Sexual activity of women and men one year before a first acute myocardial infarction

A decrease in sexual activity after an acute myocardial infarction (AMI) for both women and men has been reported with one study suggesting that this reduction in sexual activity may precede rather than proceed the AMI. The present study compared the sexual activity of women and men before AMI to the sexual activity of a normative community sample of women and men, to examine whether the above reduction in sexual activity is especially characteristic of women and men who later incur an AMI. This study also investigated the association between selected medical and sociodemographic variables and sexual inactivity of women and men before an AMI. During an interview before discharge,138 women and 760 men who were hospitalized due to a first AMI responded to a question regarding the frequency of their sexual activity 1 year before the AMI. Their sociodemographic and medical background was obtained from the interview and the medical charts. When compared to a normative sample, only women reported significantly less sexual activity during the year before their AMI. These women were also found to be at a disadvantage when compared to men on many of the sociodemographic and medical variables shown to contribute to sexual inactivity for both men and women. However, the higher percent of sexual inactivity for women during the year before AMI may not only be due to women's higher morbidity and lower sociodemographic status. Other variables not included in this study, but associated with gender, could account for this result.     

Comparison of sexual activity of women and men after a first acute myocardial infarction

Studies of gender differences in the sexual activity of men and women after a first acute myocardial infarction (AMI) have produced conflicting results. The present study was performed to determine whether there are gender differences (1) in the quantity and quality of sexual activity after a first AMI, and (2) in the relations between selected demographic and medical variables and sexual activity after AMI. Four hundred sixty-two men and 51 women with a first AMI were interviewed once before discharge and again 3 to 6 months after AMI. Patients' demographic and medical background and their frequency of and satisfaction with sexual behavior were obtained from the interviews and from medical charts. Analyses of variance showed that women reported significantly less frequency of and satisfaction with sexual activity than men before and after AMI. Both women and men reported significantly less sexual activity and less satisfaction with sexual activity after AMI than before AMI. The decrease in frequency of and satisfaction with sexual activity after AMI was similar for women and men. The relations between selected demographic and medical variables such as age, education, and perceived health before the first AMI and the frequency of and satisfaction with sexual activity of the women and men did not appear to be affected differently by the AMI. A first AMI appears to reduce the frequency of and satisfaction with sexual activity of women and men similarly 3 to 6 months after AMI.     

Fatal outcome of acute myocardial infarction in men and women

An epidemiologic study of the outcomes of acute myocardial infarction, carried out according to the WHO Register of Acute Myocardial Infarction, demonstrated that overall mortality rates are similar for men and women between 20 and 69 years of age. Prehospital mortality was significantly higher in men, as compared to women, while the opposite was true for hospital mortality. Overall, prehospital and hospital mortality rates were relatively high in the younger patients, both male and female, an evidence of a more severe course of acute myocardial infarction at a younger age.     

Prognosis following first acute myocardial infarction in Type 2 diabetes: a comparative population study.

AIMS: To estimate the incidence of death and macrovascular complications after a first myocardial infarction for patients with Type 2 diabetes. RESEARCH DESIGN: In a retrospective, incidence cohort study in the Tayside Region of Scotland we studied all patients hospitalized with a diagnosis of first acute myocardial infarction from 1 April 1993 to 31 December 1994. The primary endpoint was time to death. Secondary endpoints were 2-year incidence of hospital admission for angina, myocardial infarction, stroke, heart failure, coronary angiography, coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA). RESULTS: The 147 patients with Type 2 diabetes had significantly worse survival with an increase in relative hazard of 67% compared with non-diabetic patients. After adjustment for age, sex, smoking status, prior heart failure, prior angina, delay to hospitalization, site of infarction, drug therapy with aspirin, beta-blockers, streptokinase and hyperlipidaemia and treated hypertension, Type 2 diabetes was still associated with a 40% higher death rate compared with people without diabetes (P < 0.05) There was no significant difference in death rates in those aged over 70 years, but an indication of a trend in younger individuals with a four-fold increase in death rate in those with diabetes aged < 60 years, compared with a rate ratio of 2.6 in those with diabetes aged 61-70 years. CONCLUSIONS: Among hospitalized patients with first acute myocardial infarction, Type 2 diabetes mellitus is consistently associated with increased mortality and increased hospital admission for heart failure. The estimated 4-year survival rate is only 50%. Our results indicate that younger subjects with Type 2 diabetes and acute myocardial infarction are a high-risk group deserving of special study, and support the argument for aggressive targeting of coronary risk factors among patients with Type 2 diabetes.     

Depression and anxiety following acute myocardial infarction in women

Cardiovascular disease is the leading global cause of mortality, with ischemic heart disease causing the majority of cardiovascular deaths. Despite this, diagnostic delay commonly occurs in women experiencing acute myocardial infarction (AMI) who have a higher associated in-hospital mortality. Several studies have demonstrated that women are significantly more likely than men to experience depression and anxiety following AMI which is linked with increased morbidity, rehospitalization, and mortality, as well as decreased quality of life. Thus, it is imperative that future work aims to understand the factors that put women at higher risk for depression and anxiety following AMI, informing prevention and intervention. This narrative review will summarize the current literature on the association between AMI and mental health in women, including the impact on morbidity, mortality, and quality of life.     

Age-related changes in treatment strategies for acute myocardial infarction: a population-based study

OBJECTIVES: To compare across four age groups (<65, 65-74, 75-84, > or =85) the determinants of coronary reperfusion therapy (CRT) use in ST-segment elevation acute myocardial infarction (STE-AMI). DESIGN: Population-based, observational study. SETTING: Performed in the health district of Florence, Italy, where percutaneous coronary intervention (PCI) is the preferred CRT. PARTICIPANTS: Nine hundred thirty patients with STE-AMI prospectively enrolled in the Florence AMI registry. MEASUREMENTS: Use of CRT, clinical factors associated with CRT use. RESULTS: CRT use was reduced from 71% at younger than 65 to 31% at aged 85 and older (P<.001). After adjusting for chronic comorbidity, Killip class, admission hospital category, hospitalization delay, and AMI location, CRT use was 29% (P=.17) lower at age 75 to 84 and 63% (P<.001) lower at age 85 and older than at younger than 65. Within each age group, the probability of receiving CRT was three to five times greater in patients directly admitted to the hospital with PCI facilities. Acute cardiac failure and chronic comorbidity were associated with lower CRT use only in patients aged 65 and older. Patients aged less than 85 years who received reperfusive therapy had a significantly lower risk of death (-44%, P=.045) at 1 year, whereas it was less evident and nonsignificant (-27%, P=.27) in patients aged 85 and older. CONCLUSION: Results confirm that, although they might substantially benefit from CRT during STE-AMI, older patients are excluded from CRT even when eligible. This further indicates that clinicians are not yet completely prepared to manage most efficiently frail elderly with AMI, a task requiring a specific interdisciplinary training program in geriatric cardiology.     

Influence of risk factors on long-term survival following acute myocardial infarction: a follow-up study in central Japan

The long-term survival rate following acute myocardial infarction (AMI) was studied in 358 patients in central Japan who were monitored for 8 to 20 years after discharge from hospital for AMI. Fifteen-year cardiac survival rates were 65% in males and 72% in females. In both sexes, the survival rate decreased with increasing age at the time of AMI. The survival rate was significantly lower in recurrent MI than in first MI patients. Those who had smoked cigarettes before AMI or had hyperlipidemia during hospitalization did not show any significant decrease in cardiac survival rate, which may be due to cessation of smoking or control of hyperlipidemia after AMI. The 15-year survival rate was significantly lower in patients with a past history of angina pectoris or hypertension. Patients with a large infarct had a lower survival rate, as did those with a large cardiothoracic ratio on chest x-ray, and those who received digitalis during hospitalization. On the other hand, patients who were administered anticoagulants during hospitalization had a higher survival rate. Multiple regression analysis gave similar results. In conclusion, factors that reduced long-term survival rate after AMI were older age at time of the first attack, reduced cardiac function, and a history of angina pectoris or hypertension. Anticoagulant therapy appeared to improve the long-term survival rate.     

Gender differences in the management and survival of patients with acute myocardial infarction

Coronary heart disease (CHD) and specifically acute myocardial infarction (AMI) are the most common causes of death among both men and women throughout the world. Although CHD mortality rates have been halved in many developed countries in recent decades, some studies have pointed out significant differences regarding time-related tendencies of mortality between the sexes. This paper briefly reviews factors related to post-AMI survival and possible reasons for inequalities in survival benefit between men and women after AMI. Presentation of AMI also exhibits differences with regard to sex, and this has some effect on patient care and on mortality from the disease. CHD morbidity and mortality rates vary with socioeconomic deprivation and social patterning in most industrialized countries. Several studies have indicated that women sustaining AMI have a higher mortality than men. Although AMI affects men in greater numbers, the short-term outcomes for women are worse. Studies suggest that, over the longer term, the mortality risk for women is lower than, or similar to, that for men. It is still a major problem that in-hospital case fatality and morbidity rates in the post-infarction period are higher for women, despite lower rates of administration of thrombolytics and catheterization. Patients admitted to the hospital with an AMI should be offered optimal treatment, irrespective of age or sex.     

Determinants of treatment strategies and survival in acute myocardial infarction: a population-based study in the Florence district, Italy: results of the acute myocardial infarction Florence registry (AMI-Florence).

AIMS: The Florence Acute Myocardial Infarction Registry is a prospective, observational study aimed at identifying the determinants of use of primary PCI and of prognosis in patients with STE-AMI, in an unselected population-based setting. METHODS AND RESULTS: Nine hundred and thirty cases of STE-AMI (mean age: 70.5 years) were prospectively recorded. Factors associated with use of revascularization, or influencing survival were identified through multivariate analyses (respectively: logistic and Cox regression). Primary PCI was the preferred reperfusion therapy in the study district, with 50% of STE-AMI cases admitted within 24h, and 58% of those admitted within 12h from symptom onset treated; about 5% of patients undergone fibrinolysis (overall revascularization being 55% and 63%, respectively). Availability of PCI facilities at admission hospital was the strongest independent positive predictor of subsequent primary PCI. Advanced age, comorbidities, Killip class 3, delayed hospitalisation and other factors independently reduced the probability of receiving reperfusion. In the whole series, in-hospital mortality was 6.6% for revascularization and 15.6% for conservative therapy, 6-month mortality was 10.1% and 26.0% respectively. The independent, protective effect of primary PCI persisted at the multivariate analysis, being 44% the reduction in the risk of death at 6 months. CONCLUSION: In this unselected series of patients, primary PCI, routinely performed in high volume centres, achieved good results in terms of survival even outside the setting of a randomised clinical trial. However, the relatively high number of untreated subjects and the tendency to select less severe cases of AMI for reperfusion treatment confirm the need for an accurate reassessment of behavioural patterns in selecting patients for revascularization.     

Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction.

In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy-four patients fulfilled our criteria for thrombolysis, but only the last 35 patients included received thrombolytic therapy. As thrombolysis was not available in our Department at the start of the study, the first 39 patients included were conservatively treated (controls). No significant differences in baseline clinical characteristics were found between the two groups. In-hospital atrial fibrillation and digoxin therapy was more prevalent in controls (P less than 0.05). During exercise, thrombolysed patients reached a higher maximal work capacity compared with controls: 160 +/- 41 vs 139 +/- 34 W (P less than 0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144 min in controls (P less than 0.05). Thrombolysed patients reached a higher heart rate during transient ischaemic episodes: 114 +/- 17 vs 93 +/- 11 b.min-1 in controls (P less than 0.001). In conclusion, thrombolytic therapy administered for a first AMI significantly reduces the burden of transient myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study.     

Smokeless tobacco as a possible risk factor for myocardial infarction: a population-based study in middle-aged men

OBJECTIVES: To explore whether the use of snuff affects the risk of myocardial infarction (MI). BACKGROUND: Snuff and other forms of smokeless tobacco are widely used in some populations. Possible health hazards associated with the use of smokeless tobacco remain controversial. METHODS: In a population-based study within the framework of the Northern Sweden center of the World Health Organization Multinational Monitoring of Trend and Determinants in Cardiovascular Disease (WHO MONICA) Project, tobacco habits were compared in 25- to 64-year-old men with first-time fatal or nonfatal MI and referent subjects matched for age and place of living (687 cases, 687 referents). RESULTS: The unadjusted odds ratio (OR) for MI in regular cigarette smokers as compared with men who never used tobacco was 3.65 (95% confidence interval [CI] 2.67 to 4.99). When nonsmoking regular snuff dippers were compared with never-users of tobacco, the unadjusted OR was 0.96 (0.65 to 1.41). After adjustment for multiple cardiovascular risk factors, the OR was 3.53 (95% CI 2.48 to 5.03) for regular smoking and 0.58 (95% CI 0.35 to 0.94) for regular snuff dipping. Restricting the analyses to fatal cases of myocardial (including sudden death) showed a tendency towards increased risk among snuff dippers 1.50 (95% CI 0.45 to 5.03). CONCLUSIONS: The risk of MI is not increased in snuff dippers. Nicotine is probably not an important contributor to ischemic heart disease in smokers. A possible small or modest detrimental effect of snuff dipping on the risk for sudden death could not be excluded in this study due to a limited number of fatal cases.     

Short- and long-term prognosis after acute myocardial infarction in men versus women

The prevailing view is that women have a higher early mortality after acute myocardial infarction (AMI) than men, but several studies have shown no differences. Further, long-term differences have not been addressed widely. The present study examined gender differences in short- and long-term prognoses after AMI in The Netherlands. A nationwide cohort of 21,565 patients with a first hospitalized AMI in 1995 was identified through linkage of the National Hospital Discharge Register and the population register. Crude short- and long-term mortalities were significantly higher in women than in men (28-day hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.58 to 1.82; 5-year HR 1.52, 95% CI 1.46 to 1.59). After adjustment for age, the risk difference was attenuated at 28 days and even reversed at 5 years in favor of women (28-day HR 1.11, 95% CI 1.03 to 1.20; 5-year HR 0.94, 95% CI 0.90 to 0.99). When differences in other covariates were also taken into account, the risk differences remained virtually the same. To account for differences in reperfusion procedures, we repeated the analyses in 1,176 patients who underwent acute reperfusion therapy (angioplasty/thrombolysis). Comparable, but not statistically significant, gender differences were observed (28-day HR 1.06, 95% CI 0.65 to 1.74; 5-year HR 0.82, 95% CI 0.62 to 1.08). In conclusion, our findings in an unselected cohort covering a complete nation indicate that the worse short- and long-term prognoses after an AMI in women compared with men may largely be explained by differences in age, whereas differences in co-morbidity, origin, infarct location, and reperfusion therapy seem to contribute little.