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January 2009 Issue

Laura Wexler, MD, professor of medicine in the cardiovascular diseases division at UC.
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Women Less Likely to Survive Massive Heart Attacks

By Katie Pence
Published January 2009

Coronary heart disease, which causes heart attacks, is the leading cause of death for American women. Now, a new study coauthored by a UC researcher examines why this may be the case—especially in U.S. hospitals.

The study, based on data collected at a large number of hospitals nationwide, shows that women hospitalized with heart attacks are more likely to die than men if they suffer a massive heart attack.

The results were published in the Dec. 8, 2008, issue of the journal Circulation.

Overall, women survive heart attacks about as well as men when they are under a hospital’s care, but the study found that a gender gap remains when women have a more serious type of heart attack.

The data was collected from 420 hospitals enrolled in an American Heart Association (AHA) program called “Get With the Guidelines,” aimed at encouraging doctors to follow evidence-based regimens for treating heart attack patients. Data was recorded in a registry.

Laura Wexler, MD, coauthor of the study and professor of medicine in the cardiovascular diseases division at UC, says there has been a gap between advancements in treatment and the actual use of these treatments on patients.

“As physicians and hospitals develop programs such as ‘Get With the Guidelines’ to disseminate important advances in therapy, it is important to examine carefully whether all groups of patients are benefiting to the same extent,” Wexler says.

The study examined treatment in 78,254 heart attack cases to see if guidelines were followed and compared both the treatment and the outcomes in men and women. Data showed that approximately the same number of men and women who experienced heart attacks died in the hospital.

However, there was a difference when a more serious kind of heart attack involving total artery blockage and more extensive damage occurred. The analysis showed that 10 percent of women with massive heart attacks died in the hospital compared to about 6 percent of men.

After matching the groups of male and female patients for age and other clinical conditions that might affect prognosis, researchers found that the women were 12 percent more likely to die of a major heart attack in the hospital than men.

The study also showed that women were less likely to get recommended medicines—like aspirin—and they were less likely to get invasive treatment to restore blood flow, or it wasn’t given as quickly to women as it was to men.

Wexler says further research is needed to identify why women with severe heart attacks were more likely to die than men.

“It is not clear from this data whether differences in treatment or timeliness of treatment account for these differences or whether there is something fundamentally different—and more dangerous—about heart attacks in women,” she says.

However, she adds, it is important for all patients to receive the best available treatment, regardless of gender.

“It’s very important for the public to dismiss the idea that heart attacks are predominantly a problem in men,” she says. “Heart disease remains the leading cause of death in women and, as this study shows, may be more lethal in women than in men.”

The research was funded by the AHA.

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