Background:  Premature heart disease in women is a growing concern. We undertook this study to systematically assess the occurrence of coronary events in middle-aged women who live in rural community settings. 

Method:  A retrospective chart review was conducted on 147 women, age ≤ 65 years (mean age 55 ± 8) presenting with a myocardial infarction (MI) in a two-year time period. Results:  In this cohort, 113 subjects (77%) had no history of coronary artery disease (CAD).  Rates of traditional risk factors were high, but 43% presented with 0 or 1 risk factor.  The triglyceride level (177 mg/dL ± 102) was the only mean lipid value not at an acceptable level.  Based on risk factors present at the time of their MI, only 10% of women, without a history of CAD/CAD risk equivalent, would have qualified for medical management and 18% for therapeutic lifestyle changes using NCEP guidelines.  However, 49% were identified with metabolic syndrome.  Kaplan-Meier curves indicated there was a significant difference in event-free survival between women with a history of CAD/CAD equivalent and those without (p=0.003).  Of the 135 women followed at 1-year, 54 (40%) were readmitted for a cardiac reason (chest pain, MI, revascularization procedure). At one-year, medication use was available for 87 women. Women discharged on recommended medications maintained their use at 1 year. At 1 year, total and LDL cholesterol levels were lower while HDL levels increased, but there was no change in triglyceride.

Conclusions: More attention needs to be directed to preventing premature heart disease in women by assessing for metabolic syndrome along with traditional risk factors.  Despite good compliance with recommended medication use and significant lowering of lipid levels, this population of middle-aged women continued to suffer adverse events in the first year post-MI. 

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