European Journal of Epidemiology

, Volume 26, Issue 5, pp 385–393 | Cite as

Mortality after myocardial infarction: impact of gender and smoking status

  • Morten Grundtvig
  • Terje P. Hagen
  • Elin S. Amrud
  • Aasmund Reikvam
CARDIOVASCULAR DISEASE

Abstract

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.

Keywords

Epidemiology Gender Myocardial infarction Risk factors Sex Smoking 

Abbreviations

ACE-I

Angiotensin converting enzyme inhibitor

AP

Angina pectoris

ARB

Angiotensin receptor blocker

ASA

Aspirin

CI

Confidence interval

HR

Hazard ratio

OR

Odds ratio

MI

Myocardial infarction

Notes

Acknowledgments

Internal hospital and university funding only.

Conflict of interest

None.

References

  1. 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
  2. 2.
    Kannel WB, Hjortland MC, McNamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham study. Ann Intern Med. 1976;85:447–52.PubMedGoogle Scholar
  3. 3.
    LaCroix AZ, Lang J, Scherr P, Wallace RB, Cornoni-Huntley J, Berkman L, Curb JD, Evans D, Hennekens CH. Smoking and mortality among older men and women in three communities. N Engl J Med. 1991;324:1619–25.PubMedCrossRefGoogle Scholar
  4. 4.
    Seltzer CC. Framingham study data and “established wisdom” about cigarette smoking and coronary heart disease. J Clin Epidemiol. 1989;42:743–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Floderus B, Cederlof R, Friberg L. Smoking and mortality: a 21-year follow-up based on the Swedish Twin Registry. Int J Epidemiol. 1988;17:332–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Janghorbani M, Hedley AJ, Jones RB, Zhianpour M, Gilmour WH. Gender differential in all-cause and cardiovascular disease mortality. Int J Epidemiol. 1993;22:1056–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ. 1998;316:1043–7.PubMedGoogle Scholar
  8. 8.
    Gottlieb S, Fallavollita J, McDermott M, Brown M, Eberly S, Moss AJ. Cigarette smoking and the age at onset of a first non-fatal myocardial infarction. Coron Artery Dis. 1994;5:687–94.PubMedCrossRefGoogle Scholar
  9. 9.
    http://ssb.no/royk/arkiv/fig-2009-02-03-02.html. Internet Communication accessed 18-10-2010.
  10. 10.
    Grundtvig M, Hagen TP, German M, Reikvam A. Sex-based differences in premature first myocardial infarction caused by smoking: twice as many years lost by women as by men. Eur J Cardiovasc Prev Rehabil. 2009;16:174–9.PubMedCrossRefGoogle Scholar
  11. 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
  12. 12.
    Himbert D, Klutman M, Steg G, White K, Gulba DC. Cigarette smoking and acute coronary syndromes: a multinational observational study. Int J Cardiol. 2005;100:109–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med. 2000;160:939–44.PubMedCrossRefGoogle Scholar
  14. 14.
    Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290:86–97.PubMedCrossRefGoogle Scholar
  15. 15.
    Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y. Smoking status and long-term survival after first acute myocardial infarction a population-based cohort study. J Am Coll Cardiol. 2009;54:2382–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Kinjo K, Sato H, Sakata Y, Nakatani D, Mizuno H, Shimizu M, Sasaki T, Kijima Y, Nishino M, Uematsu M, Tanouchi J, Nanto S, Otsu K, Hori M. Impact of smoking status on long-term mortality in patients with acute myocardial infarction. Circ J. 2005;69:7–12.PubMedCrossRefGoogle Scholar
  17. 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. 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
  19. 19.
    Greenland P, Reicher-Reiss H, Goldbourt U, Behar S. In-hospital and 1-year mortality in 1, 524 women after myocardial infarction. Comparison with 4, 315 men. Circulation. 1991;83:484–91.PubMedGoogle Scholar
  20. 20.
    Hanratty B, Lawlor DA, Robinson MB, Sapsford RJ, Greenwood D, Hall A. Sex differences in risk factors, treatment and mortality after acute myocardial infarction: an observational study. J Epidemiol Community Health. 2000;54:912–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Robinson K, Conroy RM, Mulcahy R, Hickey N. The 15-year prognosis of a first acute coronary episode in women. Eur Heart J. 1992;13:67–9.PubMedGoogle Scholar
  22. 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
  23. 23.
    Martin CA, Thompson PL, Armstrong BK, Hobbs MS, de KN. Long-term prognosis after recovery from myocardial infarction: a nine year follow-up of the Perth Coronary Register. Circulation. 1983;68:961–9.PubMedGoogle Scholar
  24. 24.
    Pardaens J, Lesaffre E, Willems JL, De GH. Multivariate survival analysis for the assessment of prognostic factors and risk categories after recovery from acute myocardial infarction: the Belgian situation. Am J Epidemiol. 1985;122:805–19.PubMedGoogle Scholar
  25. 25.
    Perers E, Caidahl K, Herlitz J, Karlsson T, Hartford M. Impact of diagnosis and sex on long-term prognosis in acute coronary syndromes. Am Heart J. 2007;154:482–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Pohjola S, Siltanen P, Romo M. Five-year survival of 728 patients after myocardial infarction. A community study. Br Heart J. 1980;43:176–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Wong ND, Cupples LA, Ostfeld AM, Levy D, Kannel WB. Risk factors for long-term coronary prognosis after initial myocardial infarction: the Framingham Study. Am J Epidemiol. 1989;130:469–80.PubMedGoogle Scholar
  28. 28.
    Alfredsson J, Stenestrand U, Wallentin L, Swahn E. Gender differences in management and outcome in non-ST-elevation acute coronary syndrome. Heart. 2007;93:1357–62.PubMedCrossRefGoogle Scholar
  29. 29.
    Herlitz J, Dellborg M, Karlsson T, Evander MH, Hartford M, Perers E, Caidahl K. Treatment and outcome in acute myocardial infarction in a community in relation to gender. Int J Cardiol. 2009;135:315–22.PubMedCrossRefGoogle Scholar
  30. 30.
    Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ. Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes. 2010;3:82–92.PubMedCrossRefGoogle Scholar
  31. 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
  32. 32.
    Lee HY, Cooke CE, Robertson TA. Use of secondary prevention drug therapy in patients with acute coronary syndrome after hospital discharge. J Manag Care Pharm. 2008;14:271–80.PubMedGoogle Scholar
  33. 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
  34. 34.
    Doyle F, De La HD, McGee H, Shelley E, Conroy R. Gender differences in the presentation and management of acute coronary syndromes: a national sample of 1365 admissions. Eur J Cardiovasc Prev Rehabil. 2005;12:376–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Morten Grundtvig
    • 1
  • Terje P. Hagen
    • 2
  • Elin S. Amrud
    • 1
  • Aasmund Reikvam
    • 3
  1. 1.Department of MedicineInnlandet Hospital Trust, Division LillehammerLillehammerNorway
  2. 2.Institute of Health Management and Health EconomicsUniversity of OsloOsloNorway
  3. 3.Department of Pharmacology, Institute of Clinical MedicineUniversity of OsloOsloNorway

Personalised recommendations