A study in the European Heart Journal explores sex-based differences among nearly 3,000 adults ages 50 and younger who had a first-time heart attack. Patient registries from Brigham and Women’s Hospital and Massachusetts General Hospital in Boston were used for the study and included 404 women and 1,693 men. In-hospital mortality rates and post-hospital cardiovascular-related deaths, such as stroke or heart failure, were similar for men and women a decade after their first heart attack. However, more women died overall.
Heart attack risks varied. Diabetes, rheumatological conditions, and depression were higher in women. Elevated cholesterol levels and illegal substance use were higher in men. High blood pressure, obesity, and a family history of heart disease were similar between the sexes. More women used public insurance and had a smaller median income.
During the heart attack, most men and women experienced chest pain. Women were more likely to experience a racing heart, fatigue, and shortness of breath. More men had a large rupture or clot blocking blood flow in a main artery near their heart, which caused the heart attack. Women were less likely to have this type of plaque accumulation and obstruction. Instead, they had higher rates of single blood vessel blockages, microvascular dysfunction, coronary artery spasms, or spontaneous coronary artery tears.
With the exception of main artery blockages, women were also less likely to have invasive coronary angiographies, a catherization that enables doctors to see a blocked artery, and interventional procedures, such as a graft or stent to redirect blood flow. More men left the hospital with guideline-directed therapies, including aspirin, beta-blockers, ACE inhibitors, or statins. Arteries affected, medical insurance use, patient preferences, and gender biases likely explain some differences. However, more research is needed to study variations in treatment and overall mortality rates following a first-time heart attack in young adults.