Striking gender differences in risk factors for acute MI in young adults

Psychosocial factors may matter more for women than for men, while the reverse was true for high cholesterol, according to data from VIRGO.

Young adults who have an acute MI before age 55 have many risk factors in common regardless of gender, but new analysis of data from the VIRGO study shows that psychosocial risk factors carry particular weight in women .

Yuan Lu, ScD (Yale New Haven Hospital, CT), the lead author of the study, pointed out to TCTMD that while young women represent only a fraction of the overall population with cardiovascular disease, this translates to 40,000 MI-related hospitalizations in the United States each year. Yet risk awareness is lacking among patients and clinicians, she noted.

For women, acute MIs carry a high mortality burden after their onset, which argues for better primary prevention, Lu pointed out. “Understanding the risk factors would be very important to inform the target of intervention .”

The gender differences they found were striking, she said, and they underscore the need for targeted prevention strategies. Mental health and income level, for example, mattered more to women than to men. Hypercholesterolemia, on the other hand, was more of a determinant for men, possibly because many patients in the age group under 55 are premenopausal, she suggested.

Their study, published online in Open JAMA Networkis one of the most comprehensive on this topic to date, Lu said.

Income, mental health and more

VIRGO, a multicenter registry, was designed to study the effects of gender on outcomes in young patients with MI. Lu and colleagues performed a matched case-control study comparing 2,264 VIRGO patients who had an acute MI before age 55 with 2,264 population-based controls from the National Health and Nutrition Survey. Among them, 68.9% were women and the median age was 48 years old.

The researchers identified seven risk factors that, taken together, accounted for about 85% of the total risk of MI in both men and women. However, there were differences in the strengths of the associations. Notably, low household income was significantly related to acute MI in women, but not in men.

Risk Factors for Acute MI in Young Adults

OR

95% CI

Diabetes

Women

Men

3.59

1.76

2.72-4.74

1.19-2.60

Depression

Women

Men

3.09

1.77

2.37-4.04

1.15-2.73

Hypertension

Women

Men

2.87

2.19

2.31-3.57

1.65-2.90

Current smoking

Women

Men

3.28

3.05

2.65-4.07

2.28-4.10

Family history of premature MI

Women

Men

1.48

2.42

1.17-1.88

1.71-3.41

Low household income

Women

Men

1.79

1.35

1.28-2.50

0.82-2.23

Hypercholesterolemia

Women

Men

1.02

2.16

0.81-1.29

1.49-3.15

Diabetes, depression, hypertension, and current smoking contributed more to the total risk of acute MI in women than in men, while high cholesterol and family history of premature MI were more significant contributors in men. men.

Moreover, traditional CV risk factors were both more frequent and more strongly associated with MI type 1 than with MI type 2.

How to apply this information in practice remains a difficult question, Lu said. “I think the first step [is] educate clinicians and patients about heart attack in young women. It is important, she continued, to ask young women about topics such as depression, stress and income. “Once we have identified young women who could potentially be at high risk of developing heart disease, we can put them in touch with, for example, social workers or community health workers.” Low-income patients could benefit from coupons to use at the pharmacy or discounts on parking and transportation, for example.

Unlike lab values, “social factors are usually not documented in electronic health records,” she observed, adding, “Because they are not documented, the next time you come to see the doctor, the doctor can’t see your social history, and they can’t. weigh in and make clinical decisions to address it. It can be difficult to standardize those details in a way that fits a typical “dashboard,” she acknowledged, and tailor the selection process to a 15-minute appointment.

In terms of research, Yu said the next step is an analysis focused on participants in the VIRGO study, exploring how things like their menopausal and reproductive history relate to the risk of myocardial infarction compared to controls based on on the population. Another area ripe for further study is a risk prediction tool suitable for young patients.

Comments are closed.