Identification of Womens coronary heart disease and risk factors prior to first myocardial infarctio

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Identification of Womens coronary heart disease
and risk factors prior to first myocardial
infarction

• Barbara P. Yawn, MD, MSc
• Peter L. Wollan, PhD
• Steven J. Jacobsen, MD, PhD
• George E. Fryer, PhD
• Veronique L. Roger, MD, MPH
• Funded by R01 HS10239 and AR30582

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Purpose

• To understand when womens coronary heart disease
  (CHD) and CHD risk factors are recognized prior
  to first myocardial infarction (MI).
• Different than previous studies because we looked
  at the initial primary care diagnosis of CHD
  before any event.

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Methods

• Retrospective cohort study.
• Medical record review of all of the care 10 years
  prior to MI.
• Women with a confirmed incident MI.
• January 1, 1996 through December 31, 2001.

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Objectives

• Determine the timing of CHD diagnosis
• Determine the likelihood and timing of assessment
  for risk factors
• Determine the likelihood of treatment for
  identified risk factors

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Ability to do this project

• The Rochester Epidemiology Project (REP)
• Database that links all care
• All health care facilities in Olmsted County
• Over 97 of care to Olmsted County residents

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Population

• Over 95 white non-Hispanic
• Over 90 with a high school education
• About 20 with a graduate level degree
• Average income about same as that for all
  Minnesotans
• All with confirmed MI

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AMI Algorithm Reproduced from McGovern, et al.
Trends in survival of hospitalized myocardial
infarction patients between 1970 and 1985, Circ
199285172-179.
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Definitions of Risk Factors
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Results

• 150 women had incident MIs during the study
  period
• 8,732 ambulatory visits and 457 hospitalizations
• A mean of 9.1 years, follow up range 6.2 to 10
  years
• Mean age at incident MI was 74.7 years range
  38.9 to 99.8 years

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Results continued

• CHD diagnosis prior to first MI was present in
  52 (n78)
• Less common in those
• 98 had 1 or more modifiable risk factors prior
  to their first MI

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CHD diagnosis prior to AMI by age group
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percents are columnar percents
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Results continued

• Treatment of recognized risk factors
• 81 anti-hypertension medications
• 28 drug therapy for abnormal lipid levels
• CHD diagnosis was associated with an increased
  likelihood of risk factors and drug treatment for
  identified risk factors

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Risk factors evaluation and treatment before
incident MI in those women with and without a
pre-MI diagnosis of CHD.
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Modifiable risk factors identified prior to first
MI N150 women
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Figure 1. Timing of diagnosis of CHD prior to
incident MI.

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Figure 2. Timing of documentation of risk factor
presence prior to incident MI.
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Risk factor ecology
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Conclusions

• Missed opportunities
• 48 without CHD diagnosis prior to MI
• Women
• Failed prevention in women--? Gender bias?