Toyofuku M, Goto Y, Matsumoto T, Miyao Y, Morii I, Daikoku S, Itoh A, Miyazaki S, Nonogi H
Division of Cardiology, National Cardiovascular Center, Suita.
J Cardiol. 1996 Dec;28(6):313-9.
Women appear to be protected, until the menopause, from the development of coronary artery disease. The incidence of acute myocardial infarction in young women is very low, so there is little information on the etiology, clinical features, and prognosis for such patients. We studied 24 young female patients with acute myocardial infarction (< 50 years) among 2,457 consecutive patients with acute myocardial infarction admitted to the coronary care unit of the National Cardiovascular Center from December 1977 through August 1994. Their clinical features and in-hospital mortality were compared with 100 consecutive young male patients (< 50 years) with acute myocardial infarction. The fraction of patients of age younger than 50 years among all age groups was lower in female than in male acute myocardial infarction patients (5% vs 13%, p < 0.01). The increase of the coronary risk factors, hypercholesterolemia (25% vs 55%, p < 0.05) and cigarette smoking (17% vs 96%, p < 0.05) were less common in women. In female patients, the serum total cholesterol level was lower (195 +/- 50 vs 216 +/- 48 mg/dl, p = 0.06), and the serum high-density lipoprotein cholesterol level was higher (50 +/- 12 vs 39 +/- 12 mg/dl, p < 0.05) than in male patients. Other risk factors did not differ significantly between the two groups. Angiography 1 month after myocardial infarction showed fewer diseased coronary arteries (> 75% stenosis) in female than male patients (0.8 +/- 0.9 vs 1.8 +/- 1.0, p < 0.01), and normal coronary arteries were seen in 35% of female patients (male 6%, p < 0.05). Ten female patients (42%) had obviously non-atherosclerotic causes of acute myocardial infarction: Takayasu aortitis in three patients, coronary embolism in two, acute dissection of the aorta in two, and idiopathic coronary artery dissection, Kawasaki disease, and systemic lupus erythematosus in one each. In contrast, among male patients, only one had coronary embolism (1%). In-hospital mortality was higher in women (17%) than in men (2%, p < 0.05). Young female patients (< 50 years) with acute myocardial infarction have a low incidence of hyperlipidemia and normal coronary arteries or involvement of the left main trunk are more common compared with male patients (< 50 years). Although 42% of female patients had obvious non-atherosclerotic etiology of acute myocardial infarction, the causes varied widely.
在绝经前，女性似乎受到保护，不易患冠状动脉疾病。年轻女性急性心肌梗死的发病率非常低，因此关于此类患者的病因、临床特征和预后的信息很少。我们研究了1977年12月至1994年8月期间连续入住国立心血管中心冠心病监护病房的2457例急性心肌梗死患者中的24例年轻女性急性心肌梗死患者（年龄<50岁）。将她们的临床特征和住院死亡率与100例连续的年轻男性急性心肌梗死患者（年龄<50岁）进行比较。在所有年龄组中，年龄小于50岁的女性急性心肌梗死患者的比例低于男性（5%对13%，p<0.01）。女性中冠状动脉危险因素（高胆固醇血症（25%对55%，p<0.05）和吸烟（17%对96%，p<0.05））的增加不太常见。女性患者的血清总胆固醇水平较低（195±50对216±48mg/dl，p=0.06），血清高密度脂蛋白胆固醇水平较高（50±12对39±12mg/dl，p<0.05），高于男性患者。两组之间的其他危险因素没有显著差异。心肌梗死后1个月的血管造影显示，女性患者中病变冠状动脉（狭窄>75%）的数量少于男性患者（0.8±0.9对1.8±1.0，p<0.01），35%的女性患者可见正常冠状动脉（男性为6%，p<0.05）。10例女性患者（42%）有明显的非动脉粥样硬化性急性心肌梗死病因：3例为高安动脉炎，2例为冠状动脉栓塞，2例为主动脉急性夹层，1例为特发性冠状动脉夹层、川崎病和系统性红斑狼疮各1例。相比之下，男性患者中只有1例有冠状动脉栓塞（1%）。女性的住院死亡率高于男性（17%对2%，p<0.05）。与男性患者（年龄<50岁）相比，年轻女性急性心肌梗死患者（年龄<50岁）高脂血症的发生率较低，正常冠状动脉或左主干受累更为常见。虽然42%的女性患者有明显的非动脉粥样硬化性急性心肌梗死病因，但其病因差异很大。
