title: Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger.
abstract: Studies suggest that young women are at highest risk for failing to recognise early symptoms of acute coronary syndrome (ACS).
  
  
  
  To examine sex differences in prodromal symptoms occurring days and weeks prior to the acute presentation of ACS. We also examined health-seeking behaviours and prehospital management in young patients.
  
  
  
  Prospective cross-sectional analysis of 1145 patients (368 women) hospitalised for ACS, aged ≤55 years, from the GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome cohort study (January 2009-April 2013). Prodromal symptoms were determined using the McSweeney Acute and Prodromal Myocardial Infarction Symptom questionnaire. Health-seeking behaviour and prehospital care were determined by questionnaires.
  
  
  
  The median age was 49 years. The prevalence of prodromal symptoms was high and more women reported symptoms than men (85% vs 72%, p<0.0001). Symptoms were similar between sexes and included unusual fatigue, sleep disturbances, anxiety and arm weakness/discomfort. Chest pain was less common in both sexes (24%). Women were more likely to seek care (49% vs 42%, p=0.04). Among those who sought care, women were more likely to use an ambulance for their ACS compared with men (52% vs 39%). Cardiovascular risk-reduction therapy use was low (≤40%) in all patients and less than half perceived their care provider suspected a cardiac source.
  
  
  
  Prior to ACS, women were more likely to experience prodromal symptoms and seek medical attention than men. Prehospital care was generally similar between sexes but demonstrated underutilisation of risk-reduction therapies in at-risk young adults.
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: Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.|Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada.
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
authors.affiliation: Department of Social and Preventive Medicine, University of Montréal Hospital Research Center (CRCHUM), University of Montréal, Montréal, Québec, Canada.
authors.forename: Igor
authors.initials: I
authors.lastname: Karp
authors.affiliation: Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.affiliation: Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.|Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.|Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada.
authors.forename: Meytal Avgil
authors.initials: MA
authors.lastname: Tsadok
authors.affiliation: Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.|Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada.|Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada.
authors.forename: Kaberi
authors.initials: K
authors.lastname: Dasgupta
authors.affiliation: Faculties of Nursing, Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.affiliation: Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.|Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada.|Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D062706:Prodromal Symptoms; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D014481:United States / Q000453:epidemiology