title: Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study.
abstract: BACKGROUND
  Young women with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. An adverse lipid profile is an important risk factor for cardiovascular outcomes after AMI, but little is known about whether young women with AMI have a higher-risk lipid pattern than men. We characterized sex differences in lipid profiles and treatment utilization among young adults with AMI.
  
  
  METHODS
  A total of 2,219 adults with AMI (1,494 women) aged 18-55 years were enrolled from 103 hospitals in the United States (2008-2012). Serum lipids and lipoprotein subclasses were measured 1 month after discharge.
  
  
  RESULTS
  More than 90% of adults were discharged on a statin, but less than half received a high-intensity dose and 12% stopped taking treatments by 1 month. For both men and women, the median of low-density lipoprotein (LDL) cholesterol was reduced to <100 mg/dL 1 month after discharge for AMI, but high-density lipoprotein (HDL) cholesterol remained <40 mg/dL. Multivariate regression analyses showed that young women had favorable lipoprotein profiles compared with men: women had higher HDL cholesterol and HDL large particle, but lower total cholesterol-to-HDL cholesterol ratio and LDL small particle.
  
  
  CONCLUSIONS
  Young women with AMI had slightly favorable lipid and lipoprotein profiles compared with men, suggesting that difference in lipid and lipoprotein may not be a major contributor to sex differences in outcomes after AMI. In both men and women, statin remained inadequately used, and low HDL cholesterol level was a major lipid abnormality.
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Shengfan
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Dreyer
authors.affiliation: Quest Diagnostics Nichols Institute, San Juan Capistrano, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Caulfield
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Mary
authors.initials: M
authors.lastname: Geda
authors.affiliation: Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Lorenze
authors.affiliation: Yale-New Haven Hospital, New Haven, CT.
authors.forename: Peter
authors.initials: P
authors.lastname: Herbert
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
authors.affiliation: Department of Internal Medicine, University of Michigan Health Systems, Ann Arbor, MI.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jackson
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Electronic address: harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000293:Adolescent; D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016014:Linear Models; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids