Author + information
- Received February 25, 2015
- Revision received July 28, 2015
- Accepted August 13, 2015
- Published online November 3, 2015.
- Erica C. Leifheit-Limson, PhD∗∗ (, )
- Gail D’Onofrio, MD, MS†,
- Mitra Daneshvar, MPH∗,
- Mary Geda, MSN‡,
- Héctor Bueno, MD, PhD§,
- John A. Spertus, MD, MPH‖,
- Harlan M. Krumholz, MD, SM‡,¶ and
- Judith H. Lichtman, PhD, MPH∗,‡
- ∗Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- †Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- ‡Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- §Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ‖Saint Luke’s Mid America Heart Institute and University of Missouri–Kansas City, Kansas City, Missouri
- ¶Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- ↵∗Reprint requests and correspondence:
Dr. Erica Leifheit-Limson, Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, Connecticut 06520.
Background Differences between sexes in cardiac risk factors, perceptions of cardiac risk, and health care provider discussions about risk among young patients with acute myocardial infarction (AMI) are not well studied.
Objectives This study compared cardiac risk factor prevalence, risk perceptions, and health care provider feedback on heart disease and risk modification between young women and men hospitalized with AMI.
Methods We studied 3,501 AMI patients age 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study in U.S. and Spanish hospitals between August 2008 and January 2012, comparing the prevalence of 5 cardiac risk factors by sex. Modified Poisson regression was used to assess sex differences in self-perceived heart disease risk and self-reported provider discussions of risk and modification.
Results Nearly all patients (98%) had ≥1 risk factor, and 64% had ≥3. Only 53% of patients considered themselves at risk for heart disease, and even fewer reported being told they were at risk (46%) or that their health care provider had discussed heart disease and risk modification (49%). Women were less likely than men to be told they were at risk (relative risk: 0.89; 95% confidence interval: 0.84 to 0.96) or to have a provider discuss risk modification (relative risk: 0.84; 95% confidence interval: 0.79 to 0.89). There was no difference between women and men for self-perceived risk.
Conclusions Despite having significant cardiac risk factors, only one-half of young AMI patients believed they were at risk for heart disease before their event. Even fewer discussed their risks or risk modification with their health care providers; this issue was more pronounced among women.
The VIRGO study was supported by grant R01 HL081153-01A1K from the National Heart, Lung, and Blood Institute. Dr. Bueno has received financial support from AstraZeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Menarini Group, Novartis, Sanofi, Servier, and Ferrer. Dr. Spertus holds a copyright for the SAQ (Seattle Angina Questionnaire), the KCCQ (Kansas City Cardiomyopathy Questionnaire), and the PAQ (Peripheral Artery Questionnaire). Dr. Krumholz has served as chair of the cardiovascular scientific advisory committee for United Health Care; and has received grants from Johnson and Johnson and Medtronic. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
- Received February 25, 2015.
- Revision received July 28, 2015.
- Accepted August 13, 2015.
- 2015 American College of Cardiology Foundation