A new Yale-led study has identified for the first time which risk factors lead to a heart attack or acute myocardial infarction in men and women aged 55 and younger. The study was published May 3 in JAMA Network Open. The researchers found significant gender differences in risk factors associated with acute myocardial infarction and in the significance of the association between risk factors and vascular incident among the young, suggesting the need for a gender-specific preventive strategy. Hypertension, diabetes, depression and poverty were found to have a stronger influence on the occurrence of acute myocardial infarction in women than in men. While heart attacks are often associated with older age, this population-based case-control study examined the relationship between a wide range of acute myocardial infarction-related risk factors among younger people. The researchers used data from 2,264 patients with myocardial infarction from the VIRGO study and 2,264 population-based controls matched by age, sex, and nationality from the National Health and Nutrition Examination Survey. The main finding is that young men and women often have different risk factors. Seven risk factors — including diabetes, depression, hypertension, smoking, family history of acute myocardial infarction, low household income and high cholesterol — were associated with a greater risk of acute myocardial infarction in women. Diabetes has the greatest influence, followed by smoking, depression, hypertension, low household income, and family history of acute myocardial infarction. Among men, smoking and a family history of acute myocardial infarction are the leading risk factors. The incidence of acute myocardial infarction in younger women has increased in recent years. Population risk analysis was used to measure the impact of different risk factors at the population level. The study found that seven risk factors, many of them potentially modifiable, together accounted for most of the overall risk of acute myocardial infarction in young women (83.9%) and young men (85.1% ). Some of these factors – including hypertension, diabetes, depression and lower income – have a greater impact on young women than on young men. The researchers found that many traditional risk factors, including hypertension, diabetes and high cholesterol, were more common in type 1 acute myocardial infarction, while various subtypes of acute myocardial infarction—including type 2 acute myocardial infarction—were less common. The study is among the first and largest in this field to comprehensively assess the associations between a wide range of predisposing risk factors and incident acute myocardial infarction in young women and a comparable sample of young men. The study design also included a comparable control group,population-based from the National Health and Nutrition Examination Survey—a program to assess demographic, socioeconomic, nutritional, and health-related information. Because the incidence is low in young people, it takes a long time for the disease to manifest itself. For this reason, researchers often do not have enough data on acute myocardial infarction to draw conclusions about risk factors and their relative importance in young women and men. The proportion of younger people being hospitalized for a heart attack has been found to be increasing. There appears to be a general tendency for acute myocardial infarction to occur earlier in life, so prevention of myocardial infarction in younger people is particularly important. Previous studies have shown that factors related to female gender may be associated with heart attack risk, but there is limited data for women under 55. Female-related factors, including a history of menopause, pregnancy, menstrual cycle and others, are expected to be studied and whether these contribute to heart attack risk. References: https://dx.doi.org/10.1001/jamanetworkopen.2022.9953 https://dx.doi.org/10.1016/j.jacc.2014.04.054 https://dx.doi.org/10.1001/jamacardio. 2016.0382