Mayo Clinic Indicates Age Has Distinct Influences on Sex-Related Outcomes After Heart Attack

The objective of this study was to determine whether age is a key factor in sex-related differences among patients who experienced a heart attack.

Researchers at the Mayo Clinic have found ways that the sex and age of an individual can play a large part in who experiences a heart attack, the methods used to treat these heart attacks, and the eventual post hospital outcomes of the people who experience heart attacks, according to a press release.

The objective of this study was to determine whether age is a key factor in sex-related differences among patients who experienced a heart attack. Using public all-payer hospitalization data from the Nationwide Inpatient Sample, the research team evaluated more than 6.7 million hospitalization records for heart attacks. The researchers then categorized the information by sex and divided the patients into 4 age categories: under 45 years of age, 45 to 64 years of age, 65 to 84 years of age, and over 84 years of age.

Patients were further categorized by the type of their heart attack to fully compare the treatment given. With an ST elevation myocardial infarction (STEMI) heart attack, there is a complete blockage of an artery supplying blood to the heart. With a non-STEMI (NSTEMI) heart attack, there is no ST elevation, but there is typically a significant but partial artery blockage, according to the study authors.

Women had fewer acute heart attacks than men across all age groups. However, because there are more women than men over 84 years of age, more women had heart attacks in that age group. In the NSTEMI and STEMI groups, women had distinctive differences in their risk profiles for heart disease compared with men.

Further, women were more likely to have hypertension, diabetes, anemia, atrial fibrillation, chronic lung disease, and previous stroke. Women were also less likely than men to have had a previous heart attack and less likely to have an implantable defibrillator, a previous revascularization or experience cardiogenic shock, according to the study authors.

The data show a clear difference between the sexes for managing a heart attack in the hospital. In the NSTEMI group, women of any age were less likely than men to undergo coronary angiography imaging of the heart’s blood vessels, angioplasty to open clogged arteries with a balloon catheter, coronary artery bypass grafting to redirect blood flow, or receive mechanical circulatory support.

In the STEMI group, women were also less likely to have coronary angiography or primary angioplasty or receive mechanical circulatory support in all age groups. Compared with men, the data show that worse hospital outcomes among women are confined to those who are younger. In the NSTEMI group, women under 65 years of age were more likely than men to die at the hospital because of their heart attack.

This difference in mortality in women versus men also was observed in patients under 85 years of age in the STEMI group. For both categories of heart attack, younger women were more likely to have vascular complications and major bleeds, although the same was not true for stroke and acute kidney injury.

"These data suggest that younger women are particularly at higher risk of major complications after a heart attack and therefore should be the focus of further research to identify strategies to mitigate this increased risk," said first study author Mohamad Adnan Alkhouli, MD, in a press release.


Mayo Clinic study indicates age has distinct influences on sex-related outcomes after heart attack. Mayo Clinic. Published January 20, 2021. Accessed January 22, 2021.