Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction

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Abstract

Sex differences are known to exist in the management of older patients presenting with acute myocardial infarction (AMI). Few studies have examined the incidence and risk factors of AMI among young patients, or whether clinical management differs by sex.

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Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience.

Alice D. White, Aaron Folsom, Lloyd E. Chambless … (1996)

The community surveillance component of the Atherosclerosis Risk in Communities (ARIC) Study is designed to estimate patterns and trends of coronary heart disease (CHD) incidence, case fatality, and mortality in four U.S. communities. Community surveillance involves ongoing review of death certificates and hospital discharge records to identify CHD events in community residents aged 35-74 years. Interviews with next of kin and questionnaires completed by physicians and medical examiners or coroners were used to collect information on deaths, and review and abstraction of hospital records were used to collect information on possible fatal and nonfatal myocardial infarctions (MIs). Events were classified using standardized criteria. The initial 2-years' experience with case ascertainment and availability of information needed for classification of events is described. Average annual age-adjusted attack rates of definite MI and CHD mortality rates for blacks in two communities and whites in the four communities are presented and compared with rates based on unvalidated hospital discharge data and vital statistics. Age-adjusted rates based on ARIC classification of definite MI were lower than those based on hospital discharge diagnosis code 410 (e.g., 5.60/1000 and 11.50/1000 among Forsyth County white men, respectively). Age-adjusted rates of definite fatal CHD based on ARIC classification were similarly lower than rates based on underlying cause of death code 410; for example, Jackson black men had rates of 2.82/1000 and 4.52/1000 for definite fatal CHD and UCOD 410-414 or 429.2, respectively.

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Sex differences in medical care and early death after acute myocardial infarction.

, Kenneth LaBresh, L. Newby … (2008)

Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era. Using the Get With the Guidelines-Coronary Artery Disease database, we examined sex differences in care processes and in-hospital death among 78 254 patients with AMI in 420 US hospitals from 2001 to 2006. Women were older, had more comorbidities, less often presented with ST-elevation myocardial infarction (STEMI), and had higher unadjusted in-hospital death (8.2% versus 5.7%; P<0.0001) than men. After multivariable adjustment, sex differences in in-hospital mortality rates were no longer observed in the overall AMI cohort (adjusted odds ratio [OR]=1.04; 95% CI, 0.99 to 1.10) but persisted among STEMI patients (10.2% versus 5.5%; P<0.0001; adjusted OR=1.12; 95% CI, 1.02 to 1.23). Compared with men, women were less likely to receive early aspirin treatment (adjusted OR=0.86; 95% CI, 0.81 to 0.90), early beta-blocker treatment (adjusted OR=0.90; 95% CI, 0.86 to 0.93), reperfusion therapy (adjusted OR=0.75; 95% CI, 0.70 to 0.80), or timely reperfusion (door-to-needle time

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Weight change and diabetes incidence: findings from a national cohort of US adults.

Tim E. Ford, Shiguo Liu, Jeff D. Williamson (1997)

To examine how long-term patterns of weight change affect the risk for diabetes, especially non-insulin-dependent diabetes mellitus, the authors examined the relation of weight change over a period of about 10 years (from the baseline examination in 1971-1975 until the first follow-up examination in 1982-1984) to the 9-year incidence of diabetes mellitus (1984-1992) in a national cohort of 8,545 US adults from the National Health and Nutrition Examination Survey Epidemiologic Followup Study. Diabetes incidence was identified from death certificates, hospitalization and nursing home records, and self-report. In this cohort, 487 participants developed diabetes. The hazard ratios were 2.11 (95% confidence interval (CI) 1.40-3.18) for participants who gained 5- < 8 kg, 1.19 (95% CI 0.75-1.89) for participants who gained 8- < 11 kg, 2.57 (95% CI 1.84-3.85) for participants who gained 11- < 20 kg, and 3.85 (95% CI 2.04-7.22) for participants who gained 20 kg or more compared with participants whose weights remained relatively stable. The authors found no evidence that the results differed by age, sex, or race. They estimated that the population attributable risk was 27% for weight increases of 5 kg or more. Results from this study and other recent studies suggest that the increase in body mass index in the United States that occurred during the 1980s may portend an increase in the incidence of non-insulin-dependent diabetes mellitus with important public health consequences in future years.

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Author and article information

Journal

Title: Circulation

Abbreviated Title: Circulation

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 0009-7322

ISSN (Electronic): 1524-4539

Publication date Created: February 19 2019

Publication date (Print): February 19 2019

Volume: 139

Issue: 8

Pages: 1047-1056

Affiliations

[1 ]Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill (S.A., G.S., M.C.)

[2 ]Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill (S.A., A.KN, W.R.)

[3 ]Division of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (S.A.).

[4 ]Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (A.Q., M.V, D.L.B.).

[5 ]Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.P.).

[6 ]Social and Health Organizational Research and Evaluation Program, RTI International, Research Triangle Park, NC (D.P.).

[7 ]Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.B.).

Article

DOI: 10.1161/CIRCULATIONAHA.118.037137

PMC ID: 6380926

PubMed ID: 30586725

SO-VID: 03c3900b-91f9-46f5-a8cb-8c39ed49a211

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Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction : The ARIC Community Surveillance Study

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Abstract

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Most cited references 20

Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience.

Sex differences in medical care and early death after acute myocardial infarction.

Weight change and diabetes incidence: findings from a national cohort of US adults.

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Cited by 212

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