Predominant Risk Profiles of Middle-Aged Women Associated With Acute Myocardial Infarction and Coronary Atherosclerosis: A Cross Sectional Study in Macao

Objectives: In recent decades, the incidence of acute myocardial infarction (AMI) has increased in younger women. Classically, younger women may experience ischemic and prodromal symptoms before AMI. The aim of this study was to investigate the predominant risk factors related to AMI and the severity of obstructive atherosclerosis in symptomatic young women.
Methods: In this cross-sectional study, we retrospectively enrolled females aged between 40 and 65 years, at a single hospital, from January 2014 to December 2021. All females who had clinical symptoms or clinical evidence of coronary ischemia underwent coronary imaging. All participants were categorized into either the with AMI group or the without AMI group. In both groups, we obtained and assessed all of the cardiovascular risk factors, their medical history and basic data. Results: In total, 161 patients were enrolled, of whom 110 (68%) had coronary artery disease. A total of 51 patients (31%) had a higher incidence of hypertension, dyslipidemia, concomitant use of statins, anti-hypertensive drugs and increased low-density lipoprotein-cholesterol (LDL-c) levels before AMI. Multivariate logistic regression showed that only LDL-c level was an independent predictor of AMI (odds ratio [OR]=3.2, 95% confidence interval [CI]=1.9 to 5.45, P<0.001). Moreover, the patients with a low LDL-c level (LDL-c <2.6) had a lower incidence of AMI and a lower syntax score, compared with the higher LDL-c group (LDL-c ≥2.6). The LDL-c level was also significantly correlated with syntax score in the overall population (r=0.43, p<0.0001), those aged 40-55 years (r=0.41, p=0.01) and those aged 56-65 years (r=0.47, p<0.0001).
Conclusion: LDL-c level is significantly associated with the risk of AMI and the severity of obstructive atherosclerosis in symptomatic middle-aged women. Intensive clinical control of the LDL-c level may be necessary in this population.