Sex Differences in Young Adults Who Experience Myocardial Infarction
2020
The purpose of this review is to highlight sex differences in presentation, underlying mechanisms, treatment, and outcomes in young adults with myocardial infarction (MI). In addition to traditional plaque rupture and plaque erosion, MI in young women can be caused by spontaneous coronary artery dissection (SCAD), MI with nonobstructive coronary arteries (MINOCA), and type 2 MI. MINOCA is more common in young women compared with young men, has a different epidemiology, and is associated with non-traditional cardiovascular risk factors. Additionally, pregnancy-associated conditions (specifically pre-eclampsia, gestational diabetes, and preterm birth) and premature menopause are increasingly associated with adverse cardiovascular outcomes in young women and should be incorporated into risk assessments. Young women, when compared with young men, are more likely to have delays in the recognition and treatment of acute coronary syndrome, and are less likely to undergo timely coronary angiography and reperfusion. Additionally, rates of the use of guideline-directed medical therapy post-MI are lower for young women when compared with young men. Mechanisms of MI in young women include plaque rupture and erosion, as well as SCAD. Improving prompt recognition of acute coronary syndrome in women and closing the gap between women and men in peri- and post-MI care are key to improve outcomes in young women.
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