Objective:

To compare the long-term risk of heart failure, atrial fibrillation, stroke, and all-cause mortality among women and men with unrecognized myocardial infarction (UMI), recognized myocardial infarction (RMI), and no myocardial infarction (MI).

Key Findings:

• In women, UMI was associated with increased risks of HF (HR 1.31, 95% CI 1.01–1.71) and all-cause mortality (HR 1.21, 95% CI 1.05–1.40), but significance diminished after adjusting for risk factors.
• Recognized MI in women significantly increased risks of HF (HR 2.58, 95% CI 1.94–3.43), AF (HR 1.62, 95% CI 1.13–2.32), and all-cause mortality (HR 1.81, 95% CI 1.54–2.12).
• In men, both UMI and RMI were linked to higher risks of HF (UMI: HR 1.90, 95% CI 1.45–2.48; RMI: HR 2.49, 95% CI 2.09–2.98), AF (UMI: HR 1.91, 95% CI 1.45–2.54; RMI: HR 1.79, 95% CI 1.46–2.19), stroke (UMI: HR 2.06, 95% CI 1.52–2.80; RMI: HR 1.36, 95% CI 1.06–1.76), and all-cause mortality (UMI: HR 1.59, 95% CI 1.36–1.85; RMI: HR 1.63, 95% CI 1.46–1.81).

Interpretation:

UMI has a differential impact on long-term prognosis in women and men, indicating the necessity for sex-specific cardiovascular risk assessment and prevention strategies to improve outcomes.

Limitations:

• The study's observational nature limits causal inferences.
• Potential biases in self-reported medical history and ECG interpretations.
• Findings may not be generalizable to populations outside the Rotterdam Study.

Conclusion:

UMI is associated with significant long-term risks in both sexes, emphasizing the need for improved identification and management strategies tailored to sex differences.