Study Finds That Heart Attack in Younger Women Needs Increased Focus

May 28, 2014—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that new data suggest that younger women may not have benefited as much as other patients from the advances in the survival rate from heart attack and the overall decline in heart attacks as much as other patients. Heart attack rates in women under age 55 have changed very little in recent years. In addition, women who experience a heart attack are far less likely than men to be treated with percutaneous coronary intervention (PCI) or heart bypass surgery, and they are far more likely to face serious health problems, including stroke, as well as death, according to a study reported by Luke Kim, MD, at the SCAI 2014 scientific sessions in Las Vegas, Nevada.

“We know that it’s harder to recognize the signs of heart attack in women and that women tend to receive less aggressive treatment than men,” commented Dr. Kim in the SCAI press release. “What’s troubling is that we still aren’t doing as great a job of preventing heart attack in younger women. This is especially important, since they have worse clinical outcomes.” Dr. Kim is an assistant professor of medicine at Weill Cornell Medical College in New York, New York.

As summarized in the SCAI announcement, Dr. Kim and his colleagues analyzed data on 13,009 women and 42,444 men under the age of 55 who were hospitalized for a heart attack from 2007 to 2011. They drew their information from the Nationwide Inpatient Sample database, the largest collection in the United States of data on hospital admissions covered by all types of health insurance coverage.

The investigators observed a slight decline in the number of heart attacks among younger women between 2007 and 2009 (from 3,435 to 3,163), but little change after that, with a total of 2,988 in 2011. By comparison, the number of heart attacks in women over age 55 declined from 20,150 in 2007 to 15,419 in 2011. In men over age 55, the number of heart attacks dropped from 26,562 to 23,571 during that same period.

The investigators also reported that women had more pre-existing health problems than men, including diabetes, high blood pressure, kidney disease, peripheral vascular disease, congestive heart failure, and obesity. Women were more likely than men to have non–ST-segment elevation myocardial infarction (non-STEMI). Patients with STEMI would be treated more urgently than non-STEMI. Women also were more likely to develop shock as a complication.

There were also disparities in the treatment of heart attack. Among men, approximately 55% underwent PCI and 8.4% had bypass surgery. By comparison, approximately 30% of women had PCI and 5.8% had bypass surgery. When women were treated with either revascularization procedure, they did not fare as well as men. The investigators found that the risk of death was 10% higher among women; the risk of stroke, 31% higher; the risk of excessive bleeding, 30% higher; and the risk of vascular complications, 33% higher.

Dr. Kim concluded that one key message from this study is the importance of avoiding heart attacks in younger women, perhaps by thinking beyond traditional risk factors during diagnosis and being more committed to initiating preventive therapies. “It may be that we’re still treating men and older people more aggressively with preventive medical therapy than we are younger women. We need to improve our efforts. We have more work to do in order to optimize outcomes in this group of patients,” stated Dr. Kim.