title: Sex Versus Gender-Related Characteristics: Which Predicts Outcome After Acute Coronary Syndrome in the Young?
abstract: BACKGROUND
  "Gender" reflects social norms for women and men, whereas "sex" defines biological characteristics. Gender-related characteristics explain some differences in access to care for premature acute coronary syndrome (ACS); whether they are associated with cardiovascular outcomes is unknown.
  
  
  OBJECTIVE
  This study estimated associations between gender and sex with recurrent ACS and major adverse cardiac events (MACE) (e.g., ACS, cardiac mortality, revascularization) over 12 months in patients with ACS.
  
  
  METHODS
  We studied 273 women and 636 men age 18 to 55 years from GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome), a prospective observational cohort study, who were hospitalized for ACS between January 2009 and April 2013. Gender-related characteristics (e.g., social roles) were assessed using a self-administered questionnaire, and a composite measure of gender was derived. Outcomes included recurrent ACS and MACE over 12 months.
  
  
  RESULTS
  Feminine roles and personality traits were associated with higher rates of recurrent ACS and MACE compared with masculine characteristics. This difference persisted for recurrent ACS, after multivariable adjustment (hazard ratio from score 0 to 100: 4.50; 95% confidence interval: 1.05 to 19.27), and was a nonstatistically significant trend for MACE (hazard ratio: 1.54; 95% confidence interval: 0.90 to 2.66). A possible explanation is increased anxiety, the only condition that was more prevalent in patients with feminine characteristics and that rendered the association between gender and recurrent ACS nonstatistically significant (hazard ratio: 3.56; 95% confidence interval: 0.81 to 15.61). Female sex was not associated with outcomes post-ACS.
  
  
  CONCLUSIONS
  Younger adults with ACS with feminine gender are at an increased risk of recurrent ACS over 12 months, independent of female sex.
authors.affiliation: Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Jafna
authors.initials: J
authors.lastname: Cox
authors.affiliation: Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
authors.affiliation: Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.affiliation: Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.affiliation: Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Kaberi
authors.initials: K
authors.lastname: Daskupta
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Doreen
authors.initials: D
authors.lastname: Rabi
authors.affiliation: Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Karin H
authors.initials: KH
authors.lastname: Humphries
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.affiliation: Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Thanassoulis
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Hassan
authors.initials: H
authors.lastname: Behlouli
authors.affiliation: Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: louise.pilote@mcgill.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D000328:Adult; D001294:Attitude to Health; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: adverse cardiovascular outcomes; epidemiology; feminine gender roles and traits; premature acute coronary syndrome; stress; women