Gender differences in risk factors and clinical outcomes in young patients with acute myocardial infarction

Cho, Kyoung Im; Shin, Eun‐Seok; Ann, Soe Hee; Garg, Scot; Her, Ae-Young; Kim, Jeong Su; Han, Jun; Jeong, Myung Ho

doi:10.1136/jech-2015-207023

Cited by 16 publications

(13 citation statements)

References 36 publications

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“…These investigations found that young patients were more likely to be male, to be a smoker, and to have a family history of CHD. In agreement, young men with hypertension are significantly less likely to develop CHD than women in the same age group 32 , 39 . In summary, epidemiological data, clinical findings, and the current results support the hypothesis that microvascular changes play little to no role in the development of CHD and MI in young men.…”

Section: Discussionsupporting

confidence: 65%

“…Our study differed in that as it only included patients who experienced an MI before the age of 50. Our study adds to the literature because little is known about baseline clinical characteristics and CHD risk factors in the young MI population 32 . Prior studies that examined younger CHD or MI patients used an age cut-off of 40 or 45 years to distinguish between young and “nonyoung” patients 33 – 38 .…”

Section: Discussionmentioning

confidence: 99%

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Association between optical coherence tomography based retinal microvasculature characteristics and myocardial infarction in young men

Kromer

Tigges

Rashed

et al. 2018

Sci Rep

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Incident myocardial infarction (MI) is a leading cause of adult mortality in the United States. However, because MI has a relatively low incidence in the young population, little information exists on the disease in younger adults. Because the retina has the unique quality that its vasculature is readily and noninvasively visible, the retina is frequently studied to evaluate correlations between vessels and cardiovascular diseases. In the current study, we evaluated the retinal microvasculature of patients who had experienced an MI before 50 years of age (n = 53 subjects) and age- and sex-matched patients who had not experienced an MI (n = 53 patients). We used circular optical coherence tomography (OCT) scans to image peripapillary venules and arterioles. The diameter of each vessel was measured and the respective arterial-venous ratio (AVR) was calculated. We did not detect any significant differences between MI and control subjects in retinal vessel calibre or AVR.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Association between optical coherence tomography based retinal microvasculature characteristics and myocardial infarction in young men

Kromer

Tigges

Rashed

et al. 2018

Sci Rep

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“…There are sex-related differences in the clinical presentations, cardiovascular risk profiles, and therapeutic interventions of patients with cardiovascular disease; these differences are cited as reasons for worse prognosis in women after cardiovascular events 1 , 2 . On the other hand, in spite of a reportedly lower coronary revascularization rate in women, several observational and registry data have demonstrated that sex is not an independent predictor for worse clinical outcomes 3 , 4 . Moreover, percutaneous coronary intervention (PCI) with a contemporary drug-eluting stent (DES) has shown improved clinical outcomes in women and men 5 , 6 .…”

Section: Introductionmentioning

confidence: 95%

Sex-related impacts on clinical outcomes after percutaneous coronary intervention

Park

Han

Park

et al. 2020

Sci Rep

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The aim of this study is to investigate sex-related impacts on clinical outcomes after percutaneous coronary intervention (PCI). We analyzed 90,305 patients (29.0% of women) with the first episode of coronary artery disease who underwent PCI from the Korean National Health Insurance claims database between July 2013 and June 2017. Women were significantly older than men (71.5 ± 10.5 vs. 61.8 ± 11.7 years, p < 0.001). The study population had a median follow-up of 2.2 years (interquartile range, 1.2–3.3). In the propensity-score matched angina population (15,104 pairs), the in-hospital mortality of women was not different from men (odds ratio, 0.87; 95% confidence interval: 0.71–1.08, p = 0.202). However, the post-discharge mortality of women was significantly lower (hazard ratio, 0.74; 95% confidence interval: 0.69–0.80, p < 0.001) than that of men. In the propensity-score matched acute myocardial infarction (AMI) population (8,775 pairs), the in-hospital mortality of women was significantly higher than that of men (odds ratio, 1.19; 95% confidence interval: 1.05–1.34, p = 0.006). Meanwhile, there was no difference in mortality after discharge (hazard ratio, 0.98; 95% confidence interval: 0.91–1.06, p = 0.605). The post-discharge mortality of women was not higher than men under the contemporary PCI treatment. Altered sex-related impacts on clinical outcomes might be attributed to improved medical and procedural strategies.

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“…Despite significantly higher risk of adverse events, women are less likely to be referred for cardiac catheterizations or PCI, due to underdiagnosis and perceived risk of complications. 18 , 25 , 93 , 100 In the Canadian ACS study by Udell et al, 66.1% men and 51.8% women received cardiac catheterization in the same admission. 93 In the Israeli ACS registry, even after adjustment for GRACE score, diabetes, and year of enrolment, young women <55 years of age were less likely to undergo in-hospital coronary angiography (OR 0.6, p =0.007).…”

Section: Introductionmentioning

confidence: 99%

“… 25 In data from the Korean nationwide registry (Korea Working Group of Myocardial Infarction) between November 2005 and July 2011, women ≤50 years of age were more likely to be treated with conservative management (30.4% vs 11.2%, p <0.001) and less likely to receive optimal medical therapy and less PCI (69.5% vs 89%, p <0.001) with lower rates of PCI success (85.8% vs 92.2%, p <0.001). 100 In the GENESIS-PRAXY study, 13% women vs 3% men ( p =0.01) reported no intervention done. 38 Rodriguez et al noted that among patients <65 years, women were less likely to undergo angiography and PCI than men among all races.…”

Section: Introductionmentioning

confidence: 99%

Acute myocardial infarction in young women: current perspectives

Chandrasekhar¹,

Gill²,

Mehran³

2018

IJWH

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Acute myocardial infarction (AMI) is the leading cause of death in women worldwide. Every year, in the USA alone, more than 30,000 young women <55 years of age are hospitalized with AMI. In recent decades, the incidence of AMI is increasing in younger women in the context of increasing metabolic syndrome, diabetes mellitus, and non-traditional risk factors such as stress, anxiety, and depression. Although women are classically considered to present with atypical chest pain, several observational data confirm that men and women experience similar rates of chest pain, with some differences in intensity, duration, radiation, and the choice of descriptors. Women also experience more number of symptoms and more prodromal symptoms compared with men. Suboptimal awareness, sociocultural and financial reasons result in pre-hospital delays in women and lower rates of access to care with resulting undertreatment with guideline-directed therapies. Causes of AMI in young women include plaque-related MI, microvascular dysfunction or vasospasm, and spontaneous coronary artery dissection. Compared with men, women have greater in-hospital, early and late mortality, as a result of baseline comorbidities. Post-AMI women have lower referral to cardiac rehabilitation with more dropouts, lower levels of physical activity, and poorer improvements in health status compared with men, with higher inflammatory levels at 1-year from index presentation. Future strategies should focus on primary and secondary prevention, adherence, and post-AMI health-related quality of life. This review discusses the current evidence in the epidemiology, diagnosis, and treatment of AMI in young women.

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Gender differences in risk factors and clinical outcomes in young patients with acute myocardial infarction

Abstract: There were significant gender differences in the risk factors for coronary artery disease and the short-term and long-term clinical outcomes of young patients with AMI. Continued preventive strategies should be focused on gender-different risk factor reduction in these young patients.

Cited by 16 publications

References 36 publications

Association between optical coherence tomography based retinal microvasculature characteristics and myocardial infarction in young men

Association between optical coherence tomography based retinal microvasculature characteristics and myocardial infarction in young men

Sex-related impacts on clinical outcomes after percutaneous coronary intervention

Acute myocardial infarction in young women: current perspectives

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