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A study found that women are more likely to die following a heart attack compared to men. GIPhotoStock/Getty Images
  • Researchers compared outcomes among men and women following a heart attack.
  • They found that women are more likely to die following a heart attack than men.
  • The findings highlight the need for stricter surveillance of women following heart attacks.

Cardiovascular disease is the leading cause of death worldwide. Around 17.9 million people died from cardiovascular disease in 2019, equating to around 32% of deaths globally. Around 85% of these deaths were due to heart attack and stroke.

Men are more likely than women to have cardiovascular conditions. However, research indicates that women have worse outcomes during hospital stays than men after a heart attack.

Women may have worse outcomes than men due to older age, increased numbers of other conditions, and less use of stents to open blocked arteries. A stent is a small mesh tube that promotes blood flow by opening weak or narrowed arteries.

Gaining more insights into different outcomes among men and women following heart attacks could improve care strategies.

Recently, researchers examined outcomes among men and women admitted to hospital between 2010 and 2015 for a heart attack and treated with a stent within 48 hours of symptom onset.

They found that women are two to three times more likely to have adverse outcomes such as death than men both in the short and long term.

Dr. Steven Gundry, a cardiothoracic surgeon, Founder of Gundry MD, and host of the Dr. Gundry Podcast, not involved in the study, told Medical News Today:

“The studies are one more piece of evidence that women’s heart complaints are sadly not taken as seriously as men’s. The study [also] confirms is that pre menopausal women are equally at risk. There is this long held assumption that women are protected against heart disease by estrogen; but as with the epidemic of obesity and diabetes, that is no longer the case.”

The study was presented at the Heart Failure 2023 Congress organized by the European Society of Cardiology.

For the study, the researchers included 884 patients with an average age of 62. Just over a quarter of the participants were women.

Women were an average age of 67 years old at the start of the study, and men were an average of 60 years old.

Women were more likely to have high blood pressure, diabetes, and prior stroke than men. However, men were more likely to smoke and have coronary artery disease.

The researchers further noted that women under 55 tended to wait an average of 95 minutes in hospital for treatment, whereas men of the same age were treated after 80 minutes.

After analyzing the data, the researchers found that 11.8% of women had died 30 days after treatment, compared to just 4.6% of men.

After five years, 32.1% of women had died compared to 16.9% of men, and 34.2% of women experienced a major adverse cardiac event (MACE) compared to 19.8% of men. As MACE the authors considered all-cause death, reinfarction, hospitalizations for heart failure, and stroke.

The findings remained after adjusting for conditions that could potentially influence the results, including chronic kidney disease, hypertension, and high cholesterol.

Next, the researchers analyzed a subset of 435 patients aged 55 and older, matching men and women according to risk factors. Once again, women experienced more adverse outcomes than men.

Ultimately, 11.3% of women died within 30 days compared with 3% of men. After five years, 32.9% of women had died compared to 15.8% of men, and 34.1% of women experienced a MACE compared to 17.6% of men.

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In a press release, Dr. Mariana Martinho of Hospital Garcia de Orta, Almada, Portugal, one of the study’s authors, noted that the study did not examine reasons for different outcomes among men and women.

Dr. Martinho noted, however, that atypical symptoms of a heart attack in women and genetic predisposition may play a role. She added that her team did not find any differences in medication use to lower blood pressure or lipid levels between men and women.

When asked what might explain why women have higher mortality rates than men following a heart attack, Dr.Danine Fruge, Medical Director of Pritikin Longevity Center, not involved in the study, told MNT:

“Women tend to develop microvascular disease which makes a heart attack more challenging to recognize and to treat.”

“Instead of the classic chest pain, women commonly experience atypical symptoms during a heart attack, such as indigestion or shoulder pain which is often ignored. The more time a heart attack goes untreated, the more damage to your body so women often have an increased mortality rate by the time they present for treatment,” she explained.

“Furthermore, men often receive a stent to open a blocked artery following a heart attack, but women often cannot because their arteries are smaller in diameter which also leads to poorer outcomes after a heart attack,” she added.

Dr. Steven Gundry also told MNT that women’s complaints are less likely to be taken seriously than men, even in the emergency room.

“In terms of heart failure, many women will be treated for “swollen ankles” with a diuretic- a water pill- as if swollen ankles were a normal part of aging, instead of investigating with blood tests and/or an echocardiogram looking for heart failure as the cause and then treating that appropriately.”

To understand more about the diagnosis and treatment of heart conditions in women, MNT examined another recent study that found that many patients with heart failure die without a diagnosis — and that this is especially true for women. This work will also be presented at the Heart Failure 2023 Congress.

Heart attack and heart failure are different cardiovascular conditions. Heart attacks happen when there is a sudden loss of blood supply to the heart, and heart failure occurs when the heart can no longer pump blood around the body adequately.

In this study, researchers found that many patients treated with loop diuretics may have undiagnosed heart failure. Loop diuretics are a group of drugs used to treat symptoms and signs of congestion due to heart failure.

At the beginning of the study, 75% of patients taking loop diuretics did not have a heart failure diagnosis. Around 70% of these patients were women. Meanwhile, 50% of patients taking loop diuretics diagnosed with heart failure were women.

After five years, 40% of patients prescribed loop diuretics without heart failure at the start of the study had died during follow-up, although only 11% of these patients received a new diagnosis of heart failure. Additionally, 86% of those who died after being diagnosed with heart failure were treated with loop diuretics.

“It is likely that many patients treated with loop diuretics have undiagnosed heart failure. It is also possible that inappropriate use of loop diuretics is driving adverse outcomes,” Dr. John Cleland, Professor of Cardiology at the School of Cardiovascular and Metabolic Health, University of Glasgow, and principal investigator of this study, said in a press release.

“The combination of undiagnosed heart failure and inappropriate loop diuretic use may be one of the largest and most serious problems that cardiologists have yet to tackle. Ignoring it and hoping it goes away would be a tragedy.”

– Dr. Cleland

Dr. Nieca Goldberg, cardiologist and American Heart Association’s Go Red for Women national spokesperson, not involved in the study, told MNT that patients should be investigated for heart failure if they require loop diuretics.

“It is important to make a diagnosis of heart failure as there are other medications that we use that improve outcomes in people with heart failure. […] In addition, we need to be more aggressive in preventing high blood pressure and heart attacks in women as both of these conditions can lead to heart failure,” Dr. Goldberg explained.

When asked about the study’s limitations, Dr. Fruge said:

“The findings in this study were limited by only using an echocardiogram and a blood test to diagnose heart failure. It is very beneficial to also include a chest x-ray and a thorough physical examination […] to thoroughly evaluate for heart failure. For women, it is more difficult to identify due to diastolic heart failure and microvascular disease.”

Dr. Vicken Zeitjian, a cardiologist board certified in echocardiography and nuclear cardiology based in San Antonio, Texas, who was not involved in the study, told MNT:

“These findings further confirm what we know about outcomes in women after [heart attack]. We do know patients with more comorbidities are at higher risk for adverse outcomes. The limitation of these findings are we still don’t know how to better serve the findings i.e. how to improve outcomes in women.”

MNT spoke with Dr. Jennifer Wong, cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, not involved in the study, about the main takeaway from the findings.

“A potential implication of these studies is to look for heart disease and treat risk factors for heart disease sooner than we currently do in women. Continue to focus on prevention such as diet and exercise which can be especially helpful for preventing and treating heart failure with preserved ejection fraction, a type of heart failure more women tend to have than men,” she said.