Women are twice as likely to die compared to men

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New research suggests that the risks and symptoms of heart disease are different in women compared to men. Nattrass/Getty Images
  • According to a new study, women may be twice as likely to suffer a fatal heart attack compared to men.
  • Women have several unique risk factors that may explain this increased risk, including premature menopause, pregnancy complications, gestational hypertension, and preterm delivery.
  • Other risk factors for heart disease in women include more well-known problems: diabetes, blood pressure, smoking and family history.
  • Women are often underrepresented in cardiovascular disease research, and many risk factors and unique symptoms are often misunderstood.

Cardiovascular disease is the main cause of death world, according to the World Health Organization. Although cardiovascular disease does not discriminate by gender, men are more likely to have cardiovascular problems than women.

But new research shows that women may be twice as likely to die after a heart attack as men.

“There are many previous studies that have shown poor outcomes among women after heart attacks, and we attribute these differences to the fact that we know that women are older when they have a heart attack and have more associated comorbidities,” said Dr. Anais Hausvater, a cardiologist at NYU Langone Heart who specializes in women’s heart health, who was not involved in the study. “But in this study, they adjusted for those factors and compared younger women. These findings tell us there is more to it than that.”

The study, presented at Heart Failure 2023, a scientific meeting of the European Society of Cardiology, was a retrospective observational study. It included 884 patients with a mean age of 62 years. Twenty-seven percent were women.

As Hausvater pointed out, previous studies have found that women with ST segment elevation myocardial infarction (STEMI) have worse prognosis during hospitalization compared to men.

“A STEMI is the highest risk type of heart attack where every minute counts. This is the type of heart attack when you are taking the patient to the cardiac cath lab. Every minute of delay can contribute to worse results,” said Hausvater.

These studies attributed these findings to advanced age and an increased number of comorbidities. This study, however, compared short-term and long-term outcomes after STEMI in women and men and looked at whether gender differences were apparent in premenopausal women (55 years and younger) and postmenopausal women (over 55 years old). years).

The study followed patients admitted with STEMI and treated with PCI within 48 hours of symptom onset over a five-year period. Adverse outcomes were defined as 30-day all-cause mortality, 5-year all-cause mortality, and 5-year major adverse cardiovascular events (MACE).

Of those studied, women had higher rates of high blood pressure, diabetes and previous stroke. Men were more likely to be smokers and have coronary artery disease.

The researchers compared the risk of adverse outcomes between women and men after adjusting for other factors such as diabetes, high cholesterol, hypertension, coronary artery disease, heart failure, chronic kidney disease, peripheral artery disease, stroke, and family history.

At the 30-day mark, 11.8% of women had died, compared to 4.6% of men. By age five, 32.1 percent of women had died versus 16.9 percent of men, and 34.2 percent of women had experienced MACE within five years, while 19.8 percent of men had experienced MACE.

“We know that there is some protective effect of estrogen and that postmenopausal women tend to be at greater risk,” Hausvater said. “But we’ve been seeing over the last 10 years heart attacks among younger women, which is concerning. A lot of this likely has to do with the fact that there are risk factors for heart disease unique to women that are underrecognised.”

Hausvater said these potential risk factors could include premature menopause, pregnancy complications, gestational hypertension and premature birth.

“They all increase the risk, but they go undetected by doctors, and women don’t know they are risk factors for heart disease. We know from research that women tend to be less aware of their risk of heart disease.”

According to the American Heart Association, women are often underrepresented in cardiovascular disease research, which can paint an incomplete picture when understanding how the disease affects different genders.

According to the AHA, “Some risk factors for heart disease are specific for womensuch as menopause-related risks and breast cancer treatments, and some, such as depression, carry a different risk of cardiovascular disease in women than in men.”

“Psychosocial stress is another important risk factor for women and women, but especially women,” said Hausvater. “Increased stress, depression and anxiety is a heart disease factor that tends to affect women more.”

Lower recognition of heart disease symptoms may be one of the factors contributing to this study’s findings. Increasing women’s knowledge of heart disease symptoms can help prevent adverse outcomes.

“Chest pain is the most common among men, but women tend to have multiple symptoms at the same time. They may also experience shortness of breath, fatigue, and nausea. But as the symptoms are different, this may mean that the woman takes a long time to seek care. It can also delay treatment when you are in the hospital.”

This study was an important step in understanding the unique risks of heart disease for women. But more work is needed to understand the full picture.

“The other thing to consider is that we know that many of the treatments that we use for heart attacks, such as medications and other treatment options, have been studied in large, predominantly male trials. Women are vastly underrepresented in all of these clinical trials. It is possible that they are less effective in women and we need adequate representation of women in these trials,” said Hausvater.

All of the traditional cardiac risk factors are equally important for women, such as a history of diabetes, blood pressure, smoking, and family history. But for female patients, there are additional specific risk factors.

“I would argue that both women and professionals need to be aware of these risk factors to understand their heart disease risk,” Hausvater said. “If I was seeing a patient like this at the clinic, I would adjust my risk assessment and might lower my threshold for starting a cholesterol medication. My recommendations for lifestyle intervention would be much stricter if I felt they were at greater risk. It is important to understand the risk.”

Women are twice as likely to die compared to men

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