American Journal of Epidemiology Vol. 119, No. 4: 610-623
Copyright © 1984 by The Johns Hopkins University School of Hygiene and Public Health
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SEX DIFFERENCES IN PREINFARCTION CHARACTERISTICS AND LONGTERM SURVIVAL AMONG PATIENTS WITH MYOCARDIAL INFARCTION
1Section of Preventive Cardiology, Department of Medicine, Plan 2 CK, Ostra Hospital S-416 85 Go-teborg, Sweden
2The Nordic School of Public Health, Medicinar-egatan S-413 45 Gfiteborg, Sweden
3Reprint requests to Dr. Saga Johansson.
The prevalence of primary risk factors, previous medical history, and physical activity were assessed among 262 women and 1259 men who suffered a first nonfatal myocardial infarction between 1968 and 1977 in Göteborg, Sweden. The probability of suffering a myocardial infarction based on the conventional factors cholesterol level, systolic blood pressure and smoking habits was estimated in both sexes by means of a multiple risk function. Comparisons between sexes were made with age alone and age and estimated primary risk as confounders. Survival rate and reinfarction rate were calculated for a 5-year period of follow-up. Women with infarctions had higher serum cholesterol levels (p < 0.001) and higher blood pressure values (p < 0.001) but were less often smokers than men (p < 0.001). The female patients also reported chest pain and dyspnea on exertion, and low physical activity both at work and during lesiure time significantly more often than men; these differences remained after controlling for estimated primary risk. An overrepresentatlon of hypertension and diabetes prior to myocardial infarction was found among women below 45 years of age compared with men. A high frequency of women in this age group was also on sick leave or disability pension at onset of myocardial infarction, suggesting that mainly women with several risk factors including socloeco-nomlc factors suffer an infarction at this age. No similar and consistent differences were found between women and men of older ages. The cumulative 5-year survival rate was 80% in women and 81% in men. Below age 45 the survival rate was lower among women than men (p < 0.01). No sex difference was found in the recurrence rate of nonfatal reinfarctions. This indicates that once women have suffered a myocardial infarction they are exposed to at least as high a risk as men.
myocardial infarction; risk; sex
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