Abstract 96: Sex Differences in Pre-Event Health Status of Young Patients with Acute Myocardial Infarction: The VIRGO Study

Abstract

Background: Young women are presumed to be at low risk for coronary artery disease and may have pre-existing angina that is undetected until they present with an acute myocardial infarction (AMI). The health status (symptoms, function and quality of life) of patients prior to their AMI has received little attention in the medical literature and the pre-existing health status of young women presenting with an AMI, as compared with men, is unknown. Methods: VIRGO is a prospective observational study that enrolled 2990 AMI patients aged 18-55 years. We abstracted clinical information from medical records and health status data was collected through patient interviews that included the Seattle Angina Questionnaire [SAQ], Short Form 12 [SF-12] and EuroQol [EQ-5D]. We calculated summary statistics using t-test/chi-square analyses and used multivariable linear regression analysis to identify clinical factors associated with patients’ health status. Results: The median age was 48 yrs (IQR: 44, 52) and did not differ by sex. Women were more likely to present with obesity (54% vs. 47%), and have a history of stroke (6% vs. 3%), diabetes (40% vs. 27%), heart failure (6% vs. 3%), and renal failure (13% vs. 9%; all P-values <0.001), but less likely to have a history of dyslipidemia (66% vs. 72%, P=0.0001). Women had significantly lower general health scores (SF-12 physical summary score= 45±12 vs. 42±12, mental summary score= 48±12 vs. 44±13 and EQ-5D visual analog scale= 66±20 vs. 63±22, p<0.001 for all), more angina (SAQ angina frequency=86±18 vs. 82±22, p<0.001), worse physical function (SAQ physical limitation=86±21 vs. 78±27, p<0.001) and worse quality of life (SAQ QoL= 86±18 vs. 82±22, p<0.001) before the event as compared with men. Table 1 shows the independent effect size for women (for both SAQ-assessed physical limitation and angina frequency), confirming that female sex was independently associated with worse pre-existing health status in adjusted analyses. Conclusion: Compared with men, young women presenting with an AMI seem to have worse health status with poorer physical functioning and quality of life prior to their event. In light of these findings, it may be useful for healthcare providers to identify young women who are at increased cardiovascular risk at an earlier stage in order to optimize their health status.