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Sex dependent risk factors for mortality after myocardial infarction: individual patient data meta-analysis.

Abstract：

BACKGROUND:Although a number of risk factors are known to predict mortality within the first years after myocardial infarction, little is known about interactions between risk factors, whereas these could contribute to accurate differentiation of patients with higher and lower risk for mortality. This study explored the effect of interactions of risk factors on all-cause mortality in patients with myocardial infarction based on individual patient data meta-analysis. METHODS:Prospective data for 10,512 patients hospitalized for myocardial infarction were derived from 16 observational studies (MINDMAPS). Baseline measures included a broad set of risk factors for mortality such as age, sex, heart failure, diabetes, depression, and smoking. All two-way and three-way interactions of these risk factors were included in Lasso regression analyses to predict time-to-event related all-cause mortality. The effect of selected interactions was investigated with multilevel Cox regression models. RESULTS:Lasso regression selected five two-way interactions, of which four included sex. The addition of these interactions to multilevel Cox models suggested differential risk patterns for males and females. Younger women (age<50) had a higher risk for all-cause mortality than men in the same age group (HR 0.7 vs. 0.4), while men had a higher risk than women if they had depression (HR 1.4 vs. 1.1) or a low left ventricular ejection fraction (HR 1.7 vs. 1.3). Predictive accuracy of the Cox model was better for men than for women (area under the curves: 0.770 vs. 0.754). CONCLUSIONS:Interactions of well-known risk factors for all-cause mortality after myocardial infarction suggested important sex differences. This study gives rise to a further exploration of prediction models to improve risk assessment for men and women after myocardial infarction.

journal_name

BMC Med

journal_title

BMC medicine

authors

van Loo HM,van den Heuvel ER,Schoevers RA,Anselmino M,Carney RM,Denollet J,Doyle F,Freedland KE,Grace SL,Hosseini SH,Parakh K,Pilote L,Rafanelli C,Roest AM,Sato H,Steeds RP,Kessler RC,de Jonge P

doi

10.1186/s12916-014-0242-y

subject

Has Abstract

pub_date

2014-12-17 00:00:00

pages

242

issn

1741-7015

pii

s12916-014-0242-y

journal_volume

pub_type

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Sex dependent risk factors for mortality after myocardial infarction: individual patient data meta-analysis.