title: Ethnic variations in female vulnerability after an acute coronary event.
abstract: OBJECTIVE
  To determine the ethnic variation of short and long term female vulnerability after an acute coronary event in a population of Chinese, Indians, and Malays.
  
  
  METHODS
  Population based registry.
  
  
  METHODS
  Residents of Singapore between the ages of 20-64 years with coronary events. Case identification and classification procedures were modified from the MONICA (monitoring trends and determinants in cardiovascular disease) project.
  
  
  METHODS
  Adjusted 28 day case fatality and long term mortality.
  
  
  RESULTS
  From 1991 to 1999, there were 16 320 acute coronary events, including 3497 women. Age adjusted 28 day case fatality was greater in women (51.5% v 38.6%, p < 0.001), with a larger sex difference evident among younger Malay patients. This inequality between the sexes was observed in both the pre-hospitalisation and post-admission periods. Among hospitalised patients, women were older, were less likely to have suffered from a previous Q wave or anterior wall myocardial infarction, and had lower peak creatine kinase concentrations. Case fatality was higher among women, with adjusted hazard ratios of 1.64 (95% confidence interval (CI) 1.43 to 1.88) and 1.50 (95% CI 1.37 to 1.64) for 28 day and mean four year follow up periods. There were significant interactions of sex and age with ethnic group (p = 0.017). The adjusted hazards for mortality among Chinese, Indian, and Malay women versus men were 1.30, 1.71, and 1.96, respectively. The excess mortality among women diminished with age.
  
  
  CONCLUSIONS
  In this multiethnic population, both pre-hospitalisation and post-admission case fatality rates were substantially higher among women. The sex discrepancy in long term mortality was greatest among Malays and in the younger age groups.
authors.affiliation: Department of Cardiology, National Heart Centre, Singapore. mak_koon_hou@nhc.com.sg
authors.forename: K H
authors.initials: KH
authors.lastname: Mak
authors.forename: J D
authors.initials: JD
authors.lastname: Kark
authors.forename: K S
authors.initials: KS
authors.lastname: Chia
authors.forename: L L
authors.initials: LL
authors.lastname: Sim
authors.forename: B H
authors.initials: BH
authors.lastname: Foong
authors.forename: Z P
authors.initials: ZP
authors.lastname: Ding
authors.forename: R
authors.initials: R
authors.lastname: Kam
authors.forename: S K
authors.initials: SK
authors.lastname: Chew
mesh_terms: D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D002681:China / Q000208:ethnology; D016001:Confidence Intervals; D005260:Female; D006760:Hospitalization; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000401:mortality; D011159:Population Surveillance / Q000379:methods; D017678:Sex Distribution; D012737:Sex Factors; D012846:Singapore / Q000453:epidemiology