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The heart attack gap between men and women is narrowing in good and bad ways for women.

Two new studies show that the number of heart attacks is rising among middle-aged women and falling among men, but the risk of death after a heart attack is improving more for women than for men.

Middle-aged men have historically had a higher prevalence of heart attack and advanced heart disease than women of the same age, but researchers say the findings suggest the risk is increasing among women and decreasing in men.

“Cardiovascular illnesses have been long neglected in their role as the primary cause of mortality in women, both by patients and physicians,” write Sabine Oertelt-Prigione, MD, and Vera Regitz-Zagrosek, MD, PhD, of Charité Universitaetsmedizin, Berlin, in an editorial that accompanies the studies in the Archives of Internal Medicine.

“As these studies show, increased and continuous vigorous attention to the prevention of cardiovascular risk factors — by healthy diet, regular physical activity, and avoidance of smoke and smoking — is necessary for both men and women,” they write.

Heart Attack Gap Narrowing

In the first study, researchers compared heart attack risk factors and prevalence of heart attacks among more than 8,000 men and women aged 35 to 54 who participated in a national health survey during 1988 to 1994 and 1999 to 2004.

During both time periods, the results showed that heart attack risk factors such as total cholesterol levels, high-density lipoprotein (HDL or “good” cholesterol), blood pressure, and smoking status remained stable or improved among men but mostly worsened among women. The only heart attack risk factor that improved in women was HDL cholesterol level.

Diabetes, another major heart disease risk factor, increased among men and women, most likely because of rising obesity among both sexes.

The study also showed that although men had more heart attacks than women in the same age group during both time periods, the gap narrowed in recent years as heart attack prevalence increased among women. For example, in 1988-1994, 2.5% of men and 0.7% of women reported a heart attack compared with 2.2% of men and 1% of women in 1999-2004.

“Therefore, intensification of efforts at screening for and treating vascular risk factors in women in their midlife years may be warranted,” writes researcher Amytis Towfighi, MD, of the University of Southern California, Los Angeles.

Outlook Improving Among Women

In the second study, researchers looked at trends in the risk of death after heart attack among 916,380 men and women who had a heart attack between 1994 and 2006.

The results showed the number of people who died in the hospital after a heart attack declined dramatically among all patients and age groups, but more so in women than in men.

“We found that the number of younger women who die in the hospital after a heart attack, compared with men in the same age group, has narrowed over the last few years,” researcher Viola Vaccarino, MD, PhD, director of the Emory Program in Cardiovascular Outcomes Research and Epidemiology, says in a news release.

The decrease in death rate after heart attack was three times larger in women under the age of 55 than in men in the same age group.

Researchers found this gender difference in the declining risk of death after heart attack became progressively smaller in older men and women.