RESUMO
Importance: There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure. Methods: A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1-22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Results: ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both p < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52-0.91; p = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up. Conclusions: There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes. Trial Registration: 4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.
RESUMO
Although the classical cardiovascular risk factors (such as smoking, hypertension and hypercholesterolemia) are becoming gradually more effectively controlled, a continuous increase of the so-called "cardiometabolic risk" linked to obesity and impaired glycemic control is observed. Starting from the beginning of this century, the definition of the "metabolic syndrome" has become very popular to identify a combination of different factors concurring to increase cardiovascular risk. In the medical literature a controversy does exist concerning this question: is the metabolic syndrome a real syndrome or should it be considered a simple cluster of risk factors? In this synthetic review the analysis of the most recent studies suggests that a) the metabolic syndrome causes an increased cardiovascular risk; b) this risk varies in accordance with the number and characteristics of the diagnostic criteria used; and c) the adjustment for the traditional risk factors lowers but does not eliminate entirely the incremental relative risk attributable to the metabolic syndrome. Whether the risk of metabolic syndrome is greater than the risk attributable to the sum of each component remains to be elucidated. However, the most reliable evidence supports the opinion that the risk prediction associated with this syndrome is not greater than the sum of its parts.