PROGNOSIS AFTER THE ONSET OF CORONARY HEART-DISEASE - AN INVESTIGATION OF DIFFERENCES IN OUTCOME BETWEEN THE SEXES ACCORDING TO INITIAL CORONARY-DISEASE PRESENTATION

Citation
Jm. Murabito et al., PROGNOSIS AFTER THE ONSET OF CORONARY HEART-DISEASE - AN INVESTIGATION OF DIFFERENCES IN OUTCOME BETWEEN THE SEXES ACCORDING TO INITIAL CORONARY-DISEASE PRESENTATION, Circulation, 88(6), 1993, pp. 2548-2555
Citations number
37
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
88
Issue
6
Year of publication
1993
Pages
2548 - 2555
Database
ISI
SICI code
0009-7322(1993)88:6<2548:PATOOC>2.0.ZU;2-O
Abstract
Background. Differences exist between men and women in prognosis after the onset of coronary heart disease (CHD). Methods and Results. All F ramingham Heart Study subjects with the onset of clinically apparent c oronary disease from 1951 through 1986 were studied to compare prognos is in men and women according to CHD presentation. Coronary disease pr esentations included angina, coronary insufficiency (unstable angina), recognized myocardial infarction, unrecognized myocardial infarction, and coronary death. Less than 1% of subjects were lost to follow-up f or overall mortality. Cox modeling was used to examine the sex differe nces in outcome far each coronary presentation. New nonfatal coronary disease developed in 750 men (mean age, 63 years) and 583 women (mean age, 67 years). After onset of angina, men were at greater risk than w omen for myocardial infarction (hazards ratio [IIR], 2.20; 95% confide nce interval [CI], 1.45 to 3.34) and coronary death (HR, 2.11; 95% CI, 1.32 to 3.36) after adjustment for age and coronary disease risk fact ors. After a recognized myocardial infarction, there was a trend towar d greater risk for overall mortality in women than men after adjustmen t for age and risk factors (HR, 0.75; 95% CI, 0.53 to 1.08). In contra st, after an unrecognized myocardial infarction, men were at increased risk for death compared with women (HR, 2.01; 95% CI, 1.28 to 3.15). Conclusions. Women fare at least as poorly as men alter recognized myo cardial infarction, whereas women have a more favorable outlook than m en after the onset of angina or unrecognized myocardial infarction. Th e favorable outcome in women after angina and unrecognized myocardial infarction is due, in part, to greater misclassification of these coro nary events in women than in men.