Sex-Specific Strategies May be Necessary for Prevention of Acute MI in Young Adults

Harlan M. Krumholz, MD

New finding highlight the need for sex-specific strategies in risk factor modification and prevention of acute myocardial infarction (AMI) in young adults, resulting from signficant sex differences in risk factor profiles.

Risk factors, many modifiable, including diabetes, depression, hypertension, current smoking status, family history of premature myocardial infarction, low household income, and hypercholesterolemia accounted for 85% of the risk of first AMI in young men and women, the study authors observed.

“Given that the prevalence of these modifiable risk factors is increasing in the US, the high prevalence of risk factors and the strong association with AMI in young women together will put them at a substantial risk for future cardiovascular events,” wrote corresponding author Harlan M. Krumholz, MD, SM, Center for Outcomes Research and Evaluation, Yale New Haven Hospital.

Krumholz and colleagues noted a greater understanding of risk factors associated with AMI in young men and men, as well as how these associations vary by sex and AMI subtype, may have important implications for designing primary prevention strategies.

They used a case-control study design with 2264 patients with AMI from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study and 2264 population-based controls matched for age, sex, and race and ethnicity from the National Health and Nutrition Examination Survey (NHANES).

Investigators collected data though in-person interviews regarding participant’s sociodemographic characteristics, medical history, family history of cardiovascular diseases, and psychosocial factors.

Due to their focus on sex-specific risk factors for AMI, investigators developed separate models for men and women and compared the prevalence and odds ratios (OR) or risk factors for men vs women. They additionally calculated population attributable fraction (PAF), an estimation of the fraction of AMI cases in the population that were attributable to an exposure to 1 or several risk factors.

From the total 4528 case patients and matched controls, 3122 (68.9%) were women and the median age was 48 years.

Investigators observed significant interactions for diabetes, depression, hypertension, current smoking, and family history of diabetes were stronger in young women with AMI, whereas hypercholesterolemia had stronger associations in young men.

After multivariable adjustment, a total of 7 risk factors remained statistically significant in men or women:

• Diabetes (OR, 2.58; 95% CI, 2.72 - 4.74 in women vs 1.76 [1.19 - 2.60] in men)
• Depression (OR, 3.09; 95% CI, 2.37 - 4.04 in women vs 1.77 [1.15 -  2.73] in men)
• Hypertension (OR, 2.87; 95% CI, 2.31 - 3.57 in women vs 2.19 [1.65 - 2.90) in men)
• Current smoking (OR, 3.28 [95% CI, 2.65 - 4.07) in women vs 3.28 [2.65 - 4.07] in men)
• Family history of premature myocardial infarction (OR, 1.48; 95% CI, 1.17 - 1.88 in women vs 2.42 [1.71 - 3.41] in men)
• Low household income (OR, 1.79; 95% CI, 1.28 - 2.50 in women vs 1.35 [0.82 - 2.23] in men)
• Hypercholesterolemia (OR, 1.02; 95% CI, 0.81 - 1.29 in women vs 2.16 [1.49 - 3.15] in men)

“Risk factors also varied by subtype of AMI, with traditional cardiovascular risk factors having higher prevalence and stronger associations for type 1 AMI compared with other types of AMI not resulting from acute plaque rupture,” the study authors wrote.

The study, “Sex-Specific Risk Factors Associated With First Acute Myocardial Infarction in Young Adults,” was published online in JAMA Network Open.