Study Shows Women Have a Higher Short-Term Mortality After Heart Attack Than Men at Younger Ages/Heart Attack Registry Data Examines Gender Differences in Early Heart Attack Mortality

Women have a higher short-term mortality after heart attack than men at younger ages, according to a study published in the July 22 issue of The New England Journal of Medicine. In fact, the study, which analyzed data from the National Registry of Myocardial Infarction 2 (NRMI 2), found that women under the age of 50 are twice as likely to die after a heart attack than men in the same age group. NRMI is a multi-center, multi-phase, observational heart attack program sponsored by Genentech, Inc.

The evaluation team, headed by Viola Vaccarino, MD, PhD, Assistant Professor at the Department of Epidemiology and Public Health at Yale University School of Medicine in New Haven, Conn., examined data collected from 384,878 patients – 155,565 women and 229,313 men – enrolled in NRMI 2 at 1,658 hospitals across the U.S. Our findings clearly demonstrate that younger women who suffer heart attacks represent a distinct group of patients deserving special attention in terms of diagnosis and treatment, said Dr. Vaccarino.

Overall, female patients enrolled in the study were older then men, and thus hospital mortality was higher in this group (16.7 percent versus 11.5 percent). However, when examined in specific age groups, investigators found that gender differences in mortality significantly differed according to age. For every five-year decrease beginning at age 75, death rates for women increased by 11 percent as compared to men. Adjustments for medical history, comorbidity, clinical severity of the heart attack and early treatment intervention between the two groups only explained about one-third of the higher mortality in younger women relative to men.

Additionally, investigators observed that women at younger ages consistently are less likely to be admitted with a diagnosis of suspected heart attack and administered life-saving reperfusion (artery-opening) therapies. Though these findings may be explained by sex differences in presentation, they are consistent with previous studies which demonstrate that women are treated less aggressively for heart attack than men.

This data suggests that the female gender may play a role in short-term mortality after heart attack, particularly among younger patients, making it difficult to diagnose and treat this patient population, said Dr. Vaccarino. However, as early manifestations of coronary heart disease may be difficult to diagnose in women, more emphasis should be placed on the identification of diagnostic techniques and prognostic indicators for the early stages of this disease in the female population.

Coronary heart disease (CHD) is a condition caused by narrowing or blockage of the coronary arteries, which often leads to heart attack. Each year, more than 1.1 million Americans – 668,000 men and 439,000 women – suffer a heart attack and nearly half will die. According to the American Heart Association, heart attack is the number one killer of women over the age of 35. As women may experience heart attack symptoms differently than men, they tend to wait several hours before seeking immediate medical attention.

The National Registry of Myocardial Infarction 2, which enrolled patients from June 1994 through March 1998, was designed to evaluate the presentation, treatment and outcome patterns of heart attack patients, as well as to examine patient risk factors related to outcomes and utilization of hospital resources. The current phase of the NRMI study, NRMI 3 is enhancing the findings of NRMI 2 by broadening its focus to address the treatment and outcomes of high-risk acute coronary syndromes (ACS) patients who ultimately experience a heart attack.

NRMI is designed to collect data aimed at supporting centers continuous quality improvement efforts, and is listed as an accepted performance measurement tool to improve patient care by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the group responsible for hospital accreditation.

Since its founding in 1810, the Yale University School of Medicine has been educating leaders in research, medical education and patient care. Its missions are to expand knowledge in the basic and clinical sciences and public health, to educate the next generation of leaders in those fields, to provide excellent health care and cutting-edge therapies, and to serve the local community.

* or Tom Conroy, Yale University School of Medicine: 203/432-1345

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