that frail men may face a higher risk of death than frail women after a heart attack.
The findings challenge the common belief that women are always at greater risk of poor outcomes and suggest that treatment approaches may need to be tailored more carefully for each sex.
Researchers from the University of Leicester and partner institutions analyzed data from more than 900,000 heart attack patients over a 15-year period.
Their results, published in The Lancet Regional Health—Europe, describe what scientists call a “sex-frailty paradox.”
Frailty refers to a person’s overall physical vulnerability, often seen in older adults or those with multiple health problems.
It has long been known to increase the risk of complications, hospital readmissions, and death after serious illnesses such as heart attacks.
The study found that severe frailty is more common among women after a heart attack. However, despite being less likely to be classified as frail, men who are frail face a significantly higher chance of dying within a year of the event.
This creates a complicated picture. Women still experience well-documented inequalities in heart attack care, including delays in diagnosis and treatment. At the same time, frail men appear to have a particularly dangerous prognosis that current medical strategies may not fully address.
Lead researcher Dr. Muhammad Rashid explained that doctors have traditionally treated frailty as a uniform risk factor, without considering how it may affect men and women differently. The new findings suggest that frailty interacts with sex in ways that change outcomes.
One possible explanation is that frail men often have more severe heart disease, higher rates of diabetes, and a greater burden of multiple health conditions. Their hearts may also be less able to recover after a major cardiovascular event. Even when they receive intensive treatment, their bodies may struggle to withstand further stress.
In contrast, frailty in women may reflect a broader decline across several body systems rather than severe heart disease alone. This could mean that while women may be frail overall, their heart condition may not be as advanced as in men.
Experts say the results highlight the need for more personalized care. Current treatment guidelines often rely heavily on age and frailty scores to determine therapy, but these tools may not capture the full picture. The researchers suggest developing sex-specific assessment methods to better identify patients at highest risk.
Improving care for both men and women remains essential. Women must continue to receive equal access to proven life-saving treatments, while frail men may need additional support beyond standard heart care, such as targeted rehabilitation and management of other health conditions.
The study underscores a broader message for modern medicine: health risks are not always the same for everyone. Understanding how factors like sex and frailty interact could help doctors design treatments that save more lives after heart attacks.
Source: University of Leicester.
