Sex-Based Differences in Unrecognized Myocardial Infarction

M. Yldau van der Ende, Luis Eduardo Juarez-Orozco, Ingmar Waardenburg, Erik Lipsic, Remco A. J. Schurer, Hindrik W. van der Werf, Emelia J. Benjamin, Dirk Jan van Veldhuisen, Harold Snieder, Pim van der Harst*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: Myocardial infarction is an important cause of morbidity and mortality in both men and women. Atypical or the absence of symptoms, more prevalent among women, may contribute to unrecognized myocardial infarctions and missed opportunities for preventive therapies. The aim of this research is to investigate sex-based differences of undiagnosed myocardial infarction in the general population.

METHODS AND RESULTS: In the Lifelines Cohort Study, all individuals >= 18 years with a normal baseline ECG were followed from baseline visit till first follow-up visit (approximate to 5 years, n=97 203). Individuals with infarct-related changes between baseline and follow-up ECGs were identified. The age- and sex-specific incidence rates were calculated and sex-specific cardiac symptoms and predictors of unrecognized myocardial infarction were determined. Follow-up ECG was available after a median of 3.8 (25th and 75th percentile: 3.0-4.6) years. During follow-up, 198 women experienced myocardial infarction (incidence rate 1.92 per 1000 persons-years) compared with 365 men (incidence rate 3.30; P

CONCLUSIONS: A substantial proportion of myocardial infarctions are unrecognized, especially in women. Opportunities for secondary preventive therapies remain underutilized if myocardial infarction is unrecognized.

Original languageEnglish
Article number015519
Pages (from-to)e015519
Number of pages15
JournalJournal of the American Heart Association
Issue number13
Publication statusPublished - 7-Jul-2020


  • cohort study
  • epidemiology
  • incidence
  • sex differences
  • unrecognized myocardial infarction
  • RISK
  • MEN
  • CARE

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