Women More Than Twice as Likely to Die After Heart Attack Than Men, Study Finds

Fact checked by Nick Blackmer

• Woman may be more likely to die after a heart attack than men, new research shows.

• The findings suggest that women may need additional monitoring and check-ins after a cardiac event to remain well.

• Heart disease is the leading cause of death among women in the United States.

Women may be more than twice as likely to die after having a heart attack, compared to men, new research shows—important findings as heart disease is the leading cause of death among women in the United States.

The new study, presented at Heart Failure 2023, a scientific congress of the European Society of Cardiology, found that women admitted the hospital for a heart attack had a higher likelihood of adverse outcomes—including death and future cardiovascular events—than men of similar ages.

“Generally, women have a lower risk of cardiovascular events than men,” study author Mariana Martinho, MD, a cardiologist at Hospital Garcia de Orta in Portugal, told Health. “But when they do have a myocardial infarction, which is generally known as a heart attack, they are at a higher risk of developing future events and dying from the disease.”

The findings suggest that women may need additional monitoring and medical check-ins after a cardiac event to remain well.

“These women need regular monitoring after their heart event, with strict control of blood pressure, cholesterol levels and diabetes, and referral to cardiac rehabilitation,” Dr. Martinho said in a press release. “Smoking levels are rising in young women and this should be tackled, along with promoting physical activity and healthy living.”

Women More Likely to Die Following Heart Attack

For the study, researchers compared short– and long–term outcomes following ST-elevation myocardial infarction (STEMI)—a type of heart attack in which a coronary artery is completely blocked—in both men and women to determine sex differences.

The retrospective observational study included 884 patients admitted to the hospital with STEMI, and treated with percutaneous coronary intervention (PCI) between 2010 and 2015. The researchers identified adverse outcomes, which included 30-day all-cause mortality, five-year all cause mortality, and five-year major adverse cardiovascular events.

Percutaneous coronary intervention (PCI) is a nonsurgical procedure in which a stent is placed in a blocked artery in order to improve blood flow.

Among all 884 patients, the average age was 62, and 27% of patients were women. Women were also older than men, and had higher rates of hypertension, diabetes, and prior stroke—men, however, were likelier to be smokers and have coronary artery disease.

After adjusting for those risk risk factors and health conditions, researchers discovered women had worse short– and long–term outcomes, as well as additional cardiovascular events following a heart attack.

At the 30-day follow-up, 11.8% of women had died following a heart attack, compared to 4.6% of men. At five years, 32.1% of women had died, compared to 16.9% of men; and 34.2% of women had suffered an additional cardiovascular event, compared to 19.8% of men.

“Women had a two to three times higher likelihood of adverse outcomes than men in the short- and long-term even after adjusting for other conditions and despite receiving PCI within the same timeframe as men,” Dr. Martinho said in a press release.

For the same study, researchers conducted an additional analysis by matching men and women according to risk factors for cardiovascular disease, and then comparing adverse outcomes for men and women ages 55 and older, and ages 55 and under.

In that analysis, women were still more likely to die following a heart attack or have an additional adverse cardiovascular event.

Postmenopausal women (55 years and older) had higher rates of 30-day mortality, five-year mortality, and five-year major adverse cardiovascular events. Among premenopausal women (55 years and under), women were nearly four times more likely to have an additional major cardiovascular event compared to men, though no differences were found in all-cause mortality at 30 days or five years.

“Postmenopausal women had worse short- and long-term outcomes after myocardial infarction than men of similar age. Premenopausal women had similar short-term mortality but a poorer prognosis in the long-term compared with their male counterparts,” Dr. Martinho said in the press release. “While our study did not examine the reasons for these differences, atypical symptoms of myocardial infarction in women and genetic predisposition may play a role.”

Related: Heart Attack Symptoms Women Shouldn't Ignore

Greater Awareness Needed for Heart Disease in Women

The new study is far from the first to highlight the gender disparities in cardiovascular disease outcomes.

“I am disappointed that this most recent study is still showing what we’ve seen over and over,” Holly S. Andersen, MD, attending cardiologist and associate professor of clinical medicine at the New York-Presbyterian Hospital, Weill Cornell Medical Center, told Health. “Once a woman gets diagnosed with heart disease, she will do worse and be more likely to die from it than a man.”

For example, a 2020 study published in the journal Circulation, examined data from more than 45,000 first-time heart attack patients to determine any differences between sexes, and found that women had a higher risk than men of dying or developing heart failure in the five years after a heart attack. Additionally, a 2017 study found that women had a significantly higher risk of dying in the first year after a heart attack, compared to men.

“The increased mortality in women following heart attacks has been shown in other prior studies and it is a concern that it continues to be demonstrated in studies like this,” Laxmi Mehta, MD, a cardiologist at The Ohio State University Wexner Medical Center, told Health.

“In the past, it was shown that women had worse outcomes due to their older age and other risk factors compared to men,” Dr. Mehta continued. “Interestingly in [the new study], even after they adjusted for risk factors like diabetes, hypertension, high cholesterol, prior stroke—women still fared worse than men.”

Though more research is needed to understand why there’s a gender disparity in cardiovascular outcomes, experts say that a lack of awareness for heart disease symptoms and risk factors among women may be at least partially to blame.

“The perception of heart disease is that it’s a man’s disease,” Nicole Weinberg, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California, told Health.

“The more I talk to women, they say they’re seeing doctors but they’re looking for the big, bad stuff and not small, insidious things,” Dr. Weinberg added. “Women spend a lot more time making sure they don’t get breast cancer instead of treating their cholesterol and blood sugar issues.”

Women may also be more likely to dismiss early symptoms of heart events as being due to something less serious. “Women may present later to their medical providers for ongoing or nonspecific symptoms,” Laura Franey, MD, a cardiologist at Corewell Health, told Health, adding that heart testing and screening may also be limited for women.

Overall, “identifying gender-specific causes for poorer heart outcomes in females has been limited,” Dr. Franey said. “More studies are needed to determine why, despite improving outcomes in men, we are not seeing similar outcomes in women.”

But Dr. Franey pointed out that “identifying gender specific causes for poorer heart outcomes in females has been limited,” adding that “more studies are needed to determine why, despite improving outcomes in men, we are not seeing similar outcomes in women.”

Related: Study: Insomnia Linked to Increased Risk of Heart Attack, Especially for Women

How Women Can Protect Their Heart Health

As researchers continue trying to uncover the reasons behind the gender disparity for cardiovascular outcomes, women can take steps to boost their personal awareness of heart disease and support their heart health.

“Patients should be aware of myocardial infarction symptoms and seek emergent medical assistance when this happens,” Dr. Martinho said.

The symptoms of a heart attack can look different in women compared to men. “Women are more likely to have symptoms other than chest pain than are men,” Dr. Andersen said. “They may feel arm, jaw, or back pain, a feeling of indigestion, become weak, sweaty, or lightheaded. Most know something is wrong.”

But women also need to recognize and take action on those symptoms to get timely help. “Women are less likely to act on their symptoms,” Dr. Andersen added. “Even if they believe they are having a heart attack, they will wait longer before acting on it.”

Experts stress however, that preventing cardiovascular disease is the first step: “Prevention is key,” Dr. Weinberg said. “There’s so much more you can do for your body when you’re preventing a disease process. Once you have it, it becomes more of a sticky situation.”

“As with men, [women] should try to keep a healthy lifestyle, which includes regular physical activity and a low-fat diet, in order to prevent the development of major cardiovascular diseases such hypertension, obesity, diabetes, or high cholesterol,” Dr. Martinho said. Avoiding smoking is also important, she added.

And if a woman suffers a heart attack or cardiovascular event, she may need additional monitoring. “[Women should] be followed and treated aggressively with strict control of blood pressure, cholesterol, and sugar levels,” Dr. Andersen said, adding that they also should be referred to cardiac rehab center and encouraged to actually go.

Despite having this information on women and heart health, much more needs to happen to make sure lives are saved.

“Women’s heart disease remains under-researched, under-diagnosed, and under-treated,” Dr. Andersen said. “We need to study women’s heart disease as it is often different than men’s. We need practitioners to know women are at a higher risk and to monitor and treat them aggressively. And we need to make women aware of their risk so they can practice prevention, act on symptoms and be their own advocate for care.”

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Read the original article on Health.