Edmonton, Canada—Women face a 20% increased risk of developing heart failure or dying within 5 years after their first severe heart attack compared with men, and one key issue is that fewer women are prescribed protective medications, such as beta blockers or statins, to protect against further cardiovascular events, according to new research.
An article in the journal Circulation points out that, while studies of sex differences in heart health often focus on recurrent heart attack or death, less information is available on differences in vulnerability to heart failure.
Canadian researchers from the University of Alberta and colleagues analyzed data on more than 45,000 patients, 30.8% of them female, hospitalized for a first heart attack between 2002 and 2016 in Alberta. The focus in follow-up was what happened after either ST-segment elevation myocardial infarction (STEMI) and the less-severe non-STEMI (NSTEMI), which is more common; participants were followed for an average of 6.2 years.
The authors point out that the women patients were older and had complications and more risk factors that could have put them at greater risk for heart failure after a heart attack. In addition, among 24,737 patients who had the less-severe form of heart attack (NSTEMI) only 34.3% were women. Of the 20,327 patients who suffered STEMI, 26.5% were women and 73.5% were men.
Even after adjusting for certain confounders, according to the report, heart failure development in the hospital or after discharge continued to be higher for women than men for both types of heart attack.
Women also had a higher unadjusted rate of death in the hospital than men in both the STEMI (9.4% vs. 4.5%) and NSTEMI (4.7% vs. 2.9%) groups, although the gap narrowed for NSTEMI after confounder adjustments, the authors point out.
Average female patients also had considerably different profiles than the average male patients. The article notes that women were more likely to be an average 10 years older than men at the time of their heart attack, usually an average age of 72 years versus 61 years for the men, and that women had more complicated medical histories at the time of their heart attacks, including high blood pressure, diabetes, atrial fibrillation, and chronic obstructive pulmonary disease. All of those were risk factors that may contribute to heart failure.
Differences in how the patients were treated also were detected, however. For example, women were seen less frequently in the hospital by a cardiovascular specialist: 72.8% versus 84% for men, according to the report.
Furthermore, researchers advise, whether their heart attacks were the severe or less severe type, fewer women were prescribed medications such as beta blockers or cholesterol-lowering drugs. Female patients also had slightly lower rates of revascularization procedures to restore blood flow, such as surgical angioplasty, they said.
“Identifying when and how women may be at higher risk for heart failure after a heart attack can help providers develop more effective approaches for prevention,” explained lead study author Justin A. Ezekowitz, MBBCh, MSc, a cardiologist and codirector of the Canadian VIGOUR Centre at the University of Alberta in Edmonton, Alberta, Canada. “Better adherence to reducing cholesterol, controlling high blood pressure, getting more exercise, eating a healthy diet and stopping smoking, combined with recognition of these problems earlier in life would save thousands of lives of women—and men.”
Coauthor Padma Kaul, PhD, codirector of the Canadian VIGOUR Centre, also emphasized the importance of all patients receiving the best care, regardless of gender.
“Close enough is not good enough,” Dr. Kaul said. “There are gaps across diagnosis, access, quality of care, and follow-up for all patients, so we need to be vigilant, pay attention to our own biases and to those most vulnerable to ensure that we have done everything possible in providing the best treatment.”
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