Mortality after myocardial infarction: impact of gender and smoking status
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We have shown previously that smoking causes a first myocardial infarction (MI) to occur significantly more prematurely in women than in men. The aim of the study was to investigate mortality after MI with special emphasis on the impact of smoking and gender. The study included 2,281 consecutive patients (36.8% women) who died or were discharged from a central hospital with a diagnosis of MI from 1998 to 2005; the median follow-up of survivors was 7 years. Death after MI was adjusted for confounders. Mean age for women was 5.8 years older than for men (76.0 vs. 70.2 years) and women were less likely to have been smokers. In-hospital mortality for the first MI was 8.9% for men and 13.3% for women, and total mortality rates for all indexed MI after 7 years were 47% for men and 61% for women. Using Cox regression analysis, with all indexed MIs included, the after-discharge mortality for women was significantly lower than for men (hazard ratio 0.82; 95% confidence interval 0.70–0.96; P = 0.015). Compared with non-smokers, patients who were smokers on admission had significantly increased seven-year mortality after discharge (hazard ratio 1.30; 95% confidence interval 1.03–1.63; P = 0.002). In conclusion, current smoking at the time of the indexed MI was associated with increased mortality after 7 years follow-up. The smoking effect was independent of gender. Female gender was associated with a moderately lower risk of death during the same follow-up period.
KeywordsEpidemiology Gender Myocardial infarction Risk factors Sex Smoking
Angiotensin converting enzyme inhibitor
Angiotensin receptor blocker
Internal hospital and university funding only.
Conflict of interest
- 1.Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.PubMedCrossRefGoogle Scholar
- 9.http://ssb.no/royk/arkiv/fig-2009-02-03-02.html. Internet Communication accessed 18-10-2010.
- 11.Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21:1502–1513.Google Scholar
- 17.Hasdai D, Porter A, Rosengren A, Behar S, Boyko V, Battler A. Effect of gender on outcomes of acute coronary syndromes. Am J Cardiol. 2003;91:1466–1469, A6.Google Scholar
- 18.Hendricks AS, Goodman B, Stein JH, Carnes M. Gender differences in acute myocardial infarction: the University of Wisconsin experience. WMJ. 1999;98:30–33, 36.Google Scholar
- 22.Movahed MR, John J, Hashemzadeh M, Jamal MM, Hashemzadeh M. Trends in the age adjusted mortality from acute ST segment elevation myocardial infarction in the United States (1988–2004) based on race, gender, infarct location and comorbidities. Am J Cardiol. 2009;104:1030–4.PubMedCrossRefGoogle Scholar
- 31.McLaughlin TJ, Soumerai SB, Willison DJ, Gurwitz JH, Borbas C, Guadagnoli E, McLaughlin B, Morris N, Cheng SC, Hauptman PJ, Antman E, Casey L, Asinger R, Gobel F. Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: evidence for undertreatment in women and the elderly. Arch Intern Med. 1996;156:799–805.PubMedCrossRefGoogle Scholar
- 33.Bongard V, Cambou JP, Lezorovcz A, Ferreres J, Vahanan A, Jullen G, Coppe G, Guerllot M, Herrmann MA, Mas JL. Comparison of cardiovascular risk factors and drug use in 14, 544 French patients with a history of myocardial infarction, ischaemic stroke and/or peripheral arterial disease. Eur J Cardiovasc Prev Rehabil. 2004;11:394–402.PubMedCrossRefGoogle Scholar