Bad News: Heart Attacks More Common in Women; Good
News: Fewer are Fatal
Reduced risk of death was largest in women younger
than 55 (a52.9% reduction) and lowest in men of the same age (33.3%)
Oct. 26, 2009 - Heart attacks appear to have become
more common in middle-aged women over the past two decades, but all
women and especially those younger than 55 have recently experienced a
greater increase than men in their chances of survival following such a
heart event, according to two reports in the October 26 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals.
Middle-aged women have historically had a lower
overall risk of heart events and stroke than men of a similar age.
A recent report showing higher stroke rates among
women than men in a sample representative of the U.S. population,
however, appeared to reveal a new phenomenon and raised the question of
whether heart disease or heart attack were also becoming more prevalent
among women.
Amytis Towfighi, M.D., of the University of
Southern California, Los Angeles, and colleagues analyzed data from U.S.
adults age 35 to 54 who participated in the National Health and
Nutrition Examination Surveys (nationally representative surveys
conducted by the government) during 1988 to 1994 (4,326 participants)
and 1999 to 2004 (4,075 participants).
The researchers assessed how often men and women
had heart attacks and also compared their Framingham coronary risk
score, a measurement of heart disease risk over 10 years that includes
factors such as age, cholesterol levels, blood pressure and smoking
history.
In both study periods, men age 35 to 54 years had
more heart attacks than women in the same age group.
The gap narrowed, however, in more recent years as
heart attacks decreased in prevalence among men and increased in
prevalence among women (2.5 percent of men and 0.7 percent of women
reported a history of heart attack in 1988-1994, whereas 2.2 percent of
men and 1 percent of women did so in 1999-2004).
Between the two time periods, the average
Framingham coronary risk score showed an improving trend among men but
decreased among women.
In male participants, total cholesterol levels
remained stable, high-density lipoprotein (HDL or "good" cholesterol)
levels and systolic (top number) blood pressure levels improved and
smoking levels declined.
The only risk factor that improved among women was
HDL levels.
Diabetes prevalence increased among both men and
women, likely due to insulin resistance and the obesity epidemic in both
sexes.
"Although men in their midlife years continue to
have a higher prevalence of myocardial infarction and a higher 10-year
risk of hard coronary heart disease than women of similar age, our study
suggests that the risk is increasing in women, while decreasing in men,"
the authors write.
"Therefore, intensification of efforts at screening
for and treating vascular risk factors in women in their midlife years
may be warranted."
Death rates declining rapidly for women
In another report, Viola Vaccarino, M.D., Ph.D., of
Emory University School of Medicine, Atlanta, and colleagues
investigated trends in the rate of in-hospital deaths following heart
attack from June 1, 1994, through Dec. 31, 2006. Data were collected
from 916,380 patients through the National Registry of Myocardial
Infarction.
In-hospital death rates decreased among all
patients between 1994 and 2006, but decreased more markedly in women
than in men.
The reduced risk of death was largest in women
younger than 55 years (a 52.9 percent reduction) and lowest in men of
the same age (33.3 percent).
The absolute decrease in the risk of death among
patients younger than 55 was three times larger in women (2.7 percent)
than men (0.9 percent).
"A large part (93 percent) of this sharper decrease
in mortality of younger women compared with men in recent years was
because the risk status of women on admission improved compared with
that of men," the authors write.
"Such improvement may be due to better recognition
and management of coronary heart disease and its risk factors in women
before the acute myocardial infarction event, as suggested by the
narrowing sex difference in previous revascularization [surgical
treatment for heart disease]."
Editorial: Prevention is key for women and heart
disease
"Cardiovascular illnesses have been long neglected
in their role as the primary cause of mortality in women, both by
patients and physicians," write Sabine Oertelt-Prigione, M.D., and Vera
Regitz-Zagrosek, M.D., Ph.D., of Charitι Universitaetsmedizin, Berlin,
in an accompanying editorial.
"Men are still believed to be at greater risk for
myocardial infarction and stroke and are thus more aggressively
informed, counseled and treated for these diseases."
"The improvements described by Towfighi et al and
Vaccarino et al are encouraging and indicate that we are on the right
track. However, much needs to be done, especially in consideration of
the increase in prevalence of risk factors as obesity and type 2
diabetes mellitus in the general population."
"As these studies show, increased and continuous
vigorous attention to the prevention of cardiovascular risk factors-by
healthy diet, regular physical activity and avoidance of smoke and
smoking-is necessary for both men and women," they conclude.
What is heart failure?
Heart failure is a chronic, progressive condition
in which the heart muscle is unable to pump enough blood through the
heart to meet the bodys needs for blood and oxygen. Basically, the
heart cant keep up with its workload.
At first the heart tries to make up for this by:
● Enlarging. When the heart chamber enlarges, it
stretches more and can contract more strongly, so it pumps more blood.
● Developing more muscle mass. The increase in
muscle mass occurs because the contracting cells of the heart get
bigger. This lets the heart pump more strongly, at least initially.
● Pumping faster. This helps to increase the
heart's output.
The body also tries to compensate in other ways:
● The blood vessels narrow to keep blood pressure
up, trying to make up for the heart's loss of power.
● The body diverts blood away from less important
tissues and organs to maintain flow to the most vital organs, the heart
and brain.
These temporary measures mask the problem of heart
failure, but they don't solve it. Heart failure continues and worsens
until these substitute processes no longer work.
Eventually the heart and body just can't keep up,
and the person experiences the fatigue, breathing problems or other
symptoms that usually prompt a trip to the doctor.
The body's compensation mechanisms help explain why
some people may not become aware of their condition until years after
their heart begins its decline. (It's also a good reason to have a
regular checkup with your doctor.)
Heart failure can involve the heart's left
side, right side or both sides. However, it usually affects the left
side first.
Oct. 26, 2009 - Heart attacks appear to have become
more common in middle-aged women over the past two decades, but all
women and especially those younger than 55 have recently experienced a
greater increase than men in their chances of survival following such a
heart event, according to two reports in the October 26 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals.
What is heart failure?