Sex-Based Differences in Unrecognized Myocardial Infarction
M Yldau van der Ende1, Luis Eduardo Juarez-Orozco1, Ingmar Waardenburg1
1Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands.
Insights
Many myocardial infarctions go unrecognized, particularly in women. This highlights missed opportunities for crucial preventive therapies and underscores the need for better detection strategies in both sexes.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Myocardial infarction (MI) is a leading cause of death and disability globally.
- Women often present with atypical or absent symptoms, potentially leading to unrecognized MIs.
- Undiagnosed MIs result in missed opportunities for timely preventive treatments.
Purpose of the Study:
- To investigate sex-based differences in the incidence and recognition of myocardial infarction.
- To identify predictors and symptom profiles associated with unrecognized MIs.
- To assess the impact of unrecognized MIs on secondary preventive therapy utilization.
Main Methods:
- Analysis of data from the Lifelines Cohort Study (n=97,203) with baseline and follow-up ECGs (median 3.8 years).
- Calculation of age- and sex-specific incidence rates for myocardial infarction.
- Determination of unrecognized MIs based on symptom reporting and ECG changes.
Main Results:
- Higher incidence rate of MI in men (3.30/1000 person-years) than in women (1.92/1000 person-years).
- A substantial proportion of MIs were unrecognized: 30% in women versus 16% in men.
- Unrecognized MIs were associated with fewer specific cardiac symptoms and predictors including hypertension, smoking, and elevated blood glucose.
Conclusions:
- A significant percentage of myocardial infarctions remain unrecognized, with women disproportionately affected.
- Undiagnosed MIs lead to underutilization of secondary preventive therapies.
- Improved diagnostic strategies are needed to identify unrecognized MIs, especially in women.
Abstract:
Background Myocardial infarction is an important cause of morbidity and mortality in both men and women. Atypical or the absence of symptoms, more prevalent among women, may contribute to unrecognized myocardial infarctions and missed opportunities for preventive therapies. The aim of this research is to investigate sex-based differences of undiagnosed myocardial infarction in the general population. Methods and Results In the Lifelines Cohort Study, all individuals ≥18 years with a normal baseline ECG were followed from baseline visit till first follow-up visit (≈5 years, n=97 203). Individuals with infarct-related changes between baseline and follow-up ECGs were identified. The age- and sex-specific incidence rates were calculated and sex-specific cardiac symptoms and predictors of unrecognized myocardial infarction were determined. Follow-up ECG was available after a median of 3.8 (25th and 75th percentile: 3.0-4.6) years. During follow-up, 198 women experienced myocardial infarction (incidence rate 1.92 per 1000 persons-years) compared with 365 men (incidence rate 3.30; P<0.001 versus women). In 59 (30%) women, myocardial infarction was unrecognized compared with 60 (16%) men (P<0.001 versus women). Individuals with unrecognized myocardial infarction less often reported specific cardiac symptoms compared with individuals with recognized myocardial infarction. Predictors of unrecognized myocardial infarction were mainly hypertension, smoking, and higher blood glucose level. Conclusions A substantial proportion of myocardial infarctions are unrecognized, especially in women. Opportunities for secondary preventive therapies remain underutilized if myocardial infarction is unrecognized.
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