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Sex disparities after heart attack

Researchers are trying to understand why younger women have worse outcomes after a heart attack than men. rocketclips / Adobe Stock

Each year in the U.S., about 40,000 women ages 55 or younger have a heart attack. Previous research has found that these young women face about twice the risk of in-hospital death from heart attack as similarly aged men. Younger women also have higher rehospitalization rates after discharge. But why isn’t well understood. 

To learn more, Dr. Harlan M. Krumholz and colleagues at Yale University analyzed data on nearly 3,000 participants in the NIH-supported VIRGO study. This multicenter study gathers information on risk factors and outcomes among people who have had a heart attack.

The research team’s analysis included data on more than 2,000 women and nearly 1,000 men who had been discharged from a hospital after a heart attack. Participants were between ages 18 and 55, with an average age of 47. They were from ethnically and racially diverse backgrounds. Results were published in the Journal of the American College of Cardiology on May 9, 2023.

The team found that nearly one-third of all participants were rehospitalized in the year after leaving the hospital. Most repeat hospitalizations occurred within a month after discharge, and then the rate slowly declined. Women had 1.65 times the risk of repeat hospitalization compared to men.

Coronary-related complications were the leading cause of repeat hospitalizations for both women and men. The rate of coronary-related complications was nearly 1.5 times higher for women than for men. Risk factors like obesity and diabetes may have been key drivers of this increased coronary risk for women.

The sex disparities were greatest, however, among participants who were rehospitalized for reasons not tied to heart disease or stroke. Women were more than twice as likely as men to be rehospitalized for conditions like digestive problems, depression, and pneumonia. 

At the start of the study, more women than men identified as having low-income (48% vs. 31%) or a history of depression (49% vs. 24%). Low income is often linked to poor health status and limited access to care. And the risk for depression is known to rise after a heart attack, which may increase the risk for repeat hospitalization. Further research is needed to clarify the factors that lead to poorer outcomes for young women after a heart attack in order to develop better prevention strategies.

“We have shown for the first time that rehospitalizations following heart attacks in women aged 55 and younger are accompanied by certain non-cardiac factors, such as depression and low-income, that appear more common in women than men and are associated with more adverse outcomes,” Krumholz says. “The study reveals a need for paying greater attention to these non-cardiac risk factors in younger women in order to help design better clinical interventions and improve outcomes after discharge for a heart attack.”

*Editor’s note: text in the first bullet, third, and fifth paragraphs was adjusted soon after publication to correct inaccuracies.