New Findings Suggest Need for Sex-specific Strategies to Prevent Heart Attacks in Young Adults

In a first of its kind study, researchers at Yale identified several risk factors, “many potentially modifiable,” that are more likely to trigger an acute myocardial infarction (AMI) among men and women aged ≤55 years.

“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,” wrote study authors in JAMA Network Open.

MIs are often associated with older adults, however, an increasing proportion of US individuals hospitalized for AMI are younger than 55 years, with the largest increase in young women, according to the study.

“Young women with AMI are an unusual or extreme phenotype on account of their age,” said lead author Yuan Lu, ScD, assistant professor, Yale School of Medicine, in a university press release. “In the past, we found that young women, but not older women, have a twice higher risk of dying after an AMI than similarly aged men. In this new study, we now identified significant differences in risk factor profiles and risk factor associations with AMI by sex.”

Lu and colleagues conducted a population-based case-controlled study to examine the sex-specific associations of demographic, clinical, and psychosocial risk factors with first AMI among adults aged ≤55 years, overall, and by AMI subtype.

Here we used a novel study design with a large cohort of patients with AMI and then we identified age-sex-race matched population control from a national population survey to compare this with, and we used a case-control design to evaluate the association of these risk factors with AMI,” said Lu. “This is one of the first and largest studies to address this issue comprehensively.”

The team used data from 2264 patients with AMI (aged 18-55 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 from the National Health and Nutrition Examination Survey from 2008 to 2012.

The key finding was that 7 risk factors collectively accounted for the majority of total risk for first AMI in young women (83.9%) and young men (85.1%). These risk factors were diabetes, depression, hypertension (HTN), current smoking, family history of premature MI, low household income, and hypercholesterolemia.

According to the study, depression, HTN, 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.

Researchers also found that the distribution of risk factors varied by AMI subtype. Diabetes, hypercholesteremia, obesity, and current smoking had significantly higher prevalence in patients with type 1 AMI than in those with other types of AMI.

“Our results of different risk factors associated with distinct AMI subtypes call for a more precise assessment of AMI risk in young adults,” wrote investigators. “While current risk prediction tools target an aggregate diagnosis of AMI, development of more specific individual patient risk prediction for each AMI subtype will allow for effective application of preventive therapies in an individual patient.”

The authors noted several study limitations, among them the potential for residual confounding characteristic of observational studies and the impact of recall bias among patients responding to interviews to obtain medical history.

Reference: Lu Y, Li SX, Liu Y, et al. Sex-specific risk factors associated with first acute myocardial infarction in young adults. JAMA Netw Open. 2022;5:e229953.