Women are more likely than men to die after a heart attack, study finds

For the study, researchers included 884 patients with an average age of 62 years. Just over a quarter of the participants were women.

Women had an average age of 67 at baseline, and men had an average age of 60.

Women were more likely to have high blood pressure, diabetes and previous stroke than men. However, men were more likely to smoke and have coronary artery disease.

The researchers also noted that women under 55 tended to wait an average of 95 minutes in the hospital for treatment, while men of the same age were treated after 80 minutes.

After analyzing the data, the researchers found that 11.8% of women died 30 days after treatment, compared to just 4.6% of men.

After five years, 32.1% of women had died compared with 16.9% of men, and 34.2% of women had experienced a major adverse cardiac event (MACE) compared with 19.8% of men. As MACE, the authors considered all-cause death, reinfarction, hospitalizations for heart failure, and stroke.

The findings held after adjusting for conditions that could influence the results, including chronic kidney disease, hypertension and high cholesterol.

Next, the researchers looked at a subset of 435 patients aged 55 and older, matching men and women according to risk factors. Again, women experienced more adverse outcomes than men.

In a press release, Dr. Mariana Martinho from Hospital Garcia de Orta, Almada, Portugal, one of the study’s authors, noted that the study did not examine reasons for different outcomes between men and women.

doctor Martinho noted, however, that atypical symptoms of a heart attack in women and genetic predisposition may play a role. She added that her team found no difference in the use of drugs to lower blood pressure or lipid levels between men and women.

When asked what might explain why women have higher death rates than men after a heart attack, Dr. Danine Fruge, medical director of the Pritikin Longevity Center, not involved in the study, said MNT:

“Women tend to develop microvascular disease, which makes a heart attack more difficult to recognize and treat.”

“Instead of the classic chest pain, women often experience atypical symptoms during a heart attack, such as indigestion or shoulder pain, which are often ignored. The longer a heart attack goes untreated, the more damage to your body, so women often have an increased death rate by the time they present for treatment,” she explained.

“Furthermore, men are often given a stent to open a blocked artery after a heart attack, but women often cannot because their arteries are smaller in diameter, which also leads to worse outcomes after a heart attack,” he added. she.

doctor Steven Gundry also said MNT that women’s complaints are less likely to be taken seriously than men’s, even in the emergency room.

“In terms of heart failure, many women will be treated for “swollen ankles” with a diuretic – a water pill – as if swollen ankles are a normal part of aging, rather than investigating with blood tests and/or an echocardiogram at night. look for heart problems. failure as the cause and then treat it accordingly.”

To understand more about diagnosing and treating heart problems in women, MNT examined another recent study that found that many heart failure patients die without a diagnosis – and this is especially true for women. This work will also be presented at the 2023 Heart Failure Congress.

Heart attack and heart failure are different cardiovascular conditions. Heart attacks happen when there is a sudden loss of blood supply to the heart, and heart failure occurs when the heart can no longer pump blood around the body properly.

In this study, researchers found that many patients treated with loop diuretics may have undiagnosed heart failure. Loop diuretics are a group of medications used to treat symptoms and signs of congestion due to heart failure.

At baseline, 75% of patients taking loop diuretics did not have a diagnosis of heart failure. About 70% of these patients were women. Meanwhile, 50% of patients taking loop diuretics diagnosed with heart failure were women.

After five years, 40% of patients prescribed loop diuretics without heart failure at baseline died during follow-up, although only 11% of these patients received a new diagnosis of heart failure. Furthermore, 86% of those who died after being diagnosed with heart failure were treated with loop diuretics.

“It is likely that many patients treated with loop diuretics have undiagnosed heart failure. It is also possible that inappropriate use of loop diuretics is causing adverse outcomes,” said Dr. John Cleland, professor of cardiology at the University of Glasgow School of Cardiovascular and Metabolic Health and principal investigator of this study, in a press release.

“The combination of undiagnosed heart failure and inappropriate use of loop diuretics may be one of the biggest and most serious problems cardiologists have yet to address. To ignore it and hope it goes away would be a tragedy.”

– Dr Cleland

Dr. Nieca Goldberg, a cardiologist and Go Red for Women national spokesperson for the American Heart Association who was not involved in the study, said MNT that patients should be investigated for heart failure if they require loop diuretics.

“It’s important to get a heart failure diagnosis, as there are other medications we use that improve outcomes in people with heart failure. […] In addition, we need to be more aggressive in preventing high blood pressure and heart attacks in women, as both conditions can lead to heart failure,” explained Dr. Goldberg.

When asked about the limitations of the study, Dr. Fruge said:

“The findings of this study were limited by using only an echocardiogram and a blood test to diagnose heart failure. It is very beneficial to also include a chest X-ray and a complete physical exam. […] to thoroughly assess heart failure. For women, it is more difficult to identify due to diastolic heart failure and microvascular disease.”

doctor Vicken Zeitjian, a board certified cardiologist in echocardiography and nuclear cardiology based in San Antonio, Texas, who was not involved in the study, said MNT:

“These findings further confirm what we know about outcomes in women after [heart attack]. We know that patients with more comorbidities are at greater risk of adverse outcomes. The limitation of these findings is that we still don’t know how to best address the findings, i.e. how to improve outcomes in women.”

MNT talked with Dr. Jennifer Wong, cardiologist and medical director of Noninvasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, not involved in the study, on key findings from the results.

“A potential implication of these studies is to look for heart disease and treat risk factors for heart disease earlier than we currently do in women. Continue to focus on prevention, such as diet and exercise, which can be especially helpful in preventing and treating heart failure with preserved ejection fraction, a type of heart failure that more women tend to have than men,” she said.