Yale Bulletin and Calendar

August 23-30, 1999

Volume 28, Number 1

Women under 50 at greater risk of dying
from heart attacks than are men

Women under age 50 are twice as likely to die after a heart attack than men of the same age, according to a new Yale study.

The study, which analyzed data from the National Registry of Myocardial Infarction 2 (NRMI 2), was published in the July 22 issue of the New England Journal of Medicine. NRMI is a multi-center, multi-phase, observational heart attack program sponsored by Genentech, Inc.

The evaluation team was headed by Dr. Viola Vaccarino, assistant professor in the department of epidemiology and public health at the School of Medicine.

The researchers examined data collected from 384,878 patients -- 155,565 women and 229,313 men -- enrolled in NRMI 2 at 1,658 hospitals across the United States.

"Our Þndings clearly demonstrate that younger women who suffer heart attacks represent a distinct group of patients deserving special attention in terms of diagnosis and treatment," said Vaccarino.

Overall, female patients enrolled in the study were older then men, and thus hospital mortality was higher in this group (16.7 percent versus 11.5 percent).

However, when examined in speciÞc age groups, investigators found that gender differences in mortality signiÞcantly differed according to age. For every Þve-year decrease beginning at age 75, death rates for women increased by 11 percent as compared to men -- that is, the younger the age group, the higher the death rate for women than for men. Adjustments for medical history, comorbidity, clinical severity of the heart attack and early treatment intervention between the two groups only explained about one-third of the higher mortality in younger women relative to men, according to the researchers.

The investigators also observed that women at younger ages consistently are less likely to be admitted with a diagnosis of suspected heart attack and administered life-saving reperfusion (artery-opening) therapies. Although these Þndings may be explained by sex differences in the way women experience heart attack symptoms, they are consistent with previous studies demonstrating that women are treated less aggressively for a heart attack than men, note the researchers.

"This data suggests that the female gender may play a role in short-term mortality after heart attack, particularly among younger patients, making it difÞcult to diagnose and treat this patient population," says Vaccarino. However, she adds, since heart disease may be more difficult to diagnose in women, there should be more emphasis on developing diagnostic techniques and prognostic indicators for the early stages of this disease in the female population.

Coronary heart disease (CHD) is caused by narrowing or blockage of the coronary arteries, which often leads to heart attack. Each year, more than 1.1 million Americans -- 668,000 men and 439,000 women--suffer a heart attack; nearly half will die. According to the American Heart Association, heart attack is the number one killer of women over the age of 35. Because women may experience heart attack symptoms differently than men, they tend to wait several hours before seeking immediate medical attention.

The National Registry of Myocardial Infarction 2, which enrolled patients from June 1994 through March 1998, was designed to evaluate the presentation, treatment and outcome patterns of heart attack patients, and to examine patient risk factors related to outcomes and utilization of hospital resources.

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