Sex Differences in the Etiology of Myocardial Infarction in Patients Under 65: Beyond Atherosclerosis

Abstract

Aim: The goal is to review sex difference in etiology of non-atherosclerotic etiology of myocardial infarction (MI) in adult subjects below the age of 65 years.

Background: Atherosclerosis is the primary cause of MI, yet the recent literature reveals that the younger patients especially women are normally identified with other etiologies which comprise coronary microvascular dysfunction, vasospasm and spontaneous coronary artery dissection. These sex-distinct patterns make it difficult to diagnose and be able to improve the treatment, therefore the need to acquire a comprehensive knowledge of them to tailor them with proper care.

Methods:The retrospective evaluation of clinical records and angiographic results and laboratory data was carried out on 1,240 patients with reported MI at hospital admission between the ages of 18 and 64 years. The etiologies were divided into atherosclerotic and non-atherosclerotic ones, and the male and female cohorts were compared.

Results:Men were much more prevalent with plaque-rupture MI, whereas women were more prevalent with microvascular dysfunction and non-obstructive coronary disease. SCAD was detected mostly in females especially among the 45-59 years. In all non-atherosclerotic processes, females were not less probably to present atypically and also to be diagnosed later.

Conclusion:MI within patients aged below 65 years exhibits evident etiologic sex-specific patterns. It is important to identify non-atherosclerotic etiologies, particularly in women, to assess them more precisely, intervene in time, and treat them in a personalized way.