 45 to 64 years, age 65 to 84 years, and older than age 84 years. To fully compare the treatment given, patients were further categorized by the type of their heart attack. With an ST elevation myocardial infarction (STEMI) heart attack, there is a complete blockage of an artery supplying blood to the heart. With a non-STEMI (NSTEMI) heart attack, there is no ST elevation, but there is typically a significant but partial artery blockage.

According to Mohamad Adnan Alkhouli, MD, an interventional cardiologist at Mayo Clinic and first author of the study, women had fewer acute heart attacks than did men across all age groups. However, because there are more women than men older than age 84 years, more women had heart attacks in that age group. In the NSTEMI and STEMI groups, women had distinctive differences in their risk profiles for heart disease, compared with men. Women were more likely to have hypertension, diabetes, anemia, atrial fibrillation, chronic lung disease, and previous stroke. However, women were less likely than men to have had a previous heart attack and to have an implantable defibrillator, have a previous revascularization, or experience cardiogenic shock.

The data show a clear difference between the sexes for managing a heart attack in the hospital. In the NSTEMI group, women of any age were less likely than men to undergo coronary angiography imaging of the heart’s blood vessels, angioplasty to open clogged arteries with a balloon catheter, or coronary artery bypass grafting to redirect blood flow, or to receive mechanical circulatory support. In the STEMI group, women were also less likely to have coronary angiography or primary angioplasty or to receive mechanical circulatory support. This was consistent across all age groups.

Compared with men, the data show that worse hospital outcomes among women are confined to those who are younger. In the NSTEMI group, women younger than age 65 years were more likely than men to die at the hospital because of their heart attack.

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