Author + information
- Received June 3, 2020
- Revision received July 31, 2020
- Accepted August 12, 2020
- Published online October 5, 2020.
- Sanne A.E. Peters, PhDa,b,c,∗ (, )@saepeters,
- Lisandro D. Colantonio, MD, PhDd,
- Ligong Chen, PhDd,
- Vera Bittner, MD, MSPHe,
- Michael E. Farkouh, MD, MScf,
- Robert S. Rosenson, MDg,
- Elizabeth A. Jackson, MD, MPHe,
- Paul Dluzniewski, PhDh,
- Bharat Poudel, MSPHd,
- Paul Muntner, PhDd and
- Mark Woodward, PhDa,c,i
- aThe George Institute for Global Health, Imperial College London, London, United Kingdom
- bJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- cThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- dDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- eDivision of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- fPeter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
- gMount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
- hCenter for Observational Research, Amgen Inc., Thousand Oaks, California
- iDepartment of Epidemiology, Johns Hopkins University, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Sanne A.E. Peters, Julius Center for Health Sciences and Primary Care, Stratenum 6.131, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
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.
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.
- Received June 3, 2020.
- Revision received July 31, 2020.
- Accepted August 12, 2020.
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.