Sex Differences in Acute Coronary Syndrome Prodromal Symptoms Among Younger Patients

Study Questions:

Do differences exist in prodromal symptoms prior to acute coronary syndromes (ACS) between men and women?


Data from the GENESIS PRAXY (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome) cohort study were used for the present analysis. This prospective cross-sectional study included men and women hospitalized for ACS, between January 2009 and April 2013, who were under the age of 56 years. Participants were enrolled from 24 sites, predominantly in Canada. The diagnosis of ACS was determined by the treating physician, based on standard criteria. Symptoms related to the ACS event were assessed using the McSweeney Acute and Prodromal Myocardial Infarction Symptom questionnaire. Health-seeking behavior and prehospital care were determined by questionnaires.


A total of 1,145 adults (mean age 49 years) were included, of which 368 (32%) were women. Prodromal symptoms were high in general, but women were more likely to report such symptoms compared with men (85% vs. 72%, p < 0.0001). Similar symptoms were reported for men and women and included unusual fatigue, sleep disturbances, anxiety, and arm weakness/discomfort. Chest pain was less common in both sexes (24%). Prodromal symptoms were more often reported among men and women with cardiovascular risk factors. The presence of anxiety and depression was also more common among those with prodromal symptoms compared to those without symptoms. Women were more likely to seek care (49% vs. 42%, p = 0.04). Among those who sought care, women were more likely to use an ambulance for their ACS compared with men (52% vs. 39%). Use of cardiovascular risk-reduction therapy prior to ACS was low (≤40%) in all patients, and less than half perceived their care provider suspected a cardiac source.


The authors concluded that prior to ACS, women were more likely to experience prodromal symptoms and seek medical attention than men. Prehospital care was generally similar between sexes, but demonstrated underutilization of risk-reduction therapies in at-risk young adults.


These results suggest that risk factor modification and patient education among young adults with risk factors are warranted for both women and men.

Clinical Topics: Acute Coronary Syndromes, Prevention, Atherosclerotic Disease (CAD/PAD)

Keywords: Acute Coronary Syndrome, Secondary Prevention, Anxiety, Cardiovascular Diseases, Chest Pain, Coronary Artery Disease, Depression, Fatigue, Middle Aged, Myocardial Infarction, Prodromal Symptoms, Primary Prevention, Risk Factors, Sex Characteristics

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