Perspective:

Heart disease is the leading cause of death in women in the United States, but women develop CHD approximately 5-10 years later in life than men. Previous work has shown that age and risk factor profiles are key determinants of sex-specific differences in outcomes. This study shows that although age-specific rates of CHD are lower in women, the fundamental protective effect in women is not maintained after a coronary event (i.e., MI). Several hypotheses could explain this finding: 1) Women may have more nonobstructive coronary disease and heart failure with preserved ejection fraction, both of which have fewer validated treatments. 2) Women may have more severe MI due to delays in diagnosis, less aggressive care, or higher complication rates. 3) Women may be less likely to receive guideline-recommended treatments at goal doses or adhere to therapies. More research is needed to understand the sex-based biological differences and disparities in health services. An important take-away point is that patients with prior MI are at high risk for recurrent MI and all-cause mortality, regardless of sex.