Document Type : Original Article
Authors
1 Cardiology Department, Shafa Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
2 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences Kerman, Iran
Abstract
Background: Acute coronary syndrome (ACS) is one of the most serious diseases with high mortality. Concerning the influence of age and gender on ACS properties, this study aimed to determine gender and age-based differences in risk factors and symptoms of the ACS in a sample of Iranian patients.
Methods: This cross-sectional study was conducted on 450 patients with ACS in Kerman from 10 September, 2018 to 25 February, 2019. The data were collected through face-to-face interviews in the coronary care unit (CCU) after ACS diagnosis. A trained interviewer collected the data using a demographic and clinical information checklist. Statistical analyses were performed using chi-square, Fisher exact test, and Mann‐Whitney U test and through SPSS software (version 23).
Results: In this study, more than half of the patients with ACS were males (n=240, 53.4%). In one-third of the patients, ACS symptoms were presented in the age range of 60-69 years (n = 145, 32.2%). In the female patients compared to the male patients, there were more cases of underweight [58 (27.6%) versus 45 (18.8%), P value: 0.02], positive family history of coronary heart disease (CHD) [102 (48.6%) versus 92 (38.3%), P value: 0.02], and hypertension [119 (56.7%) versus 113 (47.1%), P value: 0.04]. In contrast, there were no differences in common symptoms and pain severity in patients in various age and sex groups. Conclusion: Attention to the differences in the profile of risk factors and symptoms of ACS in males and females of different ages, would be helpful in choosing the best clinical approach.
Highlights
Mansour Moazezenzadeh(Google Scholar)(Pubmed
Hamidreza Rashidinejad(Google Scholar)(Pubmed)
Keywords
Main Subjects
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Heidarimoghadam R, Bahremand M, et al. Sex differences in
risk factors profile and angiographic pattern of the patients
undergoing coronary angiography. Adv J Emerg Med.
2020;4(4):e87. doi: 10.22114/ajem.v0i0.336.
3. Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A,
Borges A, et al. Sex differences in presenting symptoms of acute
coronary syndrome: the EPIHeart cohort study. BMJ Open.
2018;8(2):e018798. doi: 10.1136/bmjopen-2017-018798.
4. Sarrafzadegan N, Mohammmadifard N. Cardiovascular
disease in Iran in the last 40 years: prevalence, mortality,
morbidity, challenges and strategies for cardiovascular
prevention. Arch Iran Med. 2019;22(4):204-10.
5. Cheema FM, Cheema HM, Akram Z. Identification of
risk factors of acute coronary syndrome in young patients
between 18-40 years of age at a teaching hospital. Pak J Med
Sci. 2020;36(4):821-4. doi: 10.12669/pjms.36.4.2302.
6. Dai X, Busby-Whitehead J, Alexander KP. Acute coronary
syndrome in the older adults. J Geriatr Cardiol. 2016;13(2):101-
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7. Vicent L, Martínez-Sellés M. Frailty and acute coronary
syndrome: does gender matter? J Geriatr Cardiol.
2019;16(2):138-44. doi: 10.11909/j.issn.1671-
5411.2019.02.007.
8. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A.
Epidemiology of coronary heart disease and acute coronary
syndrome. Ann Transl Med. 2016;4(13):256. doi: 10.21037/
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doi: 10.47552/ijam.v10i1.1218.
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in the outcomes of elderly patients with acute coronary
syndrome. Cardiol Res Pract. 2020;2020:5091490. doi:
10.1155/2020/5091490.
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van der Schaaf RJ, et al. Sex differences in characteristics
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Netherlands. Neth Heart J. 2019;27(5):263-71. doi: 10.1007/
s12471-019-1271-0.
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differences in symptom predictors associated with acute
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diseases in the world. Zahedan J Res Med Sci. 2011;13(1).
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hospitalized acute coronary syndromes in Western Australia.
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10.1161/circoutcomes.110.960005.
19. Neamatipoor E, Sabri A, Dahi F, Soltanipoor F. Changing risk
and demographic factors of myocardial infarction in a decade
(1371-1381) in three university hospital. Tehran Univ Med J.
2006;64(3):88-94. [Persian].
20. Ahmadi A, Sajjadi H, Etemad K, Khaledifar A, Mobasherii M.
Epidemiological characteristics and determinants of mortality
in acute coronary syndrome in Iran. J Mazandaran Univ Med
Sci. 2015;25(124):1-9. [Persian].
21. Liu R, Xu F, Zhou Y, Liu T. The characteristics of risk factors in
Chinese young women with acute coronary syndrome. BMC
Cardiovasc Disord. 2020;20(1):290. doi: 10.1186/s12872-
020-01577-z.
22. Booth GL, Kapral MK, Fung K, Tu JV. Relation between age
and cardiovascular disease in men and women with diabetes
compared with non-diabetic people: a population-based
retrospective cohort study. Lancet. 2006;368(9529):29-36.
doi: 10.1016/s0140-6736(06)68967-8.
23. Lagranha CJ, Silva TLA, Silva SCA, Braz GRF, da Silva AI,
Fernandes MP, et al. Protective effects of estrogen against
cardiovascular disease mediated via oxidative stress
in the brain. Life Sci. 2018;192:190-8. doi: 10.1016/j.
lfs.2017.11.043.
24. Wahrenberg A, Magnusson PK, Discacciati A, Ljung L,
Jernberg T, Frick M, et al. Family history of coronary artery
disease is associated with acute coronary syndrome in 28,188
chest pain patients. Eur Heart J Acute Cardiovasc Care.
2020;9(7):741-7. doi: 10.1177/2048872619853521.
25. Hindieh W, Pilote L, Cheema A, Al-Lawati H, Labos C,
Dufresne L, et al. Association between family history, a
genetic risk score, and severity of coronary artery disease
in patients with premature acute coronary syndromes.
Arterioscler Thromb Vasc Biol. 2016;36(6):1286-92. doi:
10.1161/atvbaha.115.306944.
26. Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka
PA, et al. Sex differences in demographics, risk factors,
presentation, and noninvasive testing in stable outpatients
with suspected coronary artery disease: insights from the
PROMISE trial. JACC Cardiovasc Imaging. 2016;9(4):337-46.
doi: 10.1016/j.jcmg.2016.02.001.
27. Labos C, Wang RH, Pilote L, Bogaty P, Brophy JM, Engert JC,
et al. Traditional risk factors and a Genetic Risk Score are
associated with age of first acute coronary syndrome. Heart.
2014;100(20):1620-4. doi: 10.1136/heartjnl-2013-305416.
28. Idris N, Aznal SS, Chin SP, Ahmad WA, Rosman A,
Jeyaindran S, et al. Acute coronary syndrome in women of
reproductive age. Int J Womens Health. 2011;3:375-80. doi:
10.2147/ijwh.s15825.
29. Banerjee A, Lim CC, Silver LE, Welch SJ, Banning AP,
Rothwell PM. Familial history of stroke is associated with
acute coronary syndromes in women. Circ Cardiovasc Genet.
2011;4(1):9-15. doi: 10.1161/circgenetics.110.957688.
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Kerkhof PLM, Miller VM, eds. Sex-Specific Analysis of
Cardiovascular Function. Cham: Springer; 2018. p. 257-78.
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predictors of cardiovascular risk in population studies. J
Hypertens Suppl. 1990;8(5):S3-8.
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Kremastinos D. Cigarette smoking and myocardial infarction
in young men and women: a case-control study. Int J Cardiol.
2007;116(3):371-5. doi: 10.1016/j.ijcard.2006.04.051.
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for coronary heart disease in women compared with men:
a systematic review and meta-analysis of prospective cohort
studies. Lancet. 2011;378(9799):1297-305. doi: 10.1016/
s0140-6736(11)60781-2.
34. Peters SA, Huxley RR, Woodward M. Smoking as a risk
factor for stroke in women compared with men: a systematic
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doi: 10.1161/strokeaha.113.002342.
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patients. Heart Views. 2011;12(1):1-6. doi: 10.4103/1995-
705x.81547.
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heart disease risk: a 16-year follow-up study. Health Rep.
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Windecker S, Urban P, Niedermaier G, et al. Acute coronary
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ijcard.2009.11.009.
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Clinical characteristics of patients less than forty years old
with coronary artery disease in Taiwan: a cross-sectional
study. Acta Cardiol Sin. 2017;33(3):233-40. doi: 10.6515/
acs20161026a.
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2016;217 Suppl:S27-31. doi: 10.1016/j.ijcard.2016.06.217.
2. Rouzbahani M, Mahmoudi S, Asgari N, Salehi N,
Heidarimoghadam R, Bahremand M, et al. Sex differences in
risk factors profile and angiographic pattern of the patients
undergoing coronary angiography. Adv J Emerg Med.
2020;4(4):e87. doi: 10.22114/ajem.v0i0.336.
3. Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A,
Borges A, et al. Sex differences in presenting symptoms of acute
coronary syndrome: the EPIHeart cohort study. BMJ Open.
2018;8(2):e018798. doi: 10.1136/bmjopen-2017-018798.
4. Sarrafzadegan N, Mohammmadifard N. Cardiovascular
disease in Iran in the last 40 years: prevalence, mortality,
morbidity, challenges and strategies for cardiovascular
prevention. Arch Iran Med. 2019;22(4):204-10.
5. Cheema FM, Cheema HM, Akram Z. Identification of
risk factors of acute coronary syndrome in young patients
between 18-40 years of age at a teaching hospital. Pak J Med
Sci. 2020;36(4):821-4. doi: 10.12669/pjms.36.4.2302.
6. Dai X, Busby-Whitehead J, Alexander KP. Acute coronary
syndrome in the older adults. J Geriatr Cardiol. 2016;13(2):101-
8. doi: 10.11909/j.issn.1671-5411.2016.02.012.
7. Vicent L, Martínez-Sellés M. Frailty and acute coronary
syndrome: does gender matter? J Geriatr Cardiol.
2019;16(2):138-44. doi: 10.11909/j.issn.1671-
5411.2019.02.007.
8. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A.
Epidemiology of coronary heart disease and acute coronary
syndrome. Ann Transl Med. 2016;4(13):256. doi: 10.21037/
atm.2016.06.33.
9. Pagidipati NJ, Peterson ED. Acute coronary syndromes in
women and men. Nat Rev Cardiol. 2016;13(8):471-80. doi:
10.1038/nrcardio.2016.89.
10. Madmoli M, Saeidilandi M, Latifinasab R, Fatehimoghaddam
S, Mobarez F, Darabiyan P. Hypertension and risk of acute
coronary syndrome (ACS) in patients with ACS: a study on
926 patients with ACS. Int J Ayurvedic Med. 2019;10(1):22-6.
doi: 10.47552/ijam.v10i1.1218.
11. Mirza AJ, Taha AY, Khdhir BR. Risk factors for acute coronary
syndrome in patients below the age of 40 years. Egypt Heart J.
2018;70(4):233-5. doi: 10.1016/j.ehj.2018.05.005.
12. Tai S, Li X, Yang H, Zhu Z, Tang L, Fu L, et al. Sex differences
in the outcomes of elderly patients with acute coronary
syndrome. Cardiol Res Pract. 2020;2020:5091490. doi:
10.1155/2020/5091490.
13. Ten Haaf ME, Bax M, Ten Berg JM, Brouwer J, Van’t Hof AW,
van der Schaaf RJ, et al. Sex differences in characteristics
and outcome in acute coronary syndrome patients in the
Netherlands. Neth Heart J. 2019;27(5):263-71. doi: 10.1007/
s12471-019-1271-0.
14. Asgar Pour H, Norouzzadeh R, Heidari MR. Gender
differences in symptom predictors associated with acute
coronary syndrome: a prospective observational study. IntEmerg Nurs. 2016;25:13-8. doi: 10.1016/j.ienj.2015.06.008.
15. Mirzaei S, Steffen A, Vuckovic K, Ryan C, Bronas U, ZegreHemsey J, et al. The quality of symptoms in women and men
presenting to the emergency department with suspected acute
coronary syndrome. J Emerg Nurs. 2019;45(4):357-65. doi:
10.1016/j.jen.2019.01.001.
16. Montazerifar F, Bolouri A, Mahmoudi Mozaffar M, Karajibani
M. The prevalence of metabolic syndrome in coronary
artery disease patients. Cardiol Res. 2016;7(6):202-8. doi:
10.14740/cr507w.
17. Sarrafzadegan N. Reducing the incidence of cardiovascular
diseases in the world. Zahedan J Res Med Sci. 2011;13(1).
[Persian].
18. Nedkoff LJ, Briffa TG, Preen DB, Sanfilippo FM, Hung J, Ridout
SC, et al. Age- and sex-specific trends in the incidence of
hospitalized acute coronary syndromes in Western Australia.
Circ Cardiovasc Qual Outcomes. 2011;4(5):557-64. doi:
10.1161/circoutcomes.110.960005.
19. Neamatipoor E, Sabri A, Dahi F, Soltanipoor F. Changing risk
and demographic factors of myocardial infarction in a decade
(1371-1381) in three university hospital. Tehran Univ Med J.
2006;64(3):88-94. [Persian].
20. Ahmadi A, Sajjadi H, Etemad K, Khaledifar A, Mobasherii M.
Epidemiological characteristics and determinants of mortality
in acute coronary syndrome in Iran. J Mazandaran Univ Med
Sci. 2015;25(124):1-9. [Persian].
21. Liu R, Xu F, Zhou Y, Liu T. The characteristics of risk factors in
Chinese young women with acute coronary syndrome. BMC
Cardiovasc Disord. 2020;20(1):290. doi: 10.1186/s12872-
020-01577-z.
22. Booth GL, Kapral MK, Fung K, Tu JV. Relation between age
and cardiovascular disease in men and women with diabetes
compared with non-diabetic people: a population-based
retrospective cohort study. Lancet. 2006;368(9529):29-36.
doi: 10.1016/s0140-6736(06)68967-8.
23. Lagranha CJ, Silva TLA, Silva SCA, Braz GRF, da Silva AI,
Fernandes MP, et al. Protective effects of estrogen against
cardiovascular disease mediated via oxidative stress
in the brain. Life Sci. 2018;192:190-8. doi: 10.1016/j.
lfs.2017.11.043.
24. Wahrenberg A, Magnusson PK, Discacciati A, Ljung L,
Jernberg T, Frick M, et al. Family history of coronary artery
disease is associated with acute coronary syndrome in 28,188
chest pain patients. Eur Heart J Acute Cardiovasc Care.
2020;9(7):741-7. doi: 10.1177/2048872619853521.
25. Hindieh W, Pilote L, Cheema A, Al-Lawati H, Labos C,
Dufresne L, et al. Association between family history, a
genetic risk score, and severity of coronary artery disease
in patients with premature acute coronary syndromes.
Arterioscler Thromb Vasc Biol. 2016;36(6):1286-92. doi:
10.1161/atvbaha.115.306944.
26. Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka
PA, et al. Sex differences in demographics, risk factors,
presentation, and noninvasive testing in stable outpatients
with suspected coronary artery disease: insights from the
PROMISE trial. JACC Cardiovasc Imaging. 2016;9(4):337-46.
doi: 10.1016/j.jcmg.2016.02.001.
27. Labos C, Wang RH, Pilote L, Bogaty P, Brophy JM, Engert JC,
et al. Traditional risk factors and a Genetic Risk Score are
associated with age of first acute coronary syndrome. Heart.
2014;100(20):1620-4. doi: 10.1136/heartjnl-2013-305416.
28. Idris N, Aznal SS, Chin SP, Ahmad WA, Rosman A,
Jeyaindran S, et al. Acute coronary syndrome in women of
reproductive age. Int J Womens Health. 2011;3:375-80. doi:
10.2147/ijwh.s15825.
29. Banerjee A, Lim CC, Silver LE, Welch SJ, Banning AP,
Rothwell PM. Familial history of stroke is associated with
acute coronary syndromes in women. Circ Cardiovasc Genet.
2011;4(1):9-15. doi: 10.1161/circgenetics.110.957688.
30. Taqueti VR. Sex differences in the coronary system. In:
Kerkhof PLM, Miller VM, eds. Sex-Specific Analysis of
Cardiovascular Function. Cham: Springer; 2018. p. 257-78.
doi: 10.1007/978-3-319-77932-4_17.
31. Kannel WB, Higgins M. Smoking and hypertension as
predictors of cardiovascular risk in population studies. J
Hypertens Suppl. 1990;8(5):S3-8.
32. Panagiotakos DB, Rallidis LS, Pitsavos C, Stefanadis C,
Kremastinos D. Cigarette smoking and myocardial infarction
in young men and women: a case-control study. Int J Cardiol.
2007;116(3):371-5. doi: 10.1016/j.ijcard.2006.04.051.
33. Huxley RR, Woodward M. Cigarette smoking as a risk factor
for coronary heart disease in women compared with men:
a systematic review and meta-analysis of prospective cohort
studies. Lancet. 2011;378(9799):1297-305. doi: 10.1016/
s0140-6736(11)60781-2.
34. Peters SA, Huxley RR, Woodward M. Smoking as a risk
factor for stroke in women compared with men: a systematic
review and meta-analysis of 81 cohorts, including 3,980,359
individuals and 42,401 strokes. Stroke. 2013;44(10):2821-8.
doi: 10.1161/strokeaha.113.002342.
35. Hbejan K. Smoking effect on ischemic heart disease in young
patients. Heart Views. 2011;12(1):1-6. doi: 10.4103/1995-
705x.81547.
36. Shields M, Wilkins K. Smoking, smoking cessation and
heart disease risk: a 16-year follow-up study. Health Rep.
2013;24(2):12-22.
37. Schoenenberger AW, Radovanovic D, Stauffer JC,
Windecker S, Urban P, Niedermaier G, et al. Acute coronary
syndromes in young patients: presentation, treatment and
outcome. Int J Cardiol. 2011;148(3):300-4. doi: 10.1016/j.
ijcard.2009.11.009.
38. Tsai WC, Wu KY, Lin GM, Chen SJ, Lin WS, Yang SP, et al.
Clinical characteristics of patients less than forty years old
with coronary artery disease in Taiwan: a cross-sectional
study. Acta Cardiol Sin. 2017;33(3):233-40. doi: 10.6515/
acs20161026a.
39. Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor
RJ, et al. Evidence-based guidelines for cardiovascular disease
prevention in women: 2007 update. J Am Coll Cardiol.
2007;49(11):1230-50. doi: 10.1016/j.jacc.2007.02.020.
40. Möller-Leimkühler AM. Gender differences in cardiovascular
disease and comorbid depression. Dialogues Clin Neurosci.
2007;9(1):71-83. doi: 10.31887/DCNS.2007.9.1/ammoeller.
41. DeVon HA, Vuckovic K, Burke LA, Mirzaei S, Breen K,
Robinson N, et al. What’s the risk? Older women report
fewer symptoms for suspected acute coronary syndrome than
younger women. Biores Open Access. 2018;7(1):131-8. doi:
10.1089/biores.2018.0020.
42. Leuzzi C, Sangiorgi GM, Modena MG. Gender-specific
aspects in the clinical presentation of cardiovascular
disease. Fundam Clin Pharmacol. 2010;24(6):711-7. doi:
10.1111/j.1472-8206.2010.00873.x.
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