Age and Sex Factors in Coronary Artery Disease

Abstract

Age and sex have hitherto received less consideration than they merit in publications dealing with prognosis and mortality in coronary artery disease. Yet a clear knowledge of all factors that influence mortality is of paramount importance at a time when the efficicacy of modern methods of treatment is under critical review. Even in the matter of their influence on etiology, age and sex have received less prominence than the facts would seem to justify.It is common knowledge that coronary artery disease is much more frequent in men than women: estimates have varied between seven to one (Mackenzie, 1923) and four to one (Block et al., 1952). It is also widely recognized that coronary artery disease reaches its maximum incidence in the fifth, sixth, and seventh decades of life. Nevertheless few references can be found to the striking difference between the age incidence in males and that in females. Block et al. (1952) hint at the existence of such a difference when they state that the preponderance of men becomes less in the older age groups. Johnston (1954) thinks the age incidence is about ten years later in women than in men.Mortality figures are usually quoted for entire groups of patients comprising both sexes and all ages, as though the mortality were not appreciably affected by age or sex. Yet, without actually saying so, Mackenzie (1923) implies that the disease is more rapidly fatal in the elderly than in the young when he writes (p. 138) " If we put aside the relativelyfew patients in whom death occurred before 50 years ofage we will find that the deaths follow closely that of the general death rate " (my italics). Of his 214 patients whose age at death is given (p. 118), 24 were aged under 50; the largest number of deaths occurred in the quinquennium 61-65 (p. 116). The figures of Block et al. (1952) show a steadily diminishing percentage of survivors, both at five and at ten years after onset, as the age at onset advances from under 40 to over 80. Cole et al. (1954) quote figures that show a later incidence in women than men, a steadily rising mortality in men as age increases, a relatively higher mortality in women than in men of the lower age groups, and a considerably smaller rise in mortality with increasing age in women. MATERIAL AND METHODSThe investigations, in the course of which the present observations were made, were originally begun for a different purpose, namely to assess the immediate and remote prognosis in patients who have had what may be termed an " acute coronary episode." The material therefore includes patients who have experienced such an episode-an attack of cardiac infarction, an attack of angina pectoris (" acute coronary insufficiency " or " acute cardiac ischemia "), abrupt onset of effort angina, or abrupt change in the severity or behaviour of pre-existing effort angina. It does not include cases of chronic angina of effort which have started so insidiously and progressed so slowly that no definite " episode" could be recognized. The patients were seen in consulting pr...

Importance of age in prehospital and hospital mortality of heart attacks.

“…1 Since then age has been incorporated into several "prognostic indices"2-5 yet papers continue to appear which claim very low hospital fatality rates for patients with myocardial infarction with little or no mention of the age of the population studied. 6 7 In this paper we re-emphasise the extreme importance of the patients' ages in any study of the outcome of myocardial infarction.…”

A Comparison of Arteriosclerotic Heart Disease in Males and Females

“…Analysis of the different statistics shows that the female in cidence of arteriosclerotic heart disease complicated by myo cardial infarction varies greatly from one country to the other. Many of the Anglo-Saxon (11,12,16,43,47,48) and Scandinavian (42) authors report a male to female ratio lower than the ratio found by many Italian investigators (5. 6, 9, 13).…”

“…According to some authors (5, 10, 33), the prognosis of myocardial infarction is more severe for women than for men, according to others (15) it is more severe for men than for women. Fitzgerald Peel (16), on the other hand, gives figures which seem to indicate that the death rate from infarction in the two sexes is very different in young age: up to the age of 55 years, the death rale is 6.8 per cent for men and 23.5 per cent for women; after that age, it increases to 35 and 28 per cent, respectively.…”

Coronary heart disease in the aged.

“…However, we found gross coronary atheroma in 69 %0. In the young, males are much more often affected by coronary heart disease than females, though this is much less apparent by the eighth decade (Peel, 1955). Peel also found that the expectation of life in those with coronary heart disease diminished rapidly after the age of 55.…”