Work

Long-term prognosis of unrecognized myocardial infarction in women and men from the general population: the Rotterdam Study

Year: 2025

Type: article

Abstract: AIMS: Unrecognized myocardial infarction (UMI) is associated with an adverse prognosis, but sex-specific differences in outcomes are not fully understood. METHODS AND RESULTS: We included 12 303 participants (57.6% women, mean age 64.8 years) from the Rotterdam Study. Baseline myocardial infarction (MI) status (1990-2008) was determined by electrocardiogram and medical records, categorizing participants as UMI (n = 512), recognized MI (RMI) (n = 669), or no MI (n = 11 122). Outcomes included heart failure (HF), atrial fibrillation (AF), stroke, and all-cause mortality. In women, compared with no MI, UMI was associated with larger risks of HF [hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.01-1.71] and all-cause mortality (HR 1.21, 95% CI 1.05-1.40), but lost significance after adjusting for cardiovascular risk factors. Unrecognized MI was non-significantly associated with a larger risk of stroke (HR 1.27, 95% CI 0.95-1.70), but not AF (HR 0.96, 95% CI 0.70-1.33). Recognized MI in women significantly increased risks of HF (HR 2.58, 95% CI 1.94-3.43), AF (HR 1.62, 95% CI 1.13-2.32), and all-cause mortality (HR 1.81, 95% CI 1.54-2.12), but not stroke (HR 1.41, 95% CI 0.98-2.04). Among men, both UMI and RMI were associated with larger risks of HF (UMI: HR 1.90, 95% CI 1.45-2.48, RMI: HR 2.49, 95% CI 2.09-2.98), AF (UMI: HR 1.91, 95% CI 1.45-2.54, RMI: HR 1.79, 95% CI 1.46-2.19), stroke (UMI: HR 2.06, 95% CI 1.52-2.80, RMI: HR 1.36, 95% CI 1.06-1.76), and all-cause mortality (UMI: HR 1.59, 95% CI 1.36-1.85, RMI: HR 1.63, 95% CI 1.46-1.81). CONCLUSION: Unrecognized myocardial infarction has a differential impact on the long-term prognosis in women and men, highlighting the need to identify key predictors of adverse outcomes.

Source: European Journal of Preventive Cardiology

DOI: 10.1093/eurjpc/zwaf689