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Cardiovascular Disease: Prognosis

Clinical findings confirm differences in the prognosis for men and women with heart disease. It is reported that women have 56% excess risk for early mortality, following transmural MI[1]. One reason for worse prognosis of women is that they are more likely to receive in-patient care from physicians who are less likely to prescribe as many thrombolytics, beta-blockers, and aspirins as cardiologists would[2].

One possible explanation for the difference in prognosis after MI may be physiologically based; there is evidence that there may be increased haemodynamic load, higher relative wall thickness, and reduced subendocardial viability index in women and a combination of these elements may make women more vulnerable to ischemia and cardiac failure during cardiac stress (for example, post MI).[3]

Since age is a strong predictor of outcome in cardiovascular disease, studies have analyzed the age-gender interaction and prognosis of patients. The long-term treatments and outcomes for patients hospitalized with AMI in Ontario,was affected by the age of the patients, as physicians were less insistent on referrals for coronary angiography and follow up specialty care, especially among older women. But in reality, there was better survival rate for women with increasing age. Moreover, this investigation found no relationship between age-gender and mortality and age-gender and treatments after AMI. Hence, unable to account for outcome differences between men and women after AMI[4].

These examples on gender differences in treatments and outcomes after MI, help shed light on some of the biological and clinical aspects that should be considered by physicians, while other aspects remain for further investigations, as technology and general health care improves over time.

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1. Marrugatm, J., Anto, M., Sala, J., Masia, R., and the REGICOR Investigators (1994) Influence of Gender in Acute and Long-Term Cardiac Mortality After a First Myocardial Infarction. Journal of Clinical Epidemiology, 47(2): 111-118.

2. Nohria, A., Vaccarino, V., and Krumholz, H., (1998) Gender Differences in Mortality After Myocardial Infarction: Why Women Fare Worse Than Men. Cardiology Clinics, 16 (1), 45-57.

3. Wilkinson, I.B., Cockcroft, J.R., (1999) Prognostic Significance of Diabetes in Acute Myocardial Infarction. Are the Differences Linked to Female Gender? International Journal of Cardiology, 72: 87-8.

4. Alter, D.A., Naylor, C.D., Austin, P.C., Tu, J.V., (2002) Biology or Bias: Practice Patterns and Long-Term Outcomes for Men and Women with Acute Myocardial Infarction. Journal of the American College of Cardiology. 39(12): 1909-16.

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