New research finds that the gender gap has narrowed when it comes to heart attack, though not all the changes are good news for women. Historically, women younger than 55 are at a lower risk for heart attack than men of the same age. While younger women are less likely to suffer a heart attack, when they do have one they experience worse outcomes and have a higher risk of dying than their male counterparts.
Evidence from two new studies, published October 26, 2009 in the Archives of Internal Medicine, suggests that both aspects of the gender gap for heart attack appear to have narrowed in recent years.
Heart Attack Rates Up
The first study examined how heart attack rates in women and men have changed over time. The researchers surveyed more than 4000 patients (half of them women) aged 35 to 54 as part of the National Health and Nutrition Examination Survey. The study examined people during two periods (1988-1994 and 1999-2004).
Over time, the heart attack rate in men went down, from 2.5% to 2.2%. In women, the heart attack rate actually increased: only 0.7% of women in the earlier group suffered a heart attack, compared with 1% in the later group. While younger women are still less likely than men to suffer a heart attack, this trend is alarming.
Why the increase in women but not in men? The researchers found that the difference could be explained by heart disease risk factors. Over time, men had better blood pressure control and lower smoking rates, while these improvements were not seen in women. The only risk factor that improved in women was HDL ("good") cholesterol. Diabetes, a major heart disease risk factor, increased in both women and men, probably because of the rising prevalence of obesity.
Survival after a Heart Attack Improved
Another study looked at how men and women's outcomes after a heart attack have changed over time. Researchers looked at a national registry of patients who had a heart attack between 1994 and 2006, totaling nearly 1 million cases (40% were women).
Death rates for both women and men went down over time, thanks to advances in heart attack treatment and better management of heart disease risk factors. However, women (especially younger women) experienced greater improvements than men. In people younger than 55, the chances of dying after a heart attack went down by 53% in women compared with 33% in men. As patients got older, the difference in improvement between men and women got progressively smaller.
Although younger women are still about 30% more likely than men to die after a heart attack, this study shows that the gender gap has narrowed significantly over the years. Part of this was because treatments to open blocked arteries, such as angioplasty and stents, have become more common in women. These treatments can prevent heart attacks and make ones that do happen less deadly.
Lessons for Women
Although better outcomes for women after a heart attack is encouraging, the best way to improve survival is to prevent a heart attack in the first place. As evidenced by these recent studies, there is still room for improvement in recognizing and treating heart disease risk factors in women.
Some of the differences in risk factor control between men and women are caused by unconscious bias on the part of healthcare providers, who may underestimate a woman's heart risk and not treat her risk factors as aggressively. However, women themselves are also responsible for taking an active role in their heart health. This starts with knowing your heart risk (calculate your risk here) and educating yourself about your risk factors. From there, you can work with your doctor to get your risk factors under control.
Some basic things you can do to reduce your risk of heart attack:
- Eat a heart healthy diet, with plenty of fruits and vegetables and low cholesterol and saturated fat
- Get regular exercise, at least 30 minutes a day most days each week
- If you smoke, quit
- Know your blood pressure and cholesterol numbers and work with your doctor to get them under control
Towfighi A, Zheng L, Ovbiagele B. Sex-specific trends in midlife coronary heart disease risk and prevalence. Arch Intern Med. 2009;169:1762
Vaccarino V, Parsons L et al. Sex differences in mortality after acute myocardial infarction: changes from 1994 to 2006. Arch Intern Med. 2009; 169:1767