Long-term outcome of myocardial infarction in women and men: a population perspective.
Because of women's survival advantage, the impact of myocardial infarction (MI) on long-term mortality in women compared with men may be underestimated. The authors examined this issue in a community sample of 2,462 persons aged > or = 65 years living in New Haven, Connecticut, who were free of MI at baseline and were followed for 10 years (1982-1992). By using proportional hazards models with MI hospitalizations and the sex-MI interaction as time-dependent covariables, survival for the MI cases from the date of MI was compared with survival of persons who, at the same follow-up time, were still alive and free of MI. Women survived longer than men mainly in the absence of MI. The multivariable-adjusted hazard ratios of death were 0.53 in the absence and 0.87 in the presence of MI, and MI was associated with a greater risk of death in women (adjusted hazard ratio = 5.9) than in men (adjusted hazard ratio = 3.6) (p = 0.01 for the sex-MI interaction). When out-of-hospital fatal infarctions were considered, the impact of MI on survival in women compared with men increased. In conclusion, in this elderly cohort, when viewed from a population perspective, MI had a greater impact on mortality in women and significantly narrowed women's typical survival advantage over men.
Vaccarino
V
V
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA. viola.vaccarino@yale.edu
Berkman
L F
LF
Krumholz
H M
HM
D000368:Aged; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data