Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
JAMA Netw Open. 2022 May 2;5(5):e229953. doi: 10.1001/jamanetworkopen.2022.9953.
An increasing proportion of people in the US hospitalized for acute myocardial infarction (AMI) are younger than 55 years, with the largest increase in young women. Effective prevention requires an understanding of risk factors associated with risk of AMI in young women compared with men.
To assess the sex-specific associations of demographic, clinical, and psychosocial risk factors with first AMI among adults younger than 55 years, overall, and by AMI subtype.
DESIGN, SETTING, AND PARTICIPANTS: This study used a case-control design with 2264 patients with AMI, aged 18 to 55 years, from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study and 2264 population-based controls matched for age, sex, and race and ethnicity from the National Health and Nutrition Examination Survey from 2008 to 2012. Data were analyzed from April 2020 to November 2021.
A wide range of demographic, clinical, and psychosocial risk factors.
Odds ratios (ORs) and population attributable fractions (PAF) for first AMI associated with demographic, clinical, and psychosocial risk factors.
Of the 4528 case patients and matched controls, 3122 (68.9%) were women, and the median (IQR) age was 48 (44-52) years. Seven risk factors (diabetes [OR, 3.59 (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]) collectively accounted for the majority of the total risk of AMI in women (83.9%) and men (85.1%). There were significant sex differences in risk factor associations: hypertension, depression, diabetes, current smoking, and family history of diabetes had stronger associations with AMI in young women, whereas hypercholesterolemia had a stronger association in young men. Risk factor profiles varied by AMI subtype, and traditional cardiovascular risk factors had higher prevalence and stronger ORs for type 1 AMI compared with other AMI subtypes.
In this case-control study, 7 risk factors, many potentially modifiable, accounted for 85% of the risk of first AMI in young women and men. Significant differences in risk factor profiles and risk factor associations existed by sex and by AMI subtype. These findings suggest the need for sex-specific strategies in risk factor modification and prevention of AMI in young adults. Further research is needed to improve risk assessment of AMI subtypes.
越来越多的美国因急性心肌梗死（AMI）住院的患者年龄在 55 岁以下，其中年轻女性的比例增长最大。有效的预防需要了解与年轻女性相比，男性患 AMI 的风险因素。
评估人口统计学、临床和心理社会风险因素在年轻成年人中与首次 AMI 的性别特异性关联，包括整体情况以及不同 AMI 亚型的情况。
设计、地点和参与者：本研究采用病例对照设计，纳入了 2264 名来自 VIRGO（年轻 AMI 患者的性别对预后的影响）研究的 18 至 55 岁 AMI 患者，以及 2264 名来自 2008 年至 2012 年全国健康和营养调查的年龄、性别和种族相匹配的人群对照。数据分析于 2020 年 4 月至 2021 年 11 月进行。
广泛的人口统计学、临床和心理社会风险因素。
与人口统计学、临床和心理社会风险因素相关的首次 AMI 的比值比（OR）和人群归因分数（PAF）。
在 4528 名病例患者和匹配的对照组中，3122 名（68.9%）为女性，中位（IQR）年龄为 48（44-52）岁。有 7 个风险因素（糖尿病[OR，2.72-4.74 比 1.19-2.60]在女性中；抑郁症[OR，2.37-4.04 比 1.15-2.73]在女性中；高血压[OR，2.31-3.57 比 1.65-2.90]在女性中；当前吸烟[OR，2.65-4.07 比 2.65-4.07]在女性中；家族性早发性心肌梗死史[OR，1.17-1.88 比 1.71-3.41]在女性中；低家庭收入[OR，1.28-2.50 比 0.82-2.23]在女性中；高胆固醇血症[OR，0.81-1.29 比 1.49-3.15]在女性中）共同导致了女性（83.9%）和男性（85.1%）AMI 的大部分总风险。在风险因素相关性方面存在显著的性别差异：高血压、抑郁症、糖尿病、当前吸烟和糖尿病家族史与年轻女性的 AMI 相关性更强，而高胆固醇血症与年轻男性的 AMI 相关性更强。风险因素谱因 AMI 亚型而异，传统心血管风险因素在 1 型 AMI 中比其他 AMI 亚型更为普遍，且比值比更高。
在这项病例对照研究中，有 7 个风险因素（其中许多是潜在可改变的），占年轻女性和男性首次 AMI 风险的 85%。性别和 AMI 亚型的风险因素谱和风险因素相关性存在显著差异。这些发现表明，需要针对年轻成年人的 AMI 进行特定性别的风险因素改变和预防策略。需要进一步研究以改善 AMI 亚型的风险评估。
