[Coronary disease in the postmenopausal woman. The experience of an intensive care unit over 10 years]

Abstract

Objectives: Analysis of the characteristics of acute myocardial infarction in female patients admitted to a coronary care unit during a 10 year period.

Design: Retrospective analysis of computerized data collected during a 10-year period in every patient with acute myocardial infarction admitted between 1986 and 1995.

Setting: A coronary care unit of a central hospital.

Patients and methods: Data on 2439 patients were analyzed in what concerns gender, age and hospital mortality. In the restricted group of 655 patients admitted between 1993 and 1995 the prevalence of the following risk factors was assessed: arterial hypertension, dyslipidemia, smoking and diabetes mellitus.

Results: During a 10-year period, 1918 male (M) and 521 female (F) patients were admitted, originating a 3.5 to 1 M:F ratio. The M:F relation decreased from decade to decade from 11:1 in patients under 50 years old to 1.8:1 in patients over 70 years old. Hospital mortality was 25.9% in female patients and 12.0% in male patients (p < 0.001). Mortality was similar in males and females until 60 years of age; significant differences were found only in the seventh decade of life (25% in females vs. 12% in males, p < 0.001) and in patients over 70 years old (36% in females vs. 24% in males, p < 0.005). Hypertension was significantly move prevalent in females (66% in females vs 46% in males, p < 0.001) as well as diabetes mellitus (31% in females vs. 20% in males). Similarly, a previous history of dyslipidemia was more frequently found in females than in males, but the difference was not significant (24% vs. 19%, respectively). On the contrary, smoking was significantly less frequent in female patients (11% in female patients vs. 44% in male patients, p < 0.001).

Conclusions: The probability of the occurrence of acute myocardial infarction is very low in premenopausal women. The M:F ratio decreases with aging. The risk of death progressively increases with age, and it is significantly higher in females in relation to males after the age of 60 years. Women, besides being older, have a higher prevalence of coronary artery disease risk factors, namely hypertension, diabetes mellitus and dyslipidemia.