TY - JOUR
T1 - Sex- and Age-Specific Differences in Risk Profiles and Early Outcomes in Adults With Acute Coronary Syndromes
AU - Nedkoff, Lee
AU - Greenland, Melanie
AU - Hyun, Karice
AU - Htun, Jasmin P.
AU - Redfern, Julie
AU - Stiles, Samantha
AU - Sanfilippo, Frank
AU - Briffa, Tom
AU - Chew, Derek P.
AU - Brieger, David
N1 - This study was funded by a National Heart Foundation of Australia Vanguard Grant [GNT101813] and seed funding from the National Health and Medical Research Council (NHMRC) Centre of Research Excellence (CRE) in Cardiovascular Outcomes. GRACE was supported by an unrestricted grant from Sanofi Aventis (Paris, France) to the Center for Outcomes Research, University of Massachusetts Medical School. The CONCORDANCE national registry was funded by unrestricted grants from Sanofi Aventis, Astra Zeneca, Eli Lilly, Boehringer Ingelheim, MSD/Schering Plough Joint Venture, and the National Heart Foundation of Australia. The SNAPSHOT ACS study was supported in part by: The Cardiac Society of Australia and New Zealand, the National Heart Foundation of Australia, the Agency for Clinical Innovation (NSW), the Victorian Cardiac Clinical Network, the Queensland Cardiac Clinical Network, the Cardiovascular Health Network, Department of Health, WA, Department of Health and its Cardiovascular Health Network, South Australian Health. The study was endorsed by the Australian Commission for Quality and Safety in Health Care and supported with in-kind support from each of the participating hospitals and their respective State and Territory Departments of Health. The SNAPSHOT ACS follow-up study was funded by a National Heart Foundation 2015 NSW Cardiovascular Research Network Research Development Project Grant (G 12S 7057). None of these institutions had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; or decision to submit the article for publication. L.N. is funded by a National Heart Foundation of Australia Future Leader Fellowship (GNT105038). K.H. is funded by a NHMRC Investigator Grant (GNT1196724). J.R. is funded by a NHMRC Investigator Grant Leadership Level 2 (GNT2007946).
Publisher Copyright:
© 2023 The Authors
PY - 2024/3
Y1 - 2024/3
N2 - Background: Adults <55 years comprise a quarter of all acute coronary syndromes (ACS) hospitalisations. There is a paucity of data characterising this group, particularly sex differences. This study aimed to compare the clinical and risk profile of patients with ACS aged <55 with older counterparts, and measure short-term outcomes by age and sex. Method: The study population comprised patients with ACS enrolled in the AUS-Global Registry of Acute Coronary Events (GRACE), Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) and SNAPSHOT ACS registries. We compared clinical features and combinations of major modifiable risk factors (hypertension, smoking, dyslipidaemia, and diabetes) by sex and age group (20–54, 55–74, 75–94 years). All-cause mortality and major adverse events were identified in-hospital and at 6-months. Results: There were 16,658 patients included (22.3% aged 20–54 years). Among them, 20–54 year olds had the highest proportion of ST-elevation myocardial infarction compared with sex-matched older age groups. Half of 20–54 year olds were current smokers, compared with a quarter of 55–74 year olds, and had the highest prevalence of no major modifiable risk factors (14.2% women, 12.7% men) and of single risk factors (27.6% women, 29.0% men), driven by smoking. Conversely, this age group had the highest proportion of all four modifiable risk factors (6.6% women, 4.7% men). Mortality at 6 months in 20–54 year olds was similar between men (2.3%) and women (1.7%), although lower than in older age groups. Conclusions: Younger adults with ACS are more likely to have either no risk factor, a single risk factor, or all four modifiable risk factors, than older patients. Targeted risk factor prevention and management is warranted in this age group.
AB - Background: Adults <55 years comprise a quarter of all acute coronary syndromes (ACS) hospitalisations. There is a paucity of data characterising this group, particularly sex differences. This study aimed to compare the clinical and risk profile of patients with ACS aged <55 with older counterparts, and measure short-term outcomes by age and sex. Method: The study population comprised patients with ACS enrolled in the AUS-Global Registry of Acute Coronary Events (GRACE), Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) and SNAPSHOT ACS registries. We compared clinical features and combinations of major modifiable risk factors (hypertension, smoking, dyslipidaemia, and diabetes) by sex and age group (20–54, 55–74, 75–94 years). All-cause mortality and major adverse events were identified in-hospital and at 6-months. Results: There were 16,658 patients included (22.3% aged 20–54 years). Among them, 20–54 year olds had the highest proportion of ST-elevation myocardial infarction compared with sex-matched older age groups. Half of 20–54 year olds were current smokers, compared with a quarter of 55–74 year olds, and had the highest prevalence of no major modifiable risk factors (14.2% women, 12.7% men) and of single risk factors (27.6% women, 29.0% men), driven by smoking. Conversely, this age group had the highest proportion of all four modifiable risk factors (6.6% women, 4.7% men). Mortality at 6 months in 20–54 year olds was similar between men (2.3%) and women (1.7%), although lower than in older age groups. Conclusions: Younger adults with ACS are more likely to have either no risk factor, a single risk factor, or all four modifiable risk factors, than older patients. Targeted risk factor prevention and management is warranted in this age group.
KW - Acute coronary syndrome
KW - Age-specific
KW - Registry
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85184776046&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2023.11.016
DO - 10.1016/j.hlc.2023.11.016
M3 - Article
C2 - 38326135
AN - SCOPUS:85184776046
SN - 1443-9506
VL - 33
SP - 332
EP - 341
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 3
ER -