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SWEDEHEART shows gender differences in MI prevention

Cardiac readmissions are significantly higher in women than in men, probably because of less use of secondary prevention. This was among the findings from a study published recently in the European Journal of Preventive Cardiology.1

The authors identified 51,620 patients <75 years examined at two and/or 12 months post acute myocardial infarction (AMI) in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Risk factor control and readmissions at one year were compared between the 2005 and 2012 cohorts, and between genders.

Lipid control (LDL-cholesterol <2.5 mmol/L) improved from 67.9% to 71.1% (p = 0.016) over time, achieved by 67.9% vs. 63.3%, p < 0.001 of men vs. women. Blood pressure control (<140 mmHg systolic) increased over time (59.1% vs. 69.5%, p < 0.001 in 2005 and 2012 cohorts) and was better in men (66.4% vs. 61.9%, p < 0.001). Smoking cessation rate was 55.6% without differences between genders or over time.

Dr Kristina Hambraeus (Falun Hospital, Sweden)

Dr Kristina Hambraeus (Falun Hospital, Sweden)

Cardiac readmissions occurred in 18.2% of women and 15.5% of men, decreasing from 2005 to 2012 (20.8% vs. 14.9%). Adjusted odds ratio was 1.22 (95% CI 1.14–1.32) for women vs. men and 0.94 (95% CI 0.92–0.96) for the 2012 vs. the 2005 cohort. The reasons for gender differences seen in risk factor control and readmissions require further analysis, the authors conclude.

Speaking to BJC Arrhythmia Watch, lead author Dr Kristina Hambraeus (Falun Hospital, Sweden) said: “At baseline (i.e at admission for AMI), 29.6 of men and 34.9 of women were smokers. Mean LDL at admission was 3.23 for women and 3.19 for men. Median age for women was 65 and for men it was 67 in this study, which only included patients up to the age of 75. Unfortunately I do not have any data on gender differences in patients delay time before seeking health care for AMI in this study.”

Asked why women experience a greater level of side effects with drug treatment, Dr Hambraeus replied: “This has been reported in other studies. Examples are more coughing being experienced by women on ACE-inhibitors and more myopathy being reported by women on statins. In the article I cite [another paper].2 According to the authors, there seems to be several mechanisms behind this”


1. Hambraeus K, Tydén P, Lindahl B. Time trends and gender differences in prevention guideline adherence and outcome after myocardial infarction: data from the SWEDEHEART registry. Eur J Prev Cardiol 2015.

2. Franconi F et al. Pharmacogenomics, pharmacokinetics and pharmacodynamics: interaction with biological differences between men and women. Br J Pharmacol 2014;171:580–94.

Published on: May 28, 2015

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