A new study has revealed that young women could be more likely to die than men in the decade following a heart attack.
The study, published in Oxford University’s weekly peer-reviewed medical journal of cardiology, reflects a trend that women under age 50 experience fewer heart attacks than men in the same age range, but have higher mortality rates in the years after a heart attack.
The study found that only 400 of 2100 heart attack patients treated in two hospitals in Boston were women. However, over the long-term, the female patients were more likely to die than the male patients. Over a period of 11 years of monitoring patients, researchers discovered that women were 1.6 times more likely to die from any cause than men during that time.
Dr. Ersilia DeFilippis led the team in the study and told Live Science that the differences in mortality rate between men and women were “primarily driven by non-cardiovascular death.”
Meaning, the thing that the women were dying from was not caused by a heart condition but instead causes including cancer and sepsis.
Dr. DeFilippis, a cardiology fellow at the New York Presbyterian-Columbia University Irving Medical Center, revealed a number of factors that may be contributing to these deaths, but concluded “there were no clear explanations as to why women had lower survival.”
She believes that cardiologists have “a duty to “educate women regarding the risks of cardiovascular disease and potential worrisome symptoms.”
Assistant professor in Cardiovascular Medicine at the Mayo Clinic, Dr. Marysia Tweet added that the risk factors for disease of other organs “overlap with risk factors for heart disease.”
“A heart attack and the ramifications of a heart attack may affect the health of other organs,” Dr. Tweet said in a statement. “Long-term mortality is likely due to a combination of multiple factors.”
These factors may include diabetes, rheumatoid arthritis, depression and elevated levels of stress hormones. In Dr. DeFilippis’ latest research, female patients presented with higher rates of diabetes than male patients, and had higher rates of rheumatoid arthritis.
According to a 2012 study published in the US, the ongoing inflammation can increase levels of fatty plaques in blood vessels, leading to a block of the arteries which can increase the likelihood of a heart attack. Female patients in the study also presented with higher rates of depression than male patients.
Dr Tweet said this contributed to the long-term survival of women who suffer from heart attacks.
“Depression impacts adherence to healthy lifestyle recommendations and medications,” she said in a commentary published in the European Heart Journal.
“Doctors can improve women’s care by recruiting more women into clinical trials, actively including sex-based data in studies of heart attacks and better addressing sex-specific risk factors when educating patients.”
Dr Tweet expressed that it’s also possible that the physiological changes that concur with depression worsen outcomes for women. Elevated levels of stress hormones and inflammatory molecules can worsen a female patient’s prognosis.
According to a 2018 report published in the journal Circulation, women are roughly twice as likely as men to experience stress-induced reduction in blood flow to organs after a heart attack.
“Young women with a previous myocardial infarction a group with unexplained higher mortality than men of comparable age, have shown elevated rates of MSIMI (Mental stress-induced myocardial ischemia),” the report stated. “Women in both groups showed a higher peripheral arterial tonometry ratio during mental stress but a lower reactive hyperemia index after mental stress, indicating enhanced microvascular dysfunction after stress.”
Dr Tweet also described the ways in which conditions including gestational diabetes and preeclampsia — dangerously high blood pressure during pregnancy, can place women at higher risk for heart attacks.
In 2011, a study published in the Harvard Health Publishing journal from Harvard Medical School titled “Hysterectomy linked to increase in heart disease” found that ovary removal was associated with a higher risk of heart attacks, potentially because ovaries produce the sex hormone estrogen, which is thought to protect against heart disease.
Additionally, studies have shown that women receive different care from men when they present themselves at hospitals for heart attacks.
Last month, Circulation: Heart Failure, the research found that women are 11 percent more likely to die in hospital after experiencing complications from heart attacks, and less likely to receive the same tests and treatment as their male counterparts. 23 percent of women died compared to 21.7 percent of men, indicating that gender predicted higher in-hospital death rates, even when adjusting for outside factors.
Women in the study were less likely than men to be tested for possible blockages on X-ray and less likely to receive coronary revascularization where blood flow is restored through surgery.
Compared with men, women were less likely to undergo coronary angiography to detect blockages in heart arteries, less likely to undergo an angiography on the day they were admitted to the hospital, less likely to receive stents or balloons to open blocked heart arteries and less likely to be put on a mechanical pump to maintain heart function.
When discharged from the hospital, women were less likely to be given medications prescribed after a heart attack to protect the organ from further damage such as aspirin, beta-blockers, ACE inhibitors and statins.
These differences in medical care can indicate the “persistent sex or gender disparities in clinical care and decision-making,” Dr. Tweet wrote.
Evidently, a patient’s socioeconomic status may be another critical factor in women’s long-term survival rates. Dr DeFilippis’s team found that on average, women had lower median incomes than men and were more likely to have public insurance. “Therefore, there are likely differences in access to care which are playing a role,” Dr DeFilippis said.
In the study, chest pain was the most commonly reported symptom among both men and women, but a higher number of women reported symptoms like shortness of breath, heart palpitations and fatigue.
Dr. DeFilippis believes that that further studies will be needed to tease out how these factors affect women’s long-term survival after a heart attack.