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The sex difference in 6-month MACEs and its explaining variables in acute myocardial infarction survivors: Data from
Yihong Sun1, Lin Feng2, Xian Li3
1China-Japan Friendship Hospital, Beijing, China.
Insights
Women survivors of acute myocardial infarction (AMI) face higher risks of major adverse cardiovascular events (MACEs) and death within six months post-discharge. Poorer cardiovascular risk profiles, older age, and lower socioeconomic status contribute to this gender disparity.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Acute myocardial infarction (AMI) survivors exhibit significant sex differences in developing major adverse cardiovascular events (MACEs) post-discharge.
- Understanding the factors contributing to gender disparities in cardiovascular outcomes is crucial for targeted interventions.
Purpose of the Study:
- To assess sex differences in the incidence of MACEs and mortality among AMI survivors.
- To identify factors associated with gender disparities in cardiovascular outcomes after AMI.
Main Methods:
- Analysis of 8958 patients (30.3% women) hospitalized with NSTEMI or STEMI from the CPACS 3 study.
- Comparison of 6-month MACEs and mortality rates between sexes using Cox proportional hazards models.
- Sequential adjustment for covariates including cardiovascular risk profile, age, education, and socioeconomic status.
Main Results:
- Women had significantly higher crude rates of MACEs (6.5% vs 4.5%) and total mortality (4.4% vs 2.7%) at 6 months post-discharge compared to men.
- Cardiovascular risk profile (53%), age (38%), and socioeconomic status (32%) were identified as key explanatory factors for the gender disparity.
- Medications at discharge did not contribute to the observed sex disparity in MACEs.
Conclusions:
- A significant gender disparity in MACEs and mortality persists at 6 months among AMI survivors.
- Poorer cardiovascular risk factor profiles, older age, and lower socioeconomic status in women contribute to higher post-discharge risks.
- Addressing these factors may help mitigate gender disparities in cardiovascular outcomes following AMI.
Background:
We aimed to assess sex difference in developing major adverse cardiovascular events (MACEs) after discharge and factors associated with the gender disparity among AMI survivors.
Methods:
We selected the patients hospitalized with either NSTEMI or STEMI from 101 Chinese centers in the CPACS 3 study. We compared sex differences in MACEs and mortality in 6 months after discharge using a Cox proportional hazards model, following sequential adjustment for covariates.
Results:
8958 patients with AMI were included and 30.3% were women. Overall, the crude rate of MACEs at 6 month for women were significantly higher than men (6.5% vs 4.5%; hazard ratio (HR) =1.47; 95% CI, 1.21-1.77). Women also had significantly higher total mortality compared to men (4.4% vs 2.7%; HR = 1.65; 95% CI, 1.30-2.09). Among possible explanatory factors, patients' cardiovascular risk profile might explain 53%, age 38%, low level of education and socioeconomic status 32%. Interestingly, medications at discharge did not contribute to the sex disparity in 6-month risk of MACEs. These factors could explain a similar proportion of the gender disparity in total death. All together, these factors could explain all the disparity in the risk of both MACEs (HR = 1.05,95% CI, 0.85-1.31) and total death (HR = 1.00,95% CI,0.76-1.30).
Conclusions:
The gender disparity in MACEs and total death among AMI patients continues at 6 months after discharged surviving. Multiple factors could explain the higher risk for women, including poorer cardiovascular risk factor profile, older age and lower socioeconomic status.
Trial Registration:
CPACS-3 was registered on www.clinicaltrails.gov, and the registration number is NCT01398228.
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