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. 2024 Jan 12:20:200237.
doi: 10.1016/j.ijcrp.2024.200237. eCollection 2024 Mar.

Sex and ethnic differences in unrecognized myocardial infarctions: Observations on recognition and preventive therapies from the multiethnic population-based HELIUS cohort

Bryn Hummel  1 , Julie A E van Oortmerssen  2 , CharlotteS M Borst  1 , Ralf E Harskamp  3 , Henrike Galenkamp  1   4 , Pieter G Postema  5 , Irene G M van Valkengoed  1 ; IMPRESS consortium
Affiliations

Sex and ethnic differences in unrecognized myocardial infarctions: Observations on recognition and preventive therapies from the multiethnic population-based HELIUS cohort

Bryn Hummel et al. Int J Cardiol Cardiovasc Risk Prev. .

Abstract

Background: Epidemiological studies suggest sex differences in the prevalence and characteristics of unrecognized and recognized myocardial infarction (uMI, rMI). Despite increasingly diverse populations, observations are limited in multiethnic contexts. Gaining better understanding may inform policy makers and healthcare professionals on populations at risk of uMI who could benefit from preventive measures.

Methods: We used baseline data from the multiethnic population-based HELIUS cohort (2011-2015; Amsterdam, the Netherlands). Using logistic regressions, we studied sex differences in the prevalence and proportion of uMIs across ethnic groups. Next, we studied whether symptoms, clinical parameters, and sociocultural factors were associated with uMIs. Finally, we compared secondary preventive therapies in women and men with a uMI or rMI. We relied on pathological Q-waves on a resting electrocardiogram as the electrocardiographic signature for (past) MI.

Results: Overall, and in Turkish and Moroccan subgroups, the prevalence of uMIs was higher in men than women. The proportion of uMIs was similar in women (21.0%) and men (18.4%), yet varied by ethnicity. In women and men, symptoms (chest pain, dyspnea) and clinical parameters (hypertension, hypercholesterolemia), and in women also lower educational level and diabetes were associated with lower odds of uMIs. Women (0.0%) and men (3.6%) with uMI were unlikely to receive secondary preventive therapies compared to those with rMI (28.1-40.9%).

Conclusions: The prevalence of uMIs was higher in men than women, and sex differences in the proportion of uMIs varied somewhat across ethnic groups. People with uMIs did not receive adequate preventative medications, posing a risk for recurrent events.

Keywords: Ethnic differences; Sex differences; Tertiary prevention; The HELIUS study; Unrecognized myocardial infarction.

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Conflict of interest statement

The authors report no relationships that could be construed as a conflict of interest. Table based on imputed data. OR, Odds Ratio; CI, Confidence Interval. All analyses were adjusted for age and ethnicity. *Based on self-report, baseline measurements, and medication use.

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