BACKGROUND\nPrevious studies have shown that women younger than 55 years have higher hospital mortality rates after acute myocardial infarction (MI) than age-matched men. We examined whether such mortality differences have decreased in recent years.\n\n\nMETHODS\nWe investigated temporal trends in the hospital case-fatality rates of MI by sex and age from June 1, 1994, through December 31, 2006. The study population included 916,380 patients from the National Registry of Myocardial Infarction with a confirmed diagnosis of MI.\n\n\nRESULTS\nIn-hospital mortality decreased markedly between 1994 and 2006 in all patients but more so in women than men. The mortality reduction in 2006 relative to 1994 was largest in women younger than 55 years (52.9%) and lowest in men younger than 55 years (33.3%). In patients younger than 55 years, the absolute decrease in mortality was 3 times larger in women than men (2.7% vs 0.9%). As a result, the excess mortality in younger women (<55 years) compared with men was less pronounced in 2004-2006 (unadjusted odds ratio, 1.32; 95% confidence interval, 1.07-1.67) than it was in 1994-1995 (unadjusted odds ratio, 1.93; 95% confidence interval, 1.67-2.24). The sex difference in mortality decrease was lower in older patients (P = .004 for the interaction among sex, age, and year). Changes in comorbidity and clinical severity features at admission accounted for more than 90% of these mortality trends.\n\n\nCONCLUSIONS\nIn recent years, women, particularly younger ones, experienced larger improvements in hospital mortality after MI than men. The narrowing of the mortality gap between younger women and men is largely attributable to temporal changes in risk profiles.

Abstract 6082: Sex Differences in Mortality after Acute Myocardial Infarction: Changes from 1994 to 2006

Cardiovascular disease (CVD) remains the most common cause of death in women living in developed countries and outnumbers death from all forms of cancer combined [1]. Since 1984, the number of CVD deaths for females has exceeded those for males. With the advances in the diagnosis and treatment of coronary artery disease (CAD), there have been significant decreases in cardiovascular mortality seen in both sexes, with the major decline for women occurring after the year 2000 [2]. However, this reduction in mortality among women has remained less pronounced as compared with men [3]. The reason for this disparity may be gender differences in the pathophysiology of CAD or lower awareness of coronary disease in women leading to decreased implementation of evidence based care [4]. The Yentl syndrome (as described in 1991) pointed out the ubiquitous misrecognition of CVD as an affliction of men, with women seeming to require a higher burden of proof in order to receive appropriate diagnostic tests and therapeutic interventions [5]. There are recognized gender differences including a notable 10 year delay in the onset of ischemic heart disease (IHD) in women compared to men, that have been attributed to the protective effect of estrogen [6].

Management of Stable Ischemic Heart Disease in Women

Peripheral arterial disease (PAD) is a common yet vastly underdiagnosed condition that is associated with substantial morbidity and mortality. Because atherosclerosis is a systemic disease, the presence of PAD, whether symptomatic or not, is associated with a two- to fourfold increase in the risk of myocardial infarction, stroke and cardiovascular death [1–3]. More timely diagnosis of PAD in the primary care setting has the potential not only to improve quality of life by helping to alleviate the lifestyle-impairing symptoms often associated with the disease, but also to identify individuals at high risk for cardiac and cerebrovascular events providing the opportunity to initiate effective life-saving therapies at an earlier stage [4].

Vascular Diseases – Peripheral/Aorta

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Management of Stable Ischemic Heart Disease in Women

Vascular Diseases – Peripheral/Aorta