Elsevier

American Heart Journal

Volume 136, Issue 2, August 1998, Pages 189-195
American Heart Journal

Sex differences in symptom presentation associated with acute myocardial infarction: A population-based perspective,☆☆,

https://doi.org/10.1053/hj.1998.v136.88874Get rights and content

Abstract

Objectives To describe sex differences in symptom presentation after acute myocardial infarction (AMI) while controlling for differences in age and other potentially confounding factors.

Background Although several studies have examined sex differences in diagnosis, management, and survival after AMI, limited data exist about possible sex differences in symptom presentation in the setting of AMI.

Methods Community-based study of patients hospitalized with confirmed AMI in all 16 metropolitan Worcester, Mass., hospitals (1990 census population = 437,000). Men (n = 810) and women (n = 550) hospitalized with validated AMI in 1986 and 1988 comprised the study sample.

Results After simultaneously controlling for age, medical history, and AMI characteristics through regression modeling, men were significantly less likely to complain of neck pain (adjusted odds ratio (OR) = 0.52; 95% CI: 0.35, 0.78), back pain (OR = 0.38; 95% CI: 0.26, 0.56), jaw pain (OR = 0.50; 95% CI: 0.31, 0.81), and nausea (O.R. = 0.58; 95% CI: 0.45, 0.75) than women. Conversely, men were significantly more likely to report diaphoresis (OR = 1.27; 95% CI: 1.00, 1.61) than women. There were no statistically significant sex differences in complaints of chest pain though men were more likely to complain of this symptom.

Conclusions The results of this population-based observational study suggest differences in symptom presentation in men and women hospitalized with AMI. These findings have implications for public and health care provider education concerning recognition of sex differences in AMI-related symptoms and health care seeking behaviors. (Am Heart J 1998;136:189-95.)

Section snippets

Materials and Methods

The population studied consisted of patients hospitalized with AMI (International Classification of Disease [ICD] code 410) in all 16 acute general hospitals in the Worcester, Mass., Standard Metropolitan Statistical Area (SMSA) (1990 census population = 437,000) during 1986 and 1988. Although this coronary disease surveillance system has collected incidence and mortality data over the period 1975 through 1993 on an alternating yearly basis,12, 13 data were collected only on acute symptom

Baseline characteristics

Differences in demographic, medical history, and clinical characteristics of the 810 men and 550 women hospitalized with validated AMI are shown in Table I.

. Sex differences in selected characteristics in patients with AMI

Empty CellMen (n= 810) %Women ( n = 550) %p Value
Age (yr)
 <5520.46.9
 55 to 6427.317.3<0.001
 65 to 7429.532.7
 ≥7522.843.1
Mean age (yr)64.772.1<0.001
Medical history
 Angina24.829.8<0.05
 Diabetes20.931.1<0.05
 Hypertension45.554.1<0.001
 Stroke8.58.7NS
AMI characteristics
 Initial AMI68.069.1NS
 Q-wave AMI

Discussion

The results of this multihospital population-based study suggest differences in symptom presentation in men and women hospitalized with AMI in the Worcester metropolitan area. After controlling for several demographic and clinical characteristics that could affect symptom presentation, men were significantly more likely to present to area-wide hospitals with complaints of diaphoresis while less likely to complain of nausea or back, jaw, or neck pain than women.

The strengths of this

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    From the aDepartment of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical Center, and the bSchool of Public Health and Health Sciences, University of Massachusetts.

    ☆☆

    Reprint requests: Robert J. Goldberg, PhD, Department of Medicine, Div. of Cardiovascular Medicine, University of Massachusetts Medical Center, 55 Lake Ave., North Worcester, MA 01655.

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