More middle-age women having heart attacks, but survival rates increasing

Physician experts seek more emphasis on screening and treating cardiovascular disease risk factors in women.

By — Posted Nov. 16, 2009

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Heart attacks in middle-age women have become more common in the last two decades, but women's chances of surviving have increased more than men's, especially in women younger than 55, according to separate studies in the Oct. 26 Archives of Internal Medicine.

Both studies found men age 35 to 54 experienced more heart attacks than did women in the same age group. But authors of one study, on midlife coronary heart disease risk and prevalence trends, found the gap between women and men narrowed over the past two decades, as heart attacks decreased in prevalence among men and increased in women.

In the second study, researchers analyzed gender-specific data to determine in-hospital mortality rates after acute myocardial infarction. They found rates decreased among all patients from 1994 to 2006, falling more markedly in women than men.

The steepest drop, 52.9%, occurred among women younger than 55. The mortality rate for men in the same age group decreased by 33.3%.

"The finding that mortality rates are declining in women, even more than in men -- that's real good news," said Viola Vaccarino, MD, PhD, professor of medicine at Emory University School of Medicine in Atlanta and author of the mortality study. Dr. Vaccarino and her colleagues investigated trends between 1994 and 2006 in the rate of deaths in hospitals shortly after heart attacks.

"We have already made good progress. ... We need to continue, and perhaps even intensify these efforts," Dr. Vaccarino said.

Data were collected from 916,380 patients through the National Registry of Myocardial Infarction, which includes data on treatment rates at U.S. hospitals for patients discharged after heart attacks.

Middle-age women who experienced MI tended to have more coronary risk factors and co-morbidities than did men of the same age, the study showed.

"It appears that risk factors, which may be controlled through prevention efforts, are very important in driving these mortality reductions. That is the main message for physicians," Dr. Vaccarino said.

Despite the improvement in hospital mortality rates, cardiovascular risks for middle-age women have worsened in recent years, while men's risks have improved, according to the heart-attack prevalence study.

Researchers examined data from more than 8,000 adults age 35 to 54 who participated in the National Health and Nutrition Examination Survey from 1988 to 1994 and 1999 to 2004.

The study's authors assessed how often men and women had heart attacks and also compared their Framingham Risk Scores. Between 1988 and 1994, 2.5% of men and 0.7% of women reported a history of heart attack. These figures decreased to 2.2% among men and increased to 1.0% among women from 1999 to 2004.

There was little improvement in women's coronary disease risk factors, including cholesterol, systolic blood pressure levels and smoking, according to the study's author, Amytis Towfighi, MD, assistant professor of clinical neurology at the University of Southern California Keck School of Medicine.

Among middle-age men, on the other hand, only diabetes mellitus prevalence worsened, while other risk factors remained stable or improved.

"This just tells us we have a lot of work to do in terms of preventing women from needing to go to the emergency room. There's still room for prevention of the first heart attack," said Nieca Goldberg, MD, medical director of New York University's Women's Heart Center and a spokeswoman for the American Heart Assn.

"Doctors have to be more aggressive in addressing women's risk factors, screening for diabetes and heart disease, and counseling them on nutrition and smoking cessation," Dr. Goldberg said.

Dr. Towfighi also urged physicians to look beyond the perception that hormones in premenopausal women protect them against heart disease.

"It is important for physicians to be aware that ... women are not completely protected against heart disease," Dr. Towfighi said.

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Heart attack survival improving

Although heart attacks are becoming more common for women, in-hospital mortality rates from myocardial infarction are falling more rapidly for women than are rates for men, according to a new study.

1994-95 2004-06 Reduction
Men's mortality rates
Younger than 55 2.7% 1.8% 33.3%
55 to 64 5.7% 3.3% 42.1%
65 to 74 10.5% 5.9% 43.8%
75 to 84 18.1% 10.9% 39.8%
85 and older 24.7% 16.0% 35.2%
Women's mortality rates
Younger than 55 5.1% 2.4% 52.9%
55 to 64 8.0% 3.9% 51.3%
65 to 74 13.6% 6.5% 52.2%
75 to 84 19.7% 11.3% 42.6%
85 and older 25.8% 15.0% 41.9%

Source: "Sex Differences in Mortality After Acute Myocardial Infarction,"Archives of Internal Medicine, Oct. 26 (link)

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External links

"Sex Differences in Mortality After Acute Myocardial Infarction," abstract, Archives of Internal Medicine, Oct. 26 (link)

"Sex-Specific Trends in Midlife Coronary Heart Disease Risk and Prevalence," abstract, Archives of Internal Medicine, Oct. 26 (link)

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