Women experience more heart problems after heart attack

A new study from the American Heart Association (AHA) shows that women are at higher risk for fatal complications after surviving a heart attack compared to men.

Compared to men who’d had a heart attack, women may have a 20 percent higher risk of experiencing heart failure or death from a heart attack, according to the study, which published in Circulation Monday.

The women involved in the study had their first heart attack about 10 years after men, and they had higher involvement of comorbid conditions, which may have contributed to their heightened risk of heart failure.

It isn’t crystal clear why women’s risk is greater, but the researchers suspect it may be because women are less likely to routinely visit cardiologists and have lower rates of taking heart medications.

Furthermore, data on heart attacks has historically skewed toward men, and more research identifying the clinical differences in heart attacks in men versus women is needed to close the mortality gap.

The researchers evaluated the health data of over 45,000 patients who had been hospitalized for either a severe, life threatening heart attack (STEMI) or a less severe type of heart attack (NSTEMI).

The female participants were, on average, about a decade older than the male participants when they had their first attack.

They also had high rates of comorbidities thought to contribute to heart failure — such as diabetes, high blood pressure, and chronic obstructive pulmonary disease (COPD).

The patients were followed for approximately 6 years, between 2002 and 2016.

The researchers found that women had a 20 percent higher risk of developing heart failure or dying within 5 years of their first heart attack.

It’s worth noting that women, inherently, do not necessarily have an increased risk of developing comorbidities, but their health is typically affected more by the conditions, according to Dr. Roshini Malaney, a cardiologist at Staten Island University Hospital

Women also tend to be older when they have their first heart attack, which may contribute to their chances of having another health condition.

“The risk factors for heart failure as mentioned, including hypertension, diabetes, and atrial fibrillation, are all more prevalent as we get older,” explained Dr. Michael Goyfman, director of clinical cardiology at Long Island Jewish Forest Hills Hospital. “Since the women were older, that may have been an important reason for women’s higher likelihood of having these comorbidities.”

Another risk factor may be estrogen levels.

According to Malaney, estrogen helps keep blood vessels flexible and cholesterol levels healthy.

After menopause, estrogen levels drop, which can contribute to the development of high blood pressure.

The researchers suspect women had a higher risk, in part, because they were less likely to routinely follow up with a cardiovascular specialist.

Eighty-four percent of men saw a cardiologist compared to just 72.8 percent of women.

Furthermore, women were less likely to be prescribed heart medications like beta blockers or cholesterol-lowering drugs.

“Why was there a difference seen in STEMI patients? This may be explained by lack of management by cardiology specialists or lack of prescription of standard medications such as beta blockers and statins,” says Goyfman.

“The best way for women to improve their personal cardiac outcomes, particularly if they have already suffered from a heart attack, is to ensure close follow-up with a cardiologist,” Goyfman added.

Women also had lower rates of revascularization procedures, such as surgical angioplasty, which are done to improve blood flow.

Malaney says this is all likely due to a lack of awareness about the prevalence of cardiovascular issues in women.

survey from the AHA found that only half of women recognized heart disease as a leading cause of death in women. Other evidence has found women generally worry more about breast cancer than heart disease, and women’s cardiac symptoms are often attributed to other conditions, according to Malaney.

“This causes a missed opportunity to start the medications and discuss other changes that can decrease the risk of a heart attack,” Malaney said.

Additionally, much of the past knowledge we have on heart attacks is based on research conducted on middle-aged men.

Consequently, heart disease differences in men and women have historically been under-researched.

“[Another] cause could be the lack of education and knowledge of women’s symptoms, which means they could be ignored for a longer period of time and by the time the heart attack happens, there has been more damage done to the heart muscle,” says Malaney.

According to the new study, a lot of progress has been made in the past 15 years that has closed the mortality gap between men and women who’ve had heart attacks, but more work — in regard to treatment, diagnosis, access, and follow-up care — is needed to further close the gap.

Understanding why women are at a higher risk for heart failure can help doctors develop better approaches for preventing and treating subsequent cardiovascular issues.

Furthermore, educating women about the risk factors associated with heart failure can help many adopt healthy, preventative strategies years before a heart attack were to occur.

“Just like women are advised to get mammograms to screen for breast cancer starting at a young age, they should be educated to be assessed for their risk for heart disease at a young age,” Malaney said.

A new study from the AHA has found that women who’ve survived a heart attack may have a higher risk of heart failure compared to men.

Researchers say it’s unclear why women have an increased risk, but suspect it may be due to the fact that women are less likely to routinely see a cardiologist and take heart medications like statins and beta blockers.

Though a lot of progress has been made in recent years, more work related to access, diagnosis, and treatment is needed to close the cardiovascular mortality gap between men and women.

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