title: Gender differences in pre-event health status of young patients with acute myocardial infarction: A VIRGO study analysis.
abstract: OBJECTIVE
  We assessed gender differences in pre-event health status (symptoms, functioning, quality of life) in young patients with acute myocardial infarction and whether or not this association persists following sequential adjustment for important covariates. We also evaluated the interaction between gender and prior coronary artery disease, given that aggressive symptom control is a cornerstone of care in those with known coronary disease.
  
  
  RESULTS
  A total of 3501 acute myocardial infarction patients (2349 women) aged 18-55 years were enrolled from 103 US/24 Spanish hospitals (2008-2012). Clinical/health status information was obtained by medical record abstraction and patient interviews. Pre-event health status was measured by generic (Short Form-12, EuroQoL) and disease-specific (Seattle Angina Questionnaire) measures. T-test/chi-square and multivariable linear/logistic regression analysis was utilized, sequentially adjusting for covariates. Women had more co-morbidities and significantly lower generic mean health scores than men (Short Form-12 physical health = 43 ± 12 vs. 46 ± 11 and mental health = 44 ± 13 vs. 48 ± 11); EuroQoL utility index = 0.7 ± 0.2 vs. 0.8 ± 0.2 and visual analog scale = 63 ± 22 vs. 67 ± 20, P < 0.0001 for all. Their disease-specific health status was also worse, with more angina (Seattle Angina Questionnaire angina frequency = 83 ± 22 vs. 87 ± 18), worse physical function (physical limitation = 78 ± 27 vs. 87 ± 21) and poorer quality of life (55 ± 25 vs. 60 ± 22, P<0.0001 for all). In multivariable analysis, the association between female gender and worse generic physical/mental health persisted, as well as worse disease-specific physical limitation and quality of life. The interaction between gender and prior coronary artery disease was not significant in any of the health status outcomes.
  
  
  CONCLUSIONS
  Young women have worse pre-event health status as compared with men, regardless of their coronary artery disease history. While future studies of gender differences should adjust for baseline health status, an opportunity may exist to better address the pre-event health status of women at risk for acute myocardial infarction.
authors: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, USA rachel.dreyer@yale.edu.
authors: Rachel P
authors: RP
authors: Dreyer
authors: University of Missouri - Kansas City, School of Medicine, Biomedical & Health Informatics, USA Saint Luke's Mid America Heart Institute, USA.
authors: Kim G
authors: KG
authors: Smolderen
authors: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.
authors: Kelly M
authors: KM
authors: Strait
authors: Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Australia.
authors: John F
authors: JF
authors: Beltrame
authors: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA Department of Chronic Disease Epidemiology, Yale School of Public Health, USA.
authors: Judith H
authors: JH
authors: Lichtman
authors: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA.
authors: Nancy P
authors: NP
authors: Lorenze
authors: Department of Emergency Medicine, Yale School of Medicine, USA.
authors: Gail
authors: G
authors: D'Onofrio
authors: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Spain.
authors: Héctor
authors: H
authors: Bueno
authors: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, USA Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, USA Department of Health Policy and Management, Yale School of Public Health, USA.
authors: Harlan M
authors: HM
authors: Krumholz
authors: University of Missouri - Kansas City, School of Medicine, Biomedical & Health Informatics, USA Saint Luke's Mid America Heart Institute, USA.
authors: John A
authors: JA
authors: Spertus
mesh_terms: D000293:Adolescent; D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Health status; acute myocardial infarction; quality of life; women