title: Sex Differences in Inflammatory Markers and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) Study.
abstract: Young women (≤55 years of age) with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. Elevated inflammatory markers are associated with an increased risk of cardiovascular outcomes after AMI, but little is known about whether young women have higher inflammatory levels after AMI compared with young men.
  
  
  
  We assessed sex differences in post-AMI inflammatory markers and whether such differences account for sex differences in 12-month health status, using data from 2219 adults with AMI, 18 to 55 years of age, in the United States. Inflammatory markers including high-sensitivity C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 were measured 1 month after AMI. Overall, women had higher levels of hsCRP and lipoprotein-associated phospholipase A2 after AMI compared with men, and this remained statistically significant after multivariable adjustment. Regression analyses showed that elevated 1-month hsCRP was associated with poor health status (symptom, function, and quality of life) at 12 months. However, the association between hsCRP and health status became nonsignificant after adjustment for sociodemographics, comorbidities, and treatment factors. Half of these patients had residual inflammatory risk (hsCRP >3 mg/L) compared with a third who had residual cholesterol risk (Low-density lipoprotein cholesterol >100 mg/dL).
  
  
  
  Young women with AMI had higher inflammatory levels compared with young men. Elevated 1-month hsCRP was associated with poor health status at 12 months after AMI, but this was attenuated after adjustment for patient characteristics. Targeted anti-inflammatory treatments are worthy of consideration for secondary prevention in these patients if ongoing trials of anti-inflammatory therapy prove effective.
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Shengfan
authors.initials: S
authors.lastname: Zhou
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Dreyer
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Mary
authors.initials: M
authors.lastname: Geda
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Lorenze
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.affiliation: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.). harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; C526684:PLA2G7 protein, human
keywords: C-reactive protein; biomarkers; inflammation; myocardial infarction; women