„Männerherzen schlagen kürzer” - Kardiale Erkrankungen und Sekundärprävention beim Mann

Zusammenfassung

Männer haben eine um sechs Jahre kürzere Lebenserwartung als Frauen, entwickeln eine koronare Herzerkrankung im Schnitt zehn Jahre früher, erleiden häufiger einen akuten Herztod, haben häufiger Vorhofflimmern und eine ungünstigere Prognose bei Auftreten einer Herzinsuffizienz. Hinsichtlich Symptomatik, Therapie, Diagnostik und Prognose bestehen beim akuten Myokardinfarkt widersprüchliche Daten. In den meisten Studien aber sind Frauen um sechs bis zehn Jahre älter und haben zudem in der Regel ein umfangreicheres Risikoprofil. Korrigiert man die Studiendaten aufgrund dieser unterschiedlichen Baselinecharakteristika haben Frauen bei und nach Myokardinfarkt die gleiche Morbidität und Mortalität wie Männer. Geschlechtsunterschiede beim diagnostischen und therapeutischen Vorgehen hierbei sind gering. Vielleicht schlagen Frauenherzen tatsächlich anders, Tatsache aber ist, dass Männerherzen um Jahre kürzer schlagen.

Summary

Compared to females, males live at least six years shorter, develop ischemic heart disease about ten years earlier, are more frequently subject to sudden cardiac death, have more often atrial fibrillation, and have a more unfavourable outcome after the onset of heart failure. Conflicting information exists about gender differences in presentation, treatment and outcome after acute myocardial infarction, demonstrating a higher mortality in women. But, in most studies women are six to ten years older than men and generally carry a greater burden of risk factors. After correcting for worse baseline characteristics women have the same morbidity and mortality in and after acute myocardial infarction as men. Moreover, both genders have the same benefit by secondary preventive interventions like statins etc. Gender differences in diagnostic and therapeutic procedures are small. Fact is, that the man's heart is beating for a shorter lifetime.

Key Words

gender differences - myocardial infarction - heart failure - sudden death - atrial fibrillation

Literatur

• 1 Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease.  N Engl J Med. 2001;  345 892-902
• 2 Benjamin EJ, Wolf PA, D'Agostino RB. et al. . Impact of atrial fibrillation on the risk of death. The Framingham Heart Study.  Circulation. 1998;  98 946-952
• 3 Bertrand ME, Simoons ML, Fox KA. et al. . Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force on the management of acute coronary syndromes of the European Society of Cardiology.  Eur Heart J. 2002;  23 1809-1840
• 4 Braunwald E, Antman EM, Beasley JW. et al. . ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction - 2002: summary article.  Circulation. 2002;  106 1893-1900
• 5 Chang WC, Kaul P. Westerhout CM et al. Impact of sex on long-term mortality from acute myocardial infarction vs unstable angina.  Arch Intern Med. 2003;  163 2476-2484
• 6 De Von HA, Johnson J. Symptoms of acute coronary syndromes: are there gender differences? A review of the literature.  Heart and Lung. 2002;  31 235-245
• 7 Dove JT, Jacobs AK, Kennedy JW. et al. . ACC/AHA Guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines) - executive summary.  J Am Coll Cardiol. 2001;  37 2215-2238
• 8 Feinberg WM, Blackshearv JL, Laupacis A. et al. . Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications.  Arch Intern Med. 1995;  155 469-473
• 9 Gan SG, Beaver SK, Houck PM. et al. . Treatment of acute myocardial infarction and the 30-day mortality among women and men.  N Engl J Med. 2000;  343 8-15
• 10 Gottlieb S, Harpaz D, Shotan A. et al. . Sex differences in management and outcome after acute myocardial infarction in the 1990s. A prospective observational community-based study.  Circulation. 2000;  102 2484-2490
• 11 Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults.  JAMA. 1999;  281 1291-1297
• 12 Gustafsson F, Torp-Pedersen C, Burchardt H. et al. . Female sex is associated with a better long-term survival in patients hospitalized with congestive heart failure.  Eur Heart J. 2004;  25 129-135
• 13 Heart Protection Study Collaborative Group . MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial.  Lancet. 2002;  360 7-22
• 14 Heer T, Schiele R, Schneider S. et al. . Gender differences in acute myocardial infarction in the era of reperfusion (The MITRA Registry).  Am J Cardiol. 2002;  89 511-517
• 15 Hochman JS, McCabe CH, Stone PH. et al. . Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIb.  J Am Coll Cardiol. 1997;  30 141-148
• 16 Hochman JS, Tamis JE, Thompson TD. et al. . Sex, clinical presentation, and outcome in patients with acute coronary syndromes.  N Engl J Med. 1999;  341 226-232
• 17 Kannel WB, Wilson PWF, D'Agostino RB, Cobb J. Sudden coronary death in women.  Am Heart J. 1998;  136 205-212
• 18 Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation.  Am J Cardiol. 1998;  82 2N-9N
• 19 Kerr CR, Humphries K. Gender-related differences in atrial fibrillation.  J Am Coll Cardiol. 2005;  46 1307-1308
• 20 Lenzen MJ, Scholte OP, Reimer WJM. et al. . Differences between patients with a preserved and a depressed left ventricular function: a report from the Euro Heart Survey.  Eur Heart J. 2004;  25 1214-1220
• 21 Levy S, Maarek M, Coumel P. et al. . Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study.  Circulation. 1999;  99 2028-3935
• 22 Lewis SJ, Sacks FM, Mitchell JS. et al. . Effect of pravastatin on cardiovascular events in women after myocardial infarction: the cholesterol and recurrent events (CARE) trial.  J Am Coll Cardiol. 1998;  32 140-146
• 23 Löwel H, Lewis M, Keil U. et al. . Zeitliche Trends von Herzinfarktmorbidität, -mortalität, 28-Tage-Letalität und medizinischer Versorgung. Ergebnisse des Augsburger Herzinfarktregisters von 1985 bis 1992.  Z Kardiol. 1995;  84 596-605
• 24 McCullough PA, Philbin EF, Spertus JA. et al. . Confirmation of a heart failure epidemic: findings from the resource utilization among congestive heart failure (REACH) study.  J Am Coll Cardiol. 2002;  39 60-69
• 25 Parzeller M. Deutsche Ärztezeitung vom 23.9.2003
• 26 Priori SG, Aliot E, Blomstrom-Lundqvist C. et al. . Task force on sudden cardiac death of the European Society of Cardiology.  Eur Heart J. 2001;  22 1374-1450
• 27 Rathore SS, Wang Y, Radford MJ. et al. . Sex differences in cardiac catheterization after acute myocardial infarction. The role of procedure appropriateness.  Ann Intern Med. 2002;  137 487-493
• 28 Rienstra M, Van Veldhuisen DJ, Hagens VE. et al. . Gender-related differences in rhythm control treatment in persistent atrial fibrillation. Data of the rate control versus electrical cardioversion (RACE) study.  J Am Coll Cardiol. 2005;  46 1298-1306
• 29 Roger VL, Farkouh ME, Weston SA. et al. . Sex differences in evaluation and outcome of unstable angina.  JAMA. 2000;  284 646-652
• 30 Shepherd J, Blauw GJ, Murphy MB. et al. . Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial.  Lancet. 2002;  360 1623-1630
• 31 Simon T, Mary-Krause M, Funck-Brentano C. et al. . Sex differences in the prognosis of congestive heart failure. Results from the Cardiac Insufficiency Bisoprolol study (CIBIS II).  Circulation. 2001;  103 375-380
• 32 Strödter D. Diabetes mellitus - eine kardiovaskuläre Erkrankung (2. Auflage). Bremen, London, Boston: UNI-MED Science 2004
• 33 Strödter D. Evidenz-basierte Therapie in der Kardiologie. Bremen: UNI-MED Science, London, Boston: International Medical Publishers 2004
• 34 Strödter D. Sekundärprävention bei KHK und Postinfarktpatienten - Strategien und Resultate (2. Auflage). Bremen: Uni-Med Science; London, Boston: International Medical Publishers 2003
• 35 Vaccarino V, Krumholz HM, Yarzebski J, Goldberg RJ. Sex differences in 2-year mortality after hospital discharge for myocardial infarction.  Ann Intern Med. 2001;  134 173-181
• 36 Vaccarino V, Lin ZQ, Kasl SV. et al. . Gender differences in recovery after coronary artery bypass surgery.  J Am Coll Cardiol. 2003;  41 307-314
• 37 Vaccarino V, Parsons L, Every NR. et al. . Sex-based differences in early mortality after myocardial infarction.  N Engl J Med. 1999;  341 217-225
• 38 Wenger NK. Clinical characteristics of coronary heart disease in women: emphasis on gender differences.  Cardiovasc Res. 2002;  53 558-567
• 39 White HD, Barbash GI, Modan M. et al. . After correcting for worse baseline characteristics, women treated with thrombolytic therapy for acute myocardial infarction have the same mortality and morbidity as men except for a higher incidence of hemorrhagic stroke.  Circulation. 1993;  88 2097-2103

1 Global Use of STrategies to Open occluded coronary arteries

2 Maximal Individual Therapy in Acute Myocardial Infarction

3 European Myocardial Infarction Amiodarone Trial

4 Canadian Amiodarone Myocardial Infarction Arrhythmia Trial

5 Survival With ORal d-solatol

6 TRAnsoparil Cardiac Evaluation

7 Diamond Investigations of Arrhythmia and Mortality ON Dofetilide - Myocardial Infarction

8 RAte Control versus Electrical cardioversion for persistent atrial fibrillation

9 REduction of Atherothrombosis for Continued Health

10 Cardiac Insufficiency BIsoprolol Study

11 Heart Protection Study

12 PROspective Study of Pravastatin in the Elderly at Risk

13 Cholesterol And Recurrent Events

14 National Cholesterol Education Program

Anschrift des Verfassers