Survival After the First Myocardial Infarction in Older Women: A Prospective Cohort Analysis From the WHI

Women are at high risk of death following myocardial infarction (MI), yet data on determinants of outcomes are limited. We evaluated survival and prognostic factors after a first MI in postmenopausal women enrolled in the WHI (Women's Health Initiative).

In this prospective cohort analysis, we assessed outcomes in 5600 WHI participants who survived 30 days after an initial MI. Associations between survival and baseline comorbidities, health behaviors, socioeconomic and psychosocial factors, and MI management were examined.

Over a median follow-up of 8.5 years, older age at MI was strongly associated with higher all-cause death (P<0.001), as were diabetes, hypertension, and smoking (all P<0.001). Current smokers had more than twice the mortality risk compared with never-smokers (adjusted hazard ratio [aHR], 2.24 [95% CI, 1.98-2.55]). Compared with women with ideal diet quality, those with lower Healthy Eating Index-2015 scores had a higher mortality rate (aHR, 1.21-1.38; P<0.001). Self-rated health showed a graded association with death; women reporting "poor" health had more than double the risk compared with those reporting "excellent" health (aHR, 2.33 [95% CI, 1.59-3.41]). Coronary revascularization was associated with a lower mortality rate than medical therapy alone (aHR, 0.73 [95% CI, 0.68-0.78]). Race, ethnicity, education, marital status, and income were not independently associated with death in adjusted models.

Modifiable lifestyle factors and self-rated health are independently associated with survival after a first MI in postmenopausal women, along with comorbidities and MI management. These findings support incorporating patient-reported health and behavioral metrics into post-MI risk assessment.