Women fare worse than men early after heart attack

Women who suffer a first heart attack have a greater chance of dying in the first year after the event than their male counterparts, a Dutch study shows.

While the poorer outcome for women may largely be explained by women's older age when they have a heart attack, women still seem to have a higher risk of early death even after accounting for a number of other risk factors.

Moreover, there seems to be "an excess mortality among younger women compared with men," Dr. Huiberdina L. Koek from University Medical Center Utrecht in The Netherlands and colleagues report in the American Journal of Cardiology.

These findings suggest that "special care must be applied to women," in particular, women younger than 40 years old, they write. These women may need more intensive monitoring in the first 30 days after heart attack and perhaps a greater willingness to adopt "more aggressive" therapeutic interventions.

The findings are based on a look at the records of 21,565 adults hospitalized for heart attack in 1995 in The Netherlands. In "crude" analyses across all ages, the likelihood of dying within 28 days was 70 percent higher in women compared to men. At 5 years, the risk of death was 52 percent higher in women relative to men.

Overall, age was a "strong determinant of mortality," with a 6 percent to 8 percent increase in risk of dying with every 1-year increase in age.

Once age was factored into the calculations, women remained at higher risk of death after a heart attack at 28 days and 1 year, although their risk was significantly attenuated. At 5 years, women were no longer at greater risk of dying - actually, they were at lower risk of dying, the authors report.

Numerous reasons have been given for the worse short-term prognosis of women, including older age and more simultaneous illnesses such as diabetes. Also, younger women in particular might wait longer before going to the hospital, might be less likely to be diagnosed with heart attack and might be less likely to receive clot-busting therapy.

"The lower long-term mortality in women might reflect the well-established survival advantage of women in the general population," Koek and colleagues say.

SOURCE: American Journal of Cardiology, October 15, 2006.