Sex- and Age-Specific Differences in Risk Profiles and Early Outcomes in Adults With Acute Coronary Syndromes

Lee Nedkoff; Melanie Greenland; Karice Hyun; Jasmin P Htun; Julie Redfern; Samantha Stiles; Frank Sanfilippo; Tom Briffa; Derek P Chew; David Brieger

doi:10.1016/j.hlc.2023.11.016

Sex- and Age-Specific Differences in Risk Profiles and Early Outcomes in Adults With Acute Coronary Syndromes

Heart Lung Circ. 2024 Mar;33(3):332-341. doi: 10.1016/j.hlc.2023.11.016. Epub 2024 Feb 7.

Authors

Affiliations

¹ Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia. Electronic address: lee.nedkoff@uwa.edu.au.
² Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
³ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, Sydney, NSW, Australia.
⁴ School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.
⁵ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁶ Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
⁷ Victorian Heart Institute, Monash University, Melbourne, Vic, Australia.

PMID: 38326135
DOI: 10.1016/j.hlc.2023.11.016

Abstract

Background: Adults <55 years of age comprise a quarter of all acute coronary syndromes (ACS) hospitalisations. There is a paucity of data characterising this group, particularly sex differences. This study aimed to compare the clinical and risk profile of patients with ACS aged <55 years with older counterparts, and measure short-term outcomes by age and sex.

Method: The study population comprised patients with ACS enrolled in the AUS-Global Registry of Acute Coronary Events (GRACE), Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) and SNAPSHOT ACS registries. We compared clinical features and combinations of major modifiable risk factors (hypertension, smoking, dyslipidaemia, and diabetes) by sex and age group (20-54, 55-74, 75-94 years). All-cause mortality and major adverse events were identified in-hospital and at 6-months.

Results: There were 16,658 patients included (22.3% aged 20-54 years). Among them, 20-54 year olds had the highest proportion of ST-elevation myocardial infarction compared with sex-matched older age groups. Half of 20-54 year olds were current smokers, compared with a quarter of 55-74 year olds, and had the highest prevalence of no major modifiable risk factors (14.2% women, 12.7% men) and of single risk factors (27.6% women, 29.0% men), driven by smoking. Conversely, this age group had the highest proportion of all four modifiable risk factors (6.6% women, 4.7% men). Mortality at 6 months in 20-54 year olds was similar between men (2.3%) and women (1.7%), although lower than in older age groups.

Conclusions: Younger adults with ACS are more likely to have either no risk factor, a single risk factor, or all four modifiable risk factors, than older patients. Targeted risk factor prevention and management is warranted in this age group.

Keywords: Acute coronary syndrome; Age-specific; Registry; Risk factors.

MeSH terms

Acute Coronary Syndrome* / epidemiology
Adult
Age Factors
Aged
Diabetes Mellitus*
Female
Hospital Mortality
Humans
Male
Middle Aged
Registries
Risk Factors
Smoking / epidemiology
Treatment Outcome