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Women, blacks lose more years of life after heart attack

Heart attacks seem to have a bigger effect on life expectancy for women and African Americans than for white men, a new study shows.
Women and men live equally long after heart attack – but because women in general tend to live longer than men, the women should be living longer after a heart attack, too, according to lead author Dr. Emily M. Bucholz of the Yale School of Medicine and Yale School of Public Health in New Haven, Connecticut.
Much of the differences between blacks and whites in the study could be due to differences in the way the disease first appears, and the treatments used, “but for women that was not the case,” Bucholz said.
“The thing that’s completely different from prior studies is (those studies) have not factored in what is the mean life expectancy for women in the general population,” Bucholz told Reuters Health by phone.
Every year about 735,000 Americans have a heart attack, and 15 percent die from it, according to the Centers for Disease Control and Prevention.
For the new study, researchers used data on more than 140,000 Medicare beneficiaries hospitalized for a heart attack between 1994 and 1995. Almost half were women. Less than 10 percent were black. The average age was 76.
White men and women hospitalized for heart attack at age 70 lived an average of about nine years afterward, compared to about seven years for black men and women hospitalized at the same age, the authors reported in the Journal of the American College of Cardiology.
Men lost about 3.5 years of potential life, whereas women lost 5.5 years. Whites lost an average of 4.5 years of life, and blacks lost about 5.5 years.
Black patients tended to have more severe heart attacks and more heart failure afterward. They also had more diabetes to start with, indicating that they were a sicker population than the white patients, Bucholz said.
Not only did blacks have more cardiac risk factors at the time of the heart attack, but they “also were less likely to get acute treatments,” like clot-busting drugs or cardiac procedures like angioplasty, said Dr. Jack V. Tu of Sunnybrook Health Sciences Center in Toronto.
Whether this is because black patients visit hospitals that provide poorer care, or they get a lower standard of care in hospitals that also treat white patients, is still unclear, Bucholz said.
This explains some of the racial disparity, she said.
Both women and blacks are less likely to receive certain types of cardiac care, but these gaps may be narrowing over time, Tu told Reuters Health by email. He wrote an editorial comment published with the new results.
“It’s not that every patient loses three years of life or one year of life, some live for 30 days, some live for years and years,” since heart attack severity is on a continuum, Bucholz said.
There is not much individuals can do to address these gender and race disparities, but overall national policy can address them, Bucholz said.
“This study reiterates that these disparities still exist, and we can do better,” she said.
SOURCE: Journal of the American College of Cardiology, online August 3, 2015.

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