Sex Differences in Cardiac Risk Factors, Perceived Risk, and Health Care Provider Discussion of Risk and Risk Modification Among Young Patients With Acute Myocardial Infarction: The VIRGO Study

Abstract

Background: Differences between sexes in cardiac risk factors, perceptions of cardiac risk, and health care provider discussions about risk among young patients with acute myocardial infarction (AMI) are not well studied.

Objectives: This study compared cardiac risk factor prevalence, risk perceptions, and health care provider feedback on heart disease and risk modification between young women and men hospitalized with AMI.

Methods: We studied 3,501 AMI patients age 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study in U.S. and Spanish hospitals between August 2008 and January 2012, comparing the prevalence of 5 cardiac risk factors by sex. Modified Poisson regression was used to assess sex differences in self-perceived heart disease risk and self-reported provider discussions of risk and modification.

Results: Nearly all patients (98%) had ≥1 risk factor, and 64% had ≥3. Only 53% of patients considered themselves at risk for heart disease, and even fewer reported being told they were at risk (46%) or that their health care provider had discussed heart disease and risk modification (49%). Women were less likely than men to be told they were at risk (relative risk: 0.89; 95% confidence interval: 0.84 to 0.96) or to have a provider discuss risk modification (relative risk: 0.84; 95% confidence interval: 0.79 to 0.89). There was no difference between women and men for self-perceived risk.

Conclusions: Despite having significant cardiac risk factors, only one-half of young AMI patients believed they were at risk for heart disease before their event. Even fewer discussed their risks or risk modification with their health care providers; this issue was more pronounced among women.

Keywords: myocardial infarction; prevention; risk factor; sex.

Figure 1. Perceptions and Discussions of Risk by Sex and Country

Percentage of women and men reporting that prior to their index AMI event they considered themselves at-risk for heart disease, were told by a healthcare professional that they were at-risk, or had a healthcare provider talk to them about heart disease and ways to modify their risk. P-values for comparisons by sex within the overall, United States, and Spain cohorts were calculated using χ2 tests.

Central Illustration. Risk Perceptions and Discussions before AMI: Risk-Adjusted Associations of Sex (Women versus Men) with Perceptions and Discussions of Risk

Adjusted relative risks and 95% confidence intervals for women versus men were calculated for the overall cohort, among subgroups of patients defined by documented modifiable risk factors (diabetes, dyslipidemia, hypertension, obesity, current smoking) and family history of coronary artery disease, among those with and without a personal history of coronary artery disease (i.e., prior acute myocardial infarction or revascularization procedure), and among those who did and did not visit a heart specialist in the past year. ≥ 3RFs indicates patient has at least 3 of the 5 potentially modifiable risk factors; CAD, coronary artery disease; DM, diabetes history documented in the medical chart or glucose-lowering medication on arrival; DYSLIP, dyslipidemia history documented in the medical record or lipid-control medication on arrival; HTN, hypertension history documented in the medical chart; OBESE, body mass index ≥ 30kg/m²; SMOKE, current smoking within the past 30 days.