Recurrent heart attack, the highest risk is for women

Often, even in articles published in this journal, studies on gender difference have been presented. In particular then as regards the cardiovascular system, differences between men and women have been highlighted in numerous contexts.

In cardiovascular risk factors, and among these hypertension, as well as in the symptoms and therapy of chest pain or even myocardial infarction, there are, in fact, numerous differences between the different sexes, due to different hormonal or psychological pictures or lifestyles.

In a very recent issue of the Journal of the American College of Cardiology, Mitsuaki Sawano and his collaborators from the Cardiovascular Medicine division of the Yale School of Medicine in New Haven (Connecticut-USA) published an interesting article on the difference in prognosis between young men and women in the first year after acute myocardial infarction. Using data from the Virgo Study (which investigated the role of gender difference in patients with acute coronary heart disease), approximately 3000 patients aged between 18 and 55 hospitalized for acute myocardial infarction in 103 hospitals were considered Americans and Europeans, and followed up after discharge for an average period of one year.

IN THE HOSPITAL
The prognosis of these subjects was then evaluated both in terms of cardiovascular pathology and in terms of total mortality.
Of the approximately 3,000 patients studied, 30.4% were re-admitted to hospital within the year following the infarction. Women accounted for a decidedly higher percentage than men (34.8% versus 20% respectively). The most frequent cause of rehospitalization was a recurrence of coronary artery disease, and women were also in the majority (46% more).
Re-hospitalizations for non-vascular causes were twice as high in women as in men. Not surprisingly, the majority of re-hospitalizations were concentrated in the first month after myocardial infarction. After the third month the number stabilized. Even correcting the statistical analysis for a series of confounding factors, the data show that young women, in the first year after a heart attack, have a decidedly higher risk of re-hospitalization for both vascular and non-vascular disease than their male peers.

What are the causes? Numerous studies have shown that women, at the time of a heart attack, are treated on average worse than men.

They are hospitalized less in intensive care, receive coronary angiography and possible angioplasty less frequently, just as less frequent for them is correct medical therapy with the use of ACE inhibitors or beta blockers.

DELAY
In addition, in the event of an acute heart attack, women on average arrive at the hospital with a much greater delay than men. And this translates into larger heart attacks with a worse prognosis than in men.

* Professor of Cardiology
Catholic University, Rome