Sex disparities in young adults aged 20-40 with acute coronary syndrome

Sex disparities in young adults aged 20-40 with acute coronary syndrome (ACS) are rarely known in China. We aimed to explore these sex-based differences, using a nationwide, population-based database.

Clinical data of patients with ACS (n = 89,772) registered in the Chinese Cardiovascular Association (CCA) Database-Chest Pain Centre were analyzed, including ST-elevation myocardial infarction (STEMI, 57.7%), non-ST-elevation myocardial infarction (NSTEMI, 20.7%), and unstable angina (UA, 21.5%) across males (94.0%) and females (6.0%).

Young males show a significantly higher rate of diagnostic assessment (P < 0.05) and receive approximately a 2-fold higher treatment rate than females. Young males observe a higher risk (adjusted odds ratio [aOR] 2.74, 95%CI: 2.40, 3.14) of STEMI than females. Young males aged below 24 years show a 2-fold higher in-hospital mortality (IHM) than females. Young females show a higher risk (aOR 3.23, 95%CI: 2.84, 3.67) of UA compared with males. Hypertension is associated with a higher risk of NSTEMI and UA in young males. Young females and modifiable risk factors show a positive interaction effect on the risk of STEMI and NSTEMI, whereas young males and modifiable risk factors show a positive interaction effect on the risk of UA.

Young males with ACS show higher access to medical care and a higher risk of STEMI, while young females have a higher risk of UA. Furthermore, males below 24 years have higher IHM compared to age-matched females. These disparities underscore the need for sex-specific interventions to reduce ACS incidence and improve early outcomes in young patients.