Study Finds Premenopausal Women Demonstrate Better Long-Term
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Premenopausal women have good long-term outcomes after a heart attack, according to late-breaking research presented at ESC Congress 2020, The Italian Genetic Study on Early-onset Myocardial Infarction compared outcomes of women and men under 45 who had a heart attack. The study included 2,000 patients (1,778 men and 222 women) who presented to the hospital with a heart attack before the age of 45. The primary endpoint was a composite of recurrent heart attack, stroke, or death from cardiovascular disease.

During a median follow-up of 20 years, the primary composite endpoint occurred in 25.7% of women compared to 37.0% of men. When the components of the primary endpoint were analyzed separately, the researchers found that second heart attacks were less frequent in women compared to men. However, women were more likely to have a stroke compared to men. Smoking, alcohol consumption, high blood lipids, and diabetes were more frequent in men compared to women.

Researchers said the better prognosis in premenopausal women compared to men was likely related to different mechanisms behind the heart attacks. Women were more than twice as likely to have healthy arteries than men, but coronary artery dissection (a tear in a blood vessel supplying the heart) was more frequent in women.

They said: "In men, coronary events were mostly due to blocked arteries, while in women they had other causes such as coronary dissection which is known to have a more favorable prognosis and a lower risk of recurrence."

At discharge from hospital, men were more likely than women to be prescribed medications to protect against second heart attacks, including beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The likelihood of statin treatment was similar in men and women."

They concluded: "In contrast to the prevailing literature, women experiencing an early-onset heart attack have favorable long-term outcomes compared to men, despite being prescribed fewer preventive medications."