Kerstin Dudas

Symptoms of a First Acute Myocardial Infarction in Women and Men

BACKGROUND Many studies have compared women and men for symptoms of acute myocardial infarction (AMI), but findings have been inconsistent, largely because of varying inclusion criteria, different study populations, and different methods. OBJECTIVE The purpose of this study was to analyze gender differences in symptoms in a well-defined, population-based sample of women and men who experienced a first AMI. METHODS Information on symptoms was collected from the medical charts of all patients with a first AMI, aged 25 to 74 years, who had taken part in the INTERGENE (Interplay Between Genetic Susceptibility and Environmental Factors for the Risk of Chronic Diseases) study. INTERGENE was a population-based research program on risk factors for cardiovascular disease. Medical charts were reviewed for each patient to determine the symptoms of AMI, and the prevalence of each symptom was compared according to sex. RESULTS The study included 225 patients with a first AMI: 52 women and 173 men. Chest pain was the most common symptom, affecting 88.5% (46/52) of the women and 94.8% (164/173) of the men, with no statistically significant difference between the sexes. Women had significantly higher rates of 4 symptoms: nausea (53.8% [28/52] vs 29.5% [51/173]; age-adjusted odds ratio [OR] = 2.78; 95% CI, 1.47-5.25), back pain (42.3% [22/52] vs 14.5% [25/173]; OR = 4.29; 95% CI, 2.14-8.62), dizziness (17.3% [9/52] vs 7.5% [13/173]; OR = 2.60; 95% CI, 1.04-6.50), and palpitations (11.5% [6/52] vs 2.9% [5/173]; OR = 3.99; 95% CI, 1.15-13.84). No significant gender differences were found in the proportions of patients experiencing arm or shoulder pain, diaphoresis, dyspnea, fatigue, neck pain, abdominal pain, vomiting, jaw pain, or syncope/lightheadedness. No significant differences were found in the duration, type, or location of chest pain. The medical charts listed numerically more symptoms in women than in men; 73.1% (38/52) of the women but only 48.0% (83/173) of the men reported >3 symptoms (age-adjusted OR = 3.26; 95% CI, 1.62-6.54). CONCLUSIONS Chest pain is the most common presenting symptom in both women and men with AMI. Nausea, back pain, dizziness, and palpitations were significantly more common in women. Women as a group displayed a greater number of symptoms than did men.

Predictors of coronary bypass grafting in a population of middle-aged men.

Background Coronary bypass grafting is a procedure which is usually undertaken because of extensive coronary heart disease, whereas acute myocardial infarction may occur with patients with moderate or even minimal disease. Having undergone coronary bypass grafting may thus serve as a marker for extensive coronary atherosclerosis. The aim of this study was to assess risk factors for future coronary bypass grafting as a first coronary event, and to compare them with risk factors for a first acute myocardial infarction. Design This was a prospective cohort study. Method In the Multifactor Primary Prevention Study, 7388 men aged 47-55 years and free of previous acute myocardial infarction or stroke were investigated between 1970 and 1973. During 28 years of follow-up 1664 men (22%) had an acute myocardial infarction or died from coronary disease. One hundred and forty six men (2%) underwent coronary bypass grafting with no prior acute infarction. Results Serum cholesterol was a stronger predictor of coronary bypass grafting than of acute myocardial infarction. Compared to men with serum cholesterol of 5.0 or lower, men with serum cholesterol 5.1–6.4, 6.5–7.4 and over 7.4 mmol/l had age-adjusted hazard ratios for acute myocardial infarction of 1.22 (1.00–1.49), 1.66 (1.35–2.03) and 2.04 (1.65–2.51). Corresponding hazard ratios for coronary bypass grafting were 1.57 (0.66–3.70), 3.44 (1.47–8.03) and 5.21 (2.20–12.31) (95% confidence interval). In contrast, smoking was a weaker risk factor for coronary bypass grafting than for acute myocardial infarction with no discernible increase in risk except in very heavy smokers (25 g/day or more; n = 193); hazard ratio 2.19 (1.02–4.66). Elevated blood pressure predicted coronary bypass grafting and acute myocardial infarction equally well. In multivariate analysis an increase in serum cholesterol of 1 mmol/l was associated with an odds ratio of 1.56 (1.38–1.76) for coronary bypass grafting but only 1.30 (1.24–1.36) for AMI (P for difference in odds ratio 0.004). Conclusion Elevated serum cholesterol is a stronger predictor for future coronary bypass grafting than for acute myocardial infarction. Moderate smoking was not associated with coronary bypass grafting. Different manifestations of coronary disease have different risk factor patterns, suggesting that secular changes in risk factor pattern could potentially influence the clinical expression of the disease. Eur J Cardiovasc Prev Rehabil 14: 122-127