Younger women who suffer a heart attack are more likely than men to die

Women aged 50 and under are more likely to die in the decade after a heart attack than men, according to new research.  

Scientists found mortality rates for men and women in hospital, or from heart-related issues in the following 11-year period, were roughly the same.  

But the risk of dying from other causes during the same period grew 1.6 times for women.  

Researchers believe this is because smoking, diabetes, depression and psychosocial risk factors might have stronger adverse effects on women than on men, which outweigh the protective benefits of the oestrogen hormone in women.  

Lead author Professor Ron Blankstein, from Harvard Medical School in the US, said: “It’s important to note that overall most heart attacks in people under the age of 50 occur in men. Only 19 per cent of the people in this study were women.  

“However, women who experience a heart attack at a young age often present with similar symptoms as men, are more likely to have diabetes, have lower socioeconomic status and ultimately are more likely to die in the longer term.”  

The team behind the research, published in the European Heart Journal on Wednesday, looked at 404 women and 1,693 men who had a first heart attack (a myocardial infarction) between 2000 and 2016 and were treated at two Boston hospitals — Brigham and Women’s Hospital and Massachusetts General Hospital.  

They found that, compared to men, women were less likely to receive therapeutic invasive procedures after admission to hospital with a heart attack or to be treated with certain medical therapies upon discharge, such as aspirin, beta-blockers, ACE inhibitors and statins.  

During a myocardial infarction, the blood supply to the heart is blocked suddenly, usually by a clot, and the lack of blood can cause serious damage to the heart muscle.  

Treatments can include coronary angiography, in which a catheter is inserted into a blood vessel to inject dye so that an X-ray image can show if any blood vessels are narrowed or blocked.  

Others can involve a coronary revascularisation, in which blood flow is restored by inserting a stent to keep the blood vessel open or by bypassing the blocked segment with surgery.  

Women were found to be less likely to undergo either of these procedures — 93.5 per cent versus 96.7 per cent for invasive coronary angiograph, and 82.1 per cent versus 92.6 per cent for coronary vascularisation.  

Prof Blankstein added: “While further studies will be required to evaluate the underlying reasons for these differences, clinicians need to evaluate, and if possible treat, all modifiable risk factors that may affect deaths from both cardiovascular and non-cardiovascular events.  

“This could lead to improved prevention, ideally before, but in some cases, after a heart attack.  

“We plan further research to assess underlying sex-specific risk factors that may account for the higher risk to women in this group, and which may help us understand why they had a heart attack at a young age.”  

Despite being a similar age, women were less likely than men to have STEMI (46.3 per cent compared to 55.2 per cent), but more likely to have non-obstructive coronary disease.  

An STEMI is the most serious type of heart attack where there is a long interruption to the blood supply caused by a total blockage of the coronary artery.  

The most common symptom for both sexes was chest pain, which occurred in nearly 90 per cent of patients, but women were more likely to have other symptoms as well, such as difficulty breathing, palpitations and fatigue.  

In an accompanying editorial, Dr Marysia Tweet, assistant professor of medicine at the Mayo Clinic College of Medicine and Science, in Minnesota, pointed out that depression is twice as common among women in the study compared to men.  

“Young women with depression are six times more likely to have coronary heart disease than women without depression,” she wrote. 

“This study demonstrates the continued need — and obligation — to study and improve the incidence and mortality trajectory of cardiovascular disease in the young, especially women.  

“We can each work towards this goal by increasing awareness of heart disease and ‘heart healthy’ lifestyles within our communities; engaging with local policymakers, promoting primary or secondary prevention efforts within our clinical practices; designing studies that account for sex differences; facilitating recruitment of women into clinical trials; requesting sex-based data when reviewing manuscripts; and reporting sex differences in published research.”