Original Investigation
Sex Differences in Incident and Recurrent Coronary Events and All-Cause Mortality

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Abstract

Background

Women have lower age-specific rates of incident coronary heart disease (CHD) than men. It is unclear whether women remain at lower risk for CHD events versus men following a myocardial infarction (MI).

Objectives

This study assessed sex differences in recurrent MI, recurrent CHD events, and mortality among patients with MI and compared these associations with sex differences in a control group without a history of CHD.

Methods

This study analyzed data for 171,897 women and 167,993 men age 21 years or older with health insurance in the United States who had a MI hospitalization in 2015 or 2016. Patients with a MI were frequency matched by age and calendar year to 687,588 women and 671,972 men without CHD. Beneficiaries were followed until December 2017 for MI, CHD (i.e., MI or coronary revascularization), and in Medicare for all-cause mortality.

Results

Age-standardized rates of MI per 1,000 person-years were 4.5 in women and 5.7 in men without CHD (hazard ratio [HR]: 0.64; 95% confidence interval [CI]: 0.62 to 0.67) and 60.2 in women and 59.8 in men with MI (HR: 0.94; 95% CI: 0.92 to 0.96). CHD rates in women versus men were 6.3 versus 10.7 among those without CHD (HR: 0.53; 95% CI: 0.51 to 0.54) and 84.5 versus 99.3 among those with MI (HR: 0.87; 95% CI: 0.85 to 0.89). All-cause mortality rates in women versus men were 63.7 versus 59.0 among those without CHD (HR: 0.72; 95% CI: 0.71 to 0.73) and 311.6 versus 284.5 among those with MI (HR: 0.90; 95% CI: 0.89 to 0.92).

Conclusions

The lower risk for MI, CHD, and all-cause mortality in women versus men is considerably attenuated following a MI.

Key Words

epidemiology
recurrent CHD
sex differences

Abbreviations and Acronyms

CHD
coronary heart disease
CI
confidence interval
CKD
chronic kidney disease
HR
hazard ratio
HF
heart failure
MI
myocardial infarction
PAD
peripheral artery disease
RAS
renin-angiotensin system

Cited by (0)

This work was funded by an industry/academic collaboration between Amgen Inc. and University of Alabama at Birmingham. Dr. Peters is supported by a UK Medical Research Council Skills Development Fellowship (MR/P014550/1). Dr. Woodward is supported by the National Health and Medical Research Foundation of Australia (1080206). Dr. Colantonio has received grant support from Amgen, Inc. Dr. Bittner has received grant support from Amgen, Inc., AstraZeneca, Bayer Healthcare, Dalcor, Esperion, Sanofi/Regeneron, and Novartis; and has received honoraria from Sanofi/Regeneron. Dr. Farkouh has received grant support from Amgen, Inc., Novartis, and Novo Nordisk. Dr. Rosenson has received research support through his institution from Amgen, Inc, The Medicines Company, Novartis, and Regeneron; has received honoraria from Amgen, Inc, C5, CVS Caremark, Corvidia, Kowa, The Medicines Company, Pfizer, and Regeneron; has received royalties from UpToDate, Inc.; and holds stock in MediMergent, LLC. Dr. Jackson has received research support from Amgen, Inc.; has served as a consultant for McKesson; has received royalties from UpToDate; and has served as an expert witness for DeBlase Brown Everly LLP. Dr. Dluzniewski holds stock in Amgen, Inc. Dr. Muntner has received grant support from Amgen, Inc. Dr. Woodward has received consulting fees from Amgen, Inc. and Kyowa Kirin Co., Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Nanette K. Wenger, MD, served as Guest Associate Editor for this paper. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

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