Skip to main content
SpringerLink
Log in

Mortality after myocardial infarction: impact of gender and smoking status

  • CARDIOVASCULAR DISEASE
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

We have shown previously that smoking causes a first myocardial infarction (MI) to occur significantly more prematurely in women than in men. The aim of the study was to investigate mortality after MI with special emphasis on the impact of smoking and gender. The study included 2,281 consecutive patients (36.8% women) who died or were discharged from a central hospital with a diagnosis of MI from 1998 to 2005; the median follow-up of survivors was 7 years. Death after MI was adjusted for confounders. Mean age for women was 5.8 years older than for men (76.0 vs. 70.2 years) and women were less likely to have been smokers. In-hospital mortality for the first MI was 8.9% for men and 13.3% for women, and total mortality rates for all indexed MI after 7 years were 47% for men and 61% for women. Using Cox regression analysis, with all indexed MIs included, the after-discharge mortality for women was significantly lower than for men (hazard ratio 0.82; 95% confidence interval 0.70–0.96; P = 0.015). Compared with non-smokers, patients who were smokers on admission had significantly increased seven-year mortality after discharge (hazard ratio 1.30; 95% confidence interval 1.03–1.63; P = 0.002). In conclusion, current smoking at the time of the indexed MI was associated with increased mortality after 7 years follow-up. The smoking effect was independent of gender. Female gender was associated with a moderately lower risk of death during the same follow-up period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ACE-I:

Angiotensin converting enzyme inhibitor

AP:

Angina pectoris

ARB:

Angiotensin receptor blocker

ASA:

Aspirin

CI:

Confidence interval

HR:

Hazard ratio

OR:

Odds ratio

MI:

Myocardial infarction

References

  1. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.

    Article  PubMed  Google Scholar 

  2. Kannel WB, Hjortland MC, McNamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham study. Ann Intern Med. 1976;85:447–52.

    PubMed  CAS  Google Scholar 

  3. LaCroix AZ, Lang J, Scherr P, Wallace RB, Cornoni-Huntley J, Berkman L, Curb JD, Evans D, Hennekens CH. Smoking and mortality among older men and women in three communities. N Engl J Med. 1991;324:1619–25.

    Article  PubMed  CAS  Google Scholar 

  4. Seltzer CC. Framingham study data and “established wisdom” about cigarette smoking and coronary heart disease. J Clin Epidemiol. 1989;42:743–50.

    Article  PubMed  CAS  Google Scholar 

  5. Floderus B, Cederlof R, Friberg L. Smoking and mortality: a 21-year follow-up based on the Swedish Twin Registry. Int J Epidemiol. 1988;17:332–40.

    Article  PubMed  CAS  Google Scholar 

  6. Janghorbani M, Hedley AJ, Jones RB, Zhianpour M, Gilmour WH. Gender differential in all-cause and cardiovascular disease mortality. Int J Epidemiol. 1993;22:1056–63.

    Article  PubMed  CAS  Google Scholar 

  7. Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ. 1998;316:1043–7.

    PubMed  CAS  Google Scholar 

  8. Gottlieb S, Fallavollita J, McDermott M, Brown M, Eberly S, Moss AJ. Cigarette smoking and the age at onset of a first non-fatal myocardial infarction. Coron Artery Dis. 1994;5:687–94.

    Article  PubMed  CAS  Google Scholar 

  9. http://ssb.no/royk/arkiv/fig-2009-02-03-02.html. Internet Communication accessed 18-10-2010.

  10. Grundtvig M, Hagen TP, German M, Reikvam A. Sex-based differences in premature first myocardial infarction caused by smoking: twice as many years lost by women as by men. Eur J Cardiovasc Prev Rehabil. 2009;16:174–9.

    Article  PubMed  Google Scholar 

  11. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21:1502–1513.

    Google Scholar 

  12. Himbert D, Klutman M, Steg G, White K, Gulba DC. Cigarette smoking and acute coronary syndromes: a multinational observational study. Int J Cardiol. 2005;100:109–17.

    Article  PubMed  Google Scholar 

  13. Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med. 2000;160:939–44.

    Article  PubMed  CAS  Google Scholar 

  14. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290:86–97.

    Article  PubMed  Google Scholar 

  15. Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y. Smoking status and long-term survival after first acute myocardial infarction a population-based cohort study. J Am Coll Cardiol. 2009;54:2382–7.

    Article  PubMed  Google Scholar 

  16. Kinjo K, Sato H, Sakata Y, Nakatani D, Mizuno H, Shimizu M, Sasaki T, Kijima Y, Nishino M, Uematsu M, Tanouchi J, Nanto S, Otsu K, Hori M. Impact of smoking status on long-term mortality in patients with acute myocardial infarction. Circ J. 2005;69:7–12.

    Article  PubMed  Google Scholar 

  17. Hasdai D, Porter A, Rosengren A, Behar S, Boyko V, Battler A. Effect of gender on outcomes of acute coronary syndromes. Am J Cardiol. 2003;91:1466–1469, A6.

    Google Scholar 

  18. Hendricks AS, Goodman B, Stein JH, Carnes M. Gender differences in acute myocardial infarction: the University of Wisconsin experience. WMJ. 1999;98:30–33, 36.

    Google Scholar 

  19. Greenland P, Reicher-Reiss H, Goldbourt U, Behar S. In-hospital and 1-year mortality in 1, 524 women after myocardial infarction. Comparison with 4, 315 men. Circulation. 1991;83:484–91.

    PubMed  CAS  Google Scholar 

  20. Hanratty B, Lawlor DA, Robinson MB, Sapsford RJ, Greenwood D, Hall A. Sex differences in risk factors, treatment and mortality after acute myocardial infarction: an observational study. J Epidemiol Community Health. 2000;54:912–6.

    Article  PubMed  CAS  Google Scholar 

  21. Robinson K, Conroy RM, Mulcahy R, Hickey N. The 15-year prognosis of a first acute coronary episode in women. Eur Heart J. 1992;13:67–9.

    PubMed  CAS  Google Scholar 

  22. Movahed MR, John J, Hashemzadeh M, Jamal MM, Hashemzadeh M. Trends in the age adjusted mortality from acute ST segment elevation myocardial infarction in the United States (1988–2004) based on race, gender, infarct location and comorbidities. Am J Cardiol. 2009;104:1030–4.

    Article  PubMed  Google Scholar 

  23. Martin CA, Thompson PL, Armstrong BK, Hobbs MS, de KN. Long-term prognosis after recovery from myocardial infarction: a nine year follow-up of the Perth Coronary Register. Circulation. 1983;68:961–9.

    PubMed  CAS  Google Scholar 

  24. Pardaens J, Lesaffre E, Willems JL, De GH. Multivariate survival analysis for the assessment of prognostic factors and risk categories after recovery from acute myocardial infarction: the Belgian situation. Am J Epidemiol. 1985;122:805–19.

    PubMed  CAS  Google Scholar 

  25. Perers E, Caidahl K, Herlitz J, Karlsson T, Hartford M. Impact of diagnosis and sex on long-term prognosis in acute coronary syndromes. Am Heart J. 2007;154:482–8.

    Article  PubMed  Google Scholar 

  26. Pohjola S, Siltanen P, Romo M. Five-year survival of 728 patients after myocardial infarction. A community study. Br Heart J. 1980;43:176–83.

    Article  PubMed  CAS  Google Scholar 

  27. Wong ND, Cupples LA, Ostfeld AM, Levy D, Kannel WB. Risk factors for long-term coronary prognosis after initial myocardial infarction: the Framingham Study. Am J Epidemiol. 1989;130:469–80.

    PubMed  CAS  Google Scholar 

  28. Alfredsson J, Stenestrand U, Wallentin L, Swahn E. Gender differences in management and outcome in non-ST-elevation acute coronary syndrome. Heart. 2007;93:1357–62.

    Article  PubMed  Google Scholar 

  29. Herlitz J, Dellborg M, Karlsson T, Evander MH, Hartford M, Perers E, Caidahl K. Treatment and outcome in acute myocardial infarction in a community in relation to gender. Int J Cardiol. 2009;135:315–22.

    Article  PubMed  Google Scholar 

  30. Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ. Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes. 2010;3:82–92.

    Article  PubMed  Google Scholar 

  31. McLaughlin TJ, Soumerai SB, Willison DJ, Gurwitz JH, Borbas C, Guadagnoli E, McLaughlin B, Morris N, Cheng SC, Hauptman PJ, Antman E, Casey L, Asinger R, Gobel F. Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: evidence for undertreatment in women and the elderly. Arch Intern Med. 1996;156:799–805.

    Article  PubMed  CAS  Google Scholar 

  32. Lee HY, Cooke CE, Robertson TA. Use of secondary prevention drug therapy in patients with acute coronary syndrome after hospital discharge. J Manag Care Pharm. 2008;14:271–80.

    PubMed  Google Scholar 

  33. Bongard V, Cambou JP, Lezorovcz A, Ferreres J, Vahanan A, Jullen G, Coppe G, Guerllot M, Herrmann MA, Mas JL. Comparison of cardiovascular risk factors and drug use in 14, 544 French patients with a history of myocardial infarction, ischaemic stroke and/or peripheral arterial disease. Eur J Cardiovasc Prev Rehabil. 2004;11:394–402.

    Article  PubMed  Google Scholar 

  34. Doyle F, De La HD, McGee H, Shelley E, Conroy R. Gender differences in the presentation and management of acute coronary syndromes: a national sample of 1365 admissions. Eur J Cardiovasc Prev Rehabil. 2005;12:376–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Internal hospital and university funding only.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Medicine, Innlandet Hospital Trust, Division Lillehammer, Anders Sandvigsgate 17, 2629, Lillehammer, Norway

    Morten Grundtvig & Elin S. Amrud

  2. Institute of Health Management and Health Economics, University of Oslo, Oslo, Norway

    Terje P. Hagen

  3. Department of Pharmacology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Aasmund Reikvam

Authors
  1. Morten Grundtvig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Terje P. Hagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elin S. Amrud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aasmund Reikvam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Morten Grundtvig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grundtvig, M., Hagen, T.P., Amrud, E.S. et al. Mortality after myocardial infarction: impact of gender and smoking status. Eur J Epidemiol 26, 385–393 (2011). https://doi.org/10.1007/s10654-011-9557-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-011-9557-6

Keywords

Search

Navigation