Mortality

Graph from the American Heart Assoctiation

The Mortality Rate of Women who Present With CVD is Often Higher than Men

In one study, the mortality rate for women over a 2-year period after hospital discharge was 28.9% in women, and 19.6% in men. The authors concluded that young women who survive hospitalization for myocardial infarction have a higher long-term mortality rate than men; providing “…additional evidence that younger women with myocardial infarction are at greater risk for death than men.”
In another study, authors found that “younger women undergoing CABG surgery are at a higher risk of in-hospital death than men.”

Despite improvements in myocardial protection and advances in surgical technique, sex differences in in-hospital mortality after CABG have persisted and have been notably consistent over the past 20 years. On average, in-hospital mortality is 2 times higher in women in comparison with men, and stratification according to age reveals a more pronounced difference in younger women. In addition, women have a higher incidence of periprocedural morbid events, such as stroke and bleeding, in comparison with men. Despite similar procedural success rates, albeit higher vascular and bleeding complication rates in women, in-hospital mortality also remains higher in women than in men.

Better Understanding of the Biological Factors
Underlying the Higher Female Mortality Rate is Needed

For patients undergoing CABG, congestive heart failure has been shown to account for the excess mortality in women, and congestive heart failure is an independent predictor of mortality in both women and men in revascularization studies. Compelling evidence implicates a higher incidence of hypertensive heart disease, a steeper pressure-volume relationship, and more diastolic dysfunction in women in comparison with men and is supported by reports of sex differences in molecular remodeling in pressure overload hypertrophy and in cardiac adaptation to isolated systolic hypertension. These studies have suggested that the risks for mortality during surgery are higher in women than they are in men, a difference probably due to heart and vessel size and not gender. Although mortality remains higher in women, much of the excess is due to inherent sex differences at baseline, and the remainder is perhaps due to our inability to accurately and completely account for biological factors specific to women.

References