Gender differences in heart attack outcomes: what the latest data show
Death after a heart attack appears more often in women than in men, a gap highlighted by the European Society of Cardiology and discussed by researchers and clinicians across North America. This finding has sharpened ongoing questions about how sex-specific biology shapes recovery after a myocardial infarction and whether care pathways should adapt to bridge any observed disparities. The conversation is far from settled, and many factors beyond gender alone are being explored to explain why outcomes diverge.
Earlier investigations suggested that women presenting with segmental elevation myocardial infarction may experience a less favorable prognosis than men, often reflected in longer hospitalizations. Researchers considered a range of contributing elements, including older age at presentation and a higher prevalence of additional health conditions in women. These observations prompted a broader inquiry into whether gender itself could fully account for the differences, or if a constellation of health status and lifestyle factors interacts in complex, interdependent ways that influence outcomes after a heart attack.
To examine this question, researchers led by Mariana Martigno analyzed archival data from patients hospitalized with myocardial infarction who underwent percutaneous coronary intervention between 2010 and 2015. The study tracked several outcomes: death within 30 days of the procedure, death within five years, recurrence of a heart attack, stroke due to ischemia, and a spectrum of major cardiovascular events. The dataset included 884 patients with a median age near 62 years, and women comprised about a quarter of the cohort. Within the group, women tended to be older on average (roughly 67 years) than men (about 60 years) and showed higher rates of hypertension, diabetes, and prior stroke. In contrast, men were more likely to smoke and to have established coronary artery disease. The investigators applied statistical adjustments to account for these clinical differences, aiming to isolate any independent effect of gender on long-term outcomes.
Findings revealed a clear divergence in short-term survival: 11.8% of women died within 30 days versus 4.6% of men. Over a five-year horizon, the disparity widened, with about one in three women (32.1%) dying compared with roughly one in six men (16.9%). The incidence of major cardiovascular events over five years was also higher among women, affecting about 34% of the female group and around 20% of the male group. Notably, when it came to treatment regimens and procedures, there was no significant difference reported in the therapies prescribed, suggesting that the gap in outcomes was not driven by disparities in medical management alone. The study concluded that the observed differences are unlikely to be solely a result of care patterns; they are more plausibly linked to inherent physiological and biological characteristics associated with female anatomy and cardiometabolic profiles rather than processes of care alone. (Martigno et al., 2010–2015 archival data analysis)
These results contribute to a broader understanding that sex-based biology can influence recovery trajectories after a myocardial infarction. The higher short-term and five-year mortality observed in women underscores the importance of considering sex-specific factors in risk stratification, treatment planning, and follow-up care. Clinicians can use these insights to inform conversations with patients about prognosis and to tailor monitoring for areas where risk tends to cluster, such as blood pressure control, metabolic health, and vascular health. At the same time, the absence of marked differences in the chosen therapies reinforces the idea that improving outcomes may require more nuanced management strategies beyond standard protocols or one-size-fits-all approaches. Health systems in Canada, the United States, and other advanced care settings are increasingly focused on integrating such insights into practice guidelines, with an emphasis on individualized care that accounts for gender, age, comorbidity, and lifestyle factors while maintaining equity in access to state-of-the-art interventions. (Clinical interpretation and implications drawn from the same archival study)