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Sex Differences in Incident and Recurrent Coronary Events and All-Cause Mortality
Sanne A E Peters1, Lisandro D Colantonio2, Ligong Chen2
1The George Institute for Global Health, Imperial College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Women generally have lower coronary heart disease (CHD) risk than men. However, after a myocardial infarction (MI), this protective advantage for women significantly diminishes for recurrent events and mortality.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Sex Differences in Health
Background:
- Women exhibit lower age-specific incidence rates of coronary heart disease (CHD) compared to men.
- It remains unclear if women maintain a lower risk for CHD events relative to men after experiencing a myocardial infarction (MI).
Purpose of the Study:
- To assess sex-based disparities in recurrent MI, recurrent CHD events, and all-cause mortality among patients who have had an MI.
- To compare these post-MI sex-specific associations with sex differences observed in a control group without a history of CHD.
Main Methods:
- Analysis of data from 171,897 women and 167,993 men (≥21 years) with health insurance in the US, hospitalized for MI in 2015-2016.
- Frequency matching of MI patients with a control group (687,588 women, 671,972 men) without CHD history by age and calendar year.
- Follow-up until December 2017 for MI, CHD (MI or coronary revascularization), and all-cause mortality.
Main Results:
- Among patients with MI, the hazard ratio (HR) for recurrent MI was 0.94 (95% CI: 0.92-0.96) for women vs. men; for CHD, HR was 0.87 (95% CI: 0.85-0.89); for all-cause mortality, HR was 0.90 (95% CI: 0.89-0.92).
- In the control group without CHD, women had lower rates for MI (HR: 0.64; 95% CI: 0.62-0.67), CHD (HR: 0.53; 95% CI: 0.51-0.54), and mortality (HR: 0.72; 95% CI: 0.71-0.73) compared to men.
- The protective effect of being female against MI, CHD, and mortality was significantly attenuated after experiencing an MI.
Conclusions:
- The study concludes that the previously observed lower risk of MI, CHD, and mortality in women compared to men is substantially reduced after a myocardial infarction.
- These findings highlight a critical shift in risk profiles post-MI, suggesting women may not retain the same cardiovascular protection as men following such an event.
Background:
Women have lower age-specific rates of incident coronary heart disease (CHD) than men. It is unclear whether women remain at lower risk for CHD events versus men following a myocardial infarction (MI).
Objectives:
This study assessed sex differences in recurrent MI, recurrent CHD events, and mortality among patients with MI and compared these associations with sex differences in a control group without a history of CHD.
Methods:
This study analyzed data for 171,897 women and 167,993 men age 21 years or older with health insurance in the United States who had a MI hospitalization in 2015 or 2016. Patients with a MI were frequency matched by age and calendar year to 687,588 women and 671,972 men without CHD. Beneficiaries were followed until December 2017 for MI, CHD (i.e., MI or coronary revascularization), and in Medicare for all-cause mortality.
Results:
Age-standardized rates of MI per 1,000 person-years were 4.5 in women and 5.7 in men without CHD (hazard ratio [HR]: 0.64; 95% confidence interval [CI]: 0.62 to 0.67) and 60.2 in women and 59.8 in men with MI (HR: 0.94; 95% CI: 0.92 to 0.96). CHD rates in women versus men were 6.3 versus 10.7 among those without CHD (HR: 0.53; 95% CI: 0.51 to 0.54) and 84.5 versus 99.3 among those with MI (HR: 0.87; 95% CI: 0.85 to 0.89). All-cause mortality rates in women versus men were 63.7 versus 59.0 among those without CHD (HR: 0.72; 95% CI: 0.71 to 0.73) and 311.6 versus 284.5 among those with MI (HR: 0.90; 95% CI: 0.89 to 0.92).
Conclusions:
The lower risk for MI, CHD, and all-cause mortality in women versus men is considerably attenuated following a MI.
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