Circulation, Vol 88, 2548-2555, Copyright © 1993 by American Heart Association
JM Murabito, JC Evans, MG Larson and D Levy
BACKGROUND. Differences exist between men and women in prognosis after the
onset of coronary heart disease (CHD). METHODS AND RESULTS. All Framingham
Heart Study subjects with the onset of clinically apparent coronary disease
from 1951 through 1986 were studied to compare prognosis in men and women
according to CHD presentation. Coronary disease presentations included
angina, coronary insufficiency (unstable angina), recognized myocardial
infarction, unrecognized myocardial infarction, and coronary death. Less
than 1% of subjects were lost to follow-up for overall mortality. Cox
modeling was used to examine the sex differences in outcome for each
coronary presentation. New nonfatal coronary disease developed in 750 men
(mean age, 63 years) and 583 women (mean age, 67 years). After onset of
angina, men were at greater risk than women for myocardial infarction
(hazards ratio [HR], 2.20; 95% confidence interval [CI], 1.45 to 3.34) and
coronary death (HR, 2.11; 95% CI, 1.32 to 3.36) after adjustment for age
and coronary disease risk factors. After a recognized myocardial
infarction, there was a trend toward greater risk for overall mortality in
women than men after adjustment for age and risk factors (HR, 0.75; 95% CI,
0.53 to 1.08). In contrast, after an unrecognized myocardial infarction,
men were at increased risk for death compared with women (HR, 2.01; 95% CI,
1.28 to 3.15). CONCLUSIONS. Women fare at least as poorly as men after
recognized myocardial infarction, whereas women have a more favorable
outlook than men after the onset of angina or unrecognized myocardial
infarction. The favorable outcome in women after angina and unrecognized
myocardial infarction is due, in part, to greater misclassification of
these coronary events in women than in men.
ARTICLES
Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation
Framingham Heart Study, MA 01701.
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