Newswise — Women who experience a heart attack at a young age face worse outcomes and a higher chance of returning to the hospital in the year following discharge than men of a similar age. A recent study in the Journal of the American College of Cardiology found that while second heart attacks and heart-related chest pain were the leading causes of readmission, non-cardiac hospitalizations showed the most significant difference between genders.
Dr. Mitsuaki Sawano, the lead author of the study and a postdoctoral associate at Yale-New Haven Hospital Center for Outcomes Research and Evaluation, emphasized the importance of public awareness in preventing heart attacks and implementing screening programs to identify traditional risk factors before a patient experiences a heart attack. It is a common misconception that heart attacks only occur in middle-aged or older men, but this is not the case. Dr. Sawano urged people to understand that heart attacks can also affect young women, and their symptoms may not be typical. He suggested that a comprehensive approach is necessary for the treatment of young women who have experienced a heart attack.
The study utilized information from the VIRGO study, which is an observational investigation into the symptoms, treatment, and results of heart attacks in men and women aged between 18 and 55 years old. The current research focused on 2,985 American patients, of whom 2,009 were women and 976 were men, who had been admitted to the hospital for a heart attack. After removing in-hospital deaths, the final number of participants included in the study was 2,979, with 2,007 women and 972 men.
The research investigated acute events that necessitated hospitalization for any reason, as well as cause-specific hospitalizations. Hospitalization was characterized as any stay in the hospital or observation unit lasting more than 24 hours in the year following discharge following a heart attack. The events were classified into the following categories:
- Coronary-related hospitalization: a composite of hospitalizations due to recurrent heart attack or stable/unstable angina (chest pain due to the heart)
- Other cardiac or stroke hospitalization: a composite of heart failure, arrhythmias, valvular disease and stroke
- Non-cardiac hospitalization: any hospitalization not attributed to cardiac issues, including chest pain not related to the heart, gastrointestinal problems, bleeding, psychiatric conditions, etc.
Dr. Sawano believes that young women who experience heart attacks typically have a higher prevalence of cardiovascular risk factors compared to men. Normally, premenopausal women have a lower incidence of heart attacks due to the protective effects of estrogen. Therefore, to counteract this natural protection, a greater accumulation of risk factors, such as obesity, high blood pressure, high cholesterol, and cigarette smoking, is required to cause a "breakthrough" effect.
The study's average participant age was 47 years, with 70% identifying as non-Hispanic White. Women had a greater percentage of self-identification as non-Hispanic Black compared to men. Additionally, women had a higher occurrence of comorbidities, such as obesity, congestive heart failure, prior stroke, and renal disease. Young women in the patient cohort were more likely to have a low income, a history of depression, and significantly worse overall health status when compared to men in the study.
Dr. Sawano explains that for women, the larger number of risk factors they have, the more difficult it is to control them after being discharged from the hospital. Poor management of these risk factors has been associated with unfavorable outcomes, such as the recurrence of heart attacks, chest pain due to the heart, and other atherosclerotic diseases like stroke.
The researchers discovered that women were less likely to show up at the hospital with chest pain and more likely to arrive more than six hours after experiencing symptoms. Women were also more prone to suffer from a non-ST-elevated myocardial infarction or a myocardial infarction with nonobstructive coronary arteries (MINOCA). The women experiencing MINOCA tended to be younger, more likely to identify as non-Hispanic Black, smokers, had a lower education status, and had the lowest proportion of previous coronary artery disease. These patients also reported lower levels of satisfaction with treatment compared to men or women presenting with myocardial infarction with obstructive coronary artery disease (MI-CAD). Additionally, on average, women stayed in the hospital for a longer period and received lower rates of guideline-recommended medical therapies, including aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors (ACE inhibitors).
Within one year of discharge, 34.8% of women and 23% of men were hospitalized for any cause. The primary reason for hospitalizations for women was coronary-related, followed by non-cardiac, other cardiac, and stroke-related hospitalizations. Women who had MINOCA experienced lower rates of one-year outcomes compared to those who had MI-CAD. There was a more substantial difference between women and men in terms of non-cardiac hospitalizations compared to other types of hospitalizations (145.8 vs. 69.6 per 1,000 person-years).
Sawano emphasized that the accumulation of risk factors in the MI-CAD population was associated with a high incidence of hospitalization one year after a heart attack. However, this did not mean that MINOCA patients were low-risk, as recent studies have shown that MINOCA is not a benign disease compared to similarly aged women. Therefore, these cases require further evaluation to understand the underlying mechanism and treatment of certain conditions.
The researchers' findings indicate that there is a requirement for ongoing attempts to enhance secondary preventive methods to decrease hospitalizations related to the heart. However, it also emphasizes the necessity for additional studies into the causes and mechanisms of non-cardiac hospitalizations, especially considering the significant difference between sexes.
Dr. Martha Gulati, Ms, stated in an accompanying editorial, "This study is important in identifying the increased rate of rehospitalization due to cardiovascular and non-cardiovascular factors in women compared to men, with a clear link to psychosocial and demographic factors. However, the underlying cause of the sex differences in psychosocial factors and comorbid conditions prevalence remains unknown. Why are more women than men in this cohort identified as low-income? Why is depression almost twice as prevalent in women compared to men? As a cardiovascular community, by persistently asking why, we can potentially determine what steps to take next."
One limitation of the study is that information about the specific details of non-cardiac hospitalizations was not collected. Additionally, the results may not be applicable to population groups that were not well-represented in the study cohort.
The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or follow @ACCinTouch.
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