This transcript has been edited for clarity.
This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you about some worrisome findings from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. This study was recently published in the Journal of the American College of Cardiology by investigators at Yale.
The findings can be viewed as a call to action for more attention to the needs of this high-risk patient population of young women with acute myocardial infarction (AMI). We've known for a long time that younger women (< age 55) who are hospitalized for AMI tend to have higher in-hospital mortality rates than men with AMI of similar ages. However, we haven't known the outcomes after discharge or had a good understanding of rates of readmission after discharge.
This study included about 3000 patients (ages 18-55) who were admitted for AMI to 103 US hospitals. They looked at sex differences in rates of coronary and noncoronary hospitalizations and admissions over the subsequent year after discharge. They found that women had significantly higher rates of both — a 33% higher risk for cardiac hospitalization and 51% higher rate of noncardiac hospitalization.
Why would this be? The investigators considered several possible explanations. One was the risk factor status of the women when they were hospitalized for the index AMI. They found that these women tended to have a higher prevalence of comorbidities and risk factors; they were more likely to have hypertension, high BMI, COPD, or a history of stroke. They also found that women were more likely to have certain socioeconomic factors and social determinants of health associated with more adverse outcomes, including low income, being twice as likely to self-identify as non-Hispanic Black, and a higher prevalence or history of depression.
At the time of discharge, the investigators looked at the rate at which guideline-directed medical therapies were being prescribed, and they found significant disparities. Women were significantly less likely to receive guideline-recommended therapies such as statins, aspirin, beta-blockers, ACE inhibitors, or ARBs. There were several possible explanations for these poor outcomes, suggesting that this is a very complex issue that needs to be addressed from a number of angles.
One angle is primordial and primary prevention. Women need to understand that they are at risk for heart disease, as are men. This is not just a men's disease. We need to do more to increase awareness of heart disease as a health threat to women — even young women — and manage risk factors well to prevent AMI.
But also, it is tremendously important that we eliminate these disparities in recommendations for guideline-directed care, such as statins and aspirin, with no differences between men and women. A lot can be done in that area. But it also suggests that more needs to be done in terms of addressing psychosocial issues and social determinants of health. Dr Martha Gulati wrote an editorial emphasizing that this problem will require attention in at least three areas: individual risk factors, healthcare policies and healthcare system–related factors, as well as healthcare and public policy. We need to pay more attention to these issues to make real progress in this area.
Thank you so much for your attention. This is JoAnn Manson.
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Cite this: Young Women With Acute MI: Worse Outcomes Than Men - Medscape - May 09, 2023.
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