Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 2;5(5):e229953.
doi: 10.1001/jamanetworkopen.2022.9953.

Sex-Specific Risk Factors Associated With First Acute Myocardial Infarction in Young Adults

Yuan Lu  1   2 , Shu-Xia Li  1   2 , Yuntian Liu  1 , Fatima Rodriguez  3 , Karol E Watson  4 , Rachel P Dreyer  1   5   6 , Rohan Khera  7 , Karthik Murugiah  1   2 , Gail D'Onofrio  5 , Erica S Spatz  1   2 , Khurram Nasir  8   9 , Frederick A Masoudi  10 , Harlan M Krumholz  1   2   11
Affiliations

Sex-Specific Risk Factors Associated With First Acute Myocardial Infarction in Young Adults

Yuan Lu et al. JAMA Netw Open. .

Abstract

Importance: 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.

Objectives: 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.

Exposures: A wide range of demographic, clinical, and psychosocial risk factors.

Main outcomes and measures: Odds ratios (ORs) and population attributable fractions (PAF) for first AMI associated with demographic, clinical, and psychosocial risk factors.

Results: 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.

Conclusions and relevance: 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Lu reported receiving grants (K12HL138037) from the National Heart, Lung, and Blood Institute (NHLBI) outside the submitted work. Dr Khera reported being a cofounder of Evidence2Health and receiving grants from NHLBI outside the submitted work. Dr Murugiah reported receiving grants from NHLBI outside of the submitted work. Dr D’Onofrio reported receiving grants from NHLBI during the conduct of the study; and receiving grants from National Institute on Drug Abuse outside the submitted work. Dr Nasir reported serving on advisory boards for Novartis, Novo Nordisk, and Esperion and speakers bureau for Amgen outside the submitted work; research is partly supported by the Jerold B. Katz Academy of Translational Research. Dr Masoudi reported having a contract for his role as Chief Science Officer, National Cardiovascular Data Registry, from the American College of Cardiology outside the submitted work. Dr Krumholz reported receiving personal fees from Tesseract/4Catalyst, UnitedHealth, Element Science, Aetna, Reality Labs, F-Prime, Siegfried & Jensen Law Firm, Martin/Baughman Law Firm, Arnold and Porter Law Firm; being associated with grants from Johnson & Johnson; being a cofounder of HugoHealth, a personal health information platform, cofounder of Refactor Health, an enterprise health care artificial intelligence–augmented data management company, and being associated with contracts from the Centers for Medicare & Medicaid Services, through Yale New Haven Hospital, to develop and maintain performance measures that are publicly reported outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association of Risk Factors With AMI in Women vs Men
Only risk factors that were significant in the univariable analysis were included in the multivariable analysis. Age and race and ethnicity were adjusted by matching. AMI indicates acute myocardial infarction; OR, odds ratio; PAF, population attributable fraction.
Figure 2.
Figure 2.. Association of Risk Factors With Acute Myocardial Infarction (AMI) in Type 1 AMI vs Other Types of AMI, Adjusted for Age, Sex, and Race and Ethnicity
Age, sex, and race were adjusted by matching. OR indicates odds ratio; PAF, population attributable fraction.
See this image and copyright information in PMC

References

    1. Benjamin EJ, Virani SS, Callaway CW, et al. ; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee . Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67-e492. doi:10.1161/CIR.0000000000000558 - DOI - PubMed
    1. Arora S, Stouffer GA, Kucharska-Newton AM, et al. . Twenty year trends and sex differences in young adults hospitalized with acute myocardial infarction. Circulation. 2019;139(8):1047-1056. doi:10.1161/CIRCULATIONAHA.118.037137 - DOI - PMC - PubMed
    1. Gupta A, Wang Y, Spertus JA, et al. . Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol. 2014;64(4):337-345. doi:10.1016/j.jacc.2014.04.054 - DOI - PMC - PubMed
    1. Yandrapalli S, Nabors C, Goyal A, Aronow WS, Frishman WH. Modifiable risk factors in young adults with first myocardial infarction. J Am Coll Cardiol. 2019;73(5):573-584. doi:10.1016/j.jacc.2018.10.084 - DOI - PubMed
    1. Fournier JA, Sánchez-González A, Quero J, et al. . Normal angiogram after myocardial infarction in young patients: a prospective clinical-angiographic and long-term follow-up study. Int J Cardiol. 1997;60(3):281-287. doi:10.1016/S0167-5273(97)00115-0 - DOI - PubMed

Publication types