Women Under Age 60 Have Higher Mortality Rates than Men In the Two Years Following a Heart Attack

Yale School of Medicine
Friday, 2 March 2001

Women under the age of 60 have a higher risk of dying than men under 60 in the two years after they suffer a heart attack, a study by a Yale researcher and collaborators shows.

These sex-based differences in mortality rates are independent of the severity of the heart attack and other health problems, the authors said in the article published in a recent issue of the Annals of Internal Medicine.

"Non-biological factors may be implicated," the authors said. "These factors include behavioral, psychosocial, and social factors such as continuing to smoke, social isolation, emotional stress and depression that may adversely impact women more than men and influence their survival rates following a heart attack."

The study looked at 6,826 patients at 16 community hospitals serving the Worcester, Mass., area who were hospitalized with myocardial infarction between 1975 and 1995. Their outcomes were measured two years after they were discharged from the hospital.

The overall two-year mortality rate was higher in women, 28.9 percent, than in men, 19.6 percent. When patients were examined by age group, only women younger than 60 years old had a higher mortality rate than men of similar age.

Harlan Krumholz, M.D., a co-author and associate professor of internal medicine and cardiology at Yale School of Medicine, said the researchers were unable to determine why the younger women had a worse outcome. Interestingly, the same study showed that men over the age of 79 had a higher mortality rate than women two years following a heart attack.

"The findings do indicate how important it is that women who have heart attacks receive comprehensive evaluation and treatment for all of the risk factors to avoid a future event," Krumholz said.

He said the study builds on earlier research at Yale showing that younger women have a higher rate of mortality during hospitalization for a heart attack compared with men of comparable age.

"In this study we looked at how the men and women would do over the two years following a heart attack among those who survived the initial hospitalization. There was some expectation that women would do better because we thought that those who survived the hospitalization may have been healthier than the men because fewer women made it out of the hospital in the first place. The next challenge is to understand why these differences exist and if there is anything we can do to reduce risk for younger women," Krumholz said.

The lead author of the study was Viola Vaccarino, M.D., formerly of Yale and now at Emory University School of Medicine in Atlanta. In addition to Krumholz, co-authors included Jorge Yarzebski, M.D., Joel Gore, M.D., and Robert Goldberg, all of the University of Massachusetts Medical Center in Worcester.

For more information, or to contact Yale School of Medicine, see their website at: info.med.yale.edu/ysm/