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Sex differences in survival after myocardial infarction in older adults: a community-based approach
V Vaccarino1, H M Krumholz, C F Mendes de Leon
1Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA.
Insights
Older women with myocardial infarction (MI) had similar early mortality to men. However, after surviving the initial 30 days, women experienced significantly better 1-year survival rates compared to men in this study.
Area of Science:
- Cardiology
- Gerontology
- Epidemiology
Background:
- Myocardial infarction (MI) is a leading cause of mortality in older adults.
- Sex-based differences in cardiovascular disease outcomes are well-documented but require further investigation in elderly populations.
Purpose of the Study:
- To investigate sex differences in survival following myocardial infarction (MI) among individuals aged 65 and older.
- To compare early (30-day) and late (1-year) mortality rates between older men and women post-MI.
Main Methods:
- Prospective cohort study of 223 older adults (103 women, 120 men) diagnosed with MI.
- Data collected from the New Haven cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) program.
- All-cause mortality assessed at 30 days and 1 year post-MI, with multivariable adjustments for various clinical and demographic factors.
Main Results:
- No significant difference in 30-day mortality between women and men post-MI (RR 0.85; 95% CI, 0.41-1.76 after adjustment).
- Among 30-day survivors, women demonstrated significantly higher 1-year survival rates compared to men (RR 0.44; 95% CI, 0.20-0.99 after adjustment).
Conclusions:
- Early mortality following myocardial infarction in older individuals shows minimal sex-based differences.
- Women who survive the initial 30 days post-MI exhibit improved 1-year survival compared to their male counterparts.
Objective:
To determine sex differences in survival after myocardial infarction in older individuals.
Design:
Prospective cohort study based on a community sample of older individuals. All patients were followed for 1 year after hospital admission.
Setting:
Two hospitals in New Haven, Connecticut.
Participants:
The study included 103 women and 120 men who were participants in the New Haven, CT cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) program and who were diagnosed with myocardial infarction between the inception of the community study in 1982 and December 31, 1992. The mean age of women was 79.3 and of men, 77.3.
Measurements:
Data on clinical characteristics were abstracted from medical records. Sociodemographic, psychosocial, and physical function information was derived from the EPESE interview preceding the infarction. The main outcome measure was all-cause mortality, for which three end points were used: early mortality (first 30 days), late mortality (1-year mortality among survivors of the first 30 days), and overall mortality (1-year mortality from admission in the whole sample).
Results:
Mortality in the first 30 days did not differ significantly in the two sexes. The relative risk (RR) of death in women compared with men was 0.85 (95% confidence interval [CI], 0.49-1.47) before multivariable adjustment; this was unchanged after adjustment for demographic factors, comorbidity, functional status, psychosocial factors, and clinical severity (RR, 0.85, 95% CI, 0.41-1.76). Among survivors of 30 days, women were almost two times more likely to survive at 1 year compared with men, both before multivariable adjustment (RR, 0.56, 95% CI, 0.31-1.02) and after controlling for demographic factors, comorbidity, physical function, psychosocial factors, clinical severity on admission, and hospital complications (RR, 0.44 ; 95% CI, 0.20-0.99). Analyses involving 1-year follow-up from admission for the entire sample yielded intermediate results.
Conclusion:
There was little difference in mortality in the first 30 days after myocardial infarction between older men and women, but when the early deaths were excluded, women showed an increased survival compared with men in the first year after the myocardial infarction.