UBC Theses and Dissertations
Sex differences in acute myocardial infarction in younger adults Izadnegahdar, Mona A.
Background: Younger adults have been identified as an emerging ‘at-risk’ population with a rising prevalence of cardiac risk factors and hospitalization for acute myocardial infarction (AMI). Coupled with this is an unexplained excess early AMI mortality risk in younger women compared to younger men. Self-perceived health status (symptoms, physical function and disease perception) has been proposed as a contributing factor; however, not much is known about sex differences in health status outcomes of younger adults post AMI. The overarching goal of this thesis is to enhance our understanding of AMI in younger adults (20-55 years). The main objectives are: 1) to examine sex differences and 10-year trends in AMI hospitalization and early AMI mortality, and to determine whether the sex gap in early AMI mortality has changed in recent years, and 2) to examine the sex differences and changes in health status during the first year following AMI. Methods: The age- and sex-specific 10-year trends in AMI hospitalization and 30-day AMI mortality were based on population-based, administrative data in British Columbia (BC) and assessed using negative binomial and logistic regression, respectively. Sex differences and changes in health status were assessed using prospectively collected data on 286 younger AMI patients, in BC. Linear and generalized linear mixed models were used to assess health status changes. Results: Between 2000-2009, younger adults, particularly women, did not experience the same declining AMI hospitalization rates as older adults. Furthermore, for early AMI mortality, the observed sex differences among younger adults persisted, even after adjusting for comorbidities. While health status in both men and women diminished in the first month following AMI, driven by worse angina and physical function, it improved thereafter. Younger women consistently had significantly worse cardiac-related physical function, disease perception, and overall physical and mental health than younger men during the first year; however, the changes in health status were similar in men and women. Conclusions: The findings highlight a persistent sex difference in early mortality and health status following AMI among younger adults. The first month after AMI is a critical period to intensify support and treatment in order to improve outcomes.
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