RESUMO
BACKGROUND: Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender-specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist. METHODS AND RESULTS: We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web-System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age-adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST-segment elevation MI. Compared with men, younger women and women with ST-segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16, P<0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48, P<0.001) and were less likely to be prescribed evidence-based treatment at discharge (P<0.001 for ß-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y12 antagonists). Differences in treatment between the genders did not decrease over the study period (P>0.1 for all treatments). CONCLUSIONS: Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST-segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence-based treatment.
Assuntos
Medicina Baseada em Evidências/tendências , Disparidades em Assistência à Saúde/tendências , Infarto do Miocárdio/terapia , Padrões de Prática Médica/tendências , Avaliação de Processos em Cuidados de Saúde/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Fidelidade a Diretrizes/tendências , Disparidades nos Níveis de Saúde , Mortalidade Hospitalar , Humanos , Internet , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Razão de Chances , Guias de Prática Clínica como Assunto , Pontuação de Propensão , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Suécia/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the possible connection between erectile dysfunction (ED) and cardiovascular disease (CVD) in one of its more severe forms, namely myocardial infarction (MI). MATERIAL AND METHODS: The incidence of ED in men hospitalized due to MI (n=100) was compared with that reported in a questionnaire sent to an age-matched control population (n=129). RESULTS: The incidence of ED before MI (34%) was similar to that in the control population (30%). After MI, 53% reported ED. Smoking was much more common among the men with MI (82%) than among the controls (45%). Smoking was, however, only slightly more common among controls with (50%) than without (40%) ED. None of the men in the study group had consulted a physician due to ED before the MI and only 10/53 (19%) with ED after the MI had consulted a physician for this reason. Among the controls without a history of CVD, 18% reported ED, compared to 34% of the men before the MI but without clinical evidence of CVD and/or diabetes (p=NS). CONCLUSIONS: The well-known association between CVD and ED was confirmed. However, the lack of a sharp rise in the prevalence of ED prior to MI does not support the idea that ED is a clinically useful predictor of MI.