Sex- and gender-related risk factor burden in patients with premature acute coronary syndrome.
BACKGROUND
Few contemporary data exist on traditional (TRF) and non-TRF (NTRF) burden in patients with premature acute coronary syndrome (ACS).


METHODS
Prevalence of TRFs and NTRFs were measured in 1015 young (55 years old or younger) ACS patients recruited from 26 centres in Canada, the United States, and Switzerland. Risk factors were compared across sex and family history categories, and against a sample of the general Canadian population based on the 2000-2001 Canadian Community Health Survey. The 10- and 30-year risks of cardiovascular disease (CVD) were estimated using Framingham Risk Scores.


RESULTS
Risk factors were more prevalent in premature ACS patients compared with the general population. Young women with a family history of coronary artery disease showed the greatest risk factor burden including TRFs of hypertension (67%), dyslipidemia (67%), obesity (53%), smoking (42%), and diabetes (33%), and NTRFs of anxiety (55%), low household income (44%), and depression (37%). The estimated median 10-year risk of CVD was 7% (interquartile range [IQR], 3%-9%) in women and 13% (IQR, 7%-17%) in men, whereas the 30-year risk of CVD was 36% (IQR, 22%-49%) in women and 44% (IQR, 31%-57%) in men.


CONCLUSIONS
Patients with premature ACS, especially women with a positive family history, are characterized by a very high risk factor burden that is poorly captured by 10-year risk estimates but better captured by 30-year estimates. Consideration of NTRFs and use of 30-year risk estimates might better estimate risk in young individuals and improve the prevention of premature ACS.
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
Jin
J
Choi
Division of General Internal Medicine, McGill University Health Centre, Montreal, Québec, Canada.
Stella Styliani
SS
Daskalopoulou
Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada.
George
G
Thanassoulis
University of Montreal Hospital Research Centre and Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada.
Igor
I
Karp
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
Roxanne
R
Pelletier
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
Hassan
H
Behlouli
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: louise.pilote@mcgill.ca.
Louise
L
Pilote
D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D017677:Age Distribution; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D014481:United States / Q000453:epidemiology