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Acute MI risk high in middle-aged men with dyslipidemia
Dyslipidemia appears to be a stronger risk factor for acute MI in middle-aged men than in middle-aged women.
Researchers in Norway investigated whether dyslipidemia-related risk factors for acute MI differ by sex.
Current guidelines for dyslipidemia management do not distinguish between men and women in terms of risk factors for acute MI, according to the study background.
The researchers analyzed data from the Nord-Trøndelag health study (HUNT 2), a population-based cohort study from 1995 to 1997 in which more than 65,000 Norwegians answered survey questions and had blood samples collected. They focused on those younger than 60 years at baseline (n=23,525 women, 20,725 men). Those participants were followed for 12 years to record the occurrence of first MI and presence of dyslipidemia.
“We hypothesized that estrogens would protect women [aged younger than] 60 years from some of the cardiovascular consequences — hence, myocardial infarctions — of having dyslipidemia,” researcher Erik Madssen, MD, told Cardiology Today. “Thus, our main findings support this hypothesis and were not unexpected. However, we did not expect that the proportion of myocardial infarction cases attributable to the synergy between male sex and dyslipidemia would be this strong. That surprised us in some way.”
During the follow-up period, 553 men had a first MI compared with 157 women. The proportion of acute MI cases among men that could be attributed to the association of male sex and dyslipidemia was 0.46 (95% CI, 0.35-0.57) for high total serum cholesterol, 0.23 (95% CI, 0.05-0.41) for low HDL cholesterol and 0.52 (95% CI, 0.42-0.62) for high non-HDL cholesterol.
The researchers found no evidence that risk factors for acute MI related to obesity or hypertension in the study population differed by sex. The proportion of acute MI cases among men that could be attributed to the association of male sex and obesity was 0.02 (95% CI, –0.21 to 0.25). The proportion of acute MI cases among men that could be attributed to male sex and hypertension was –0.01 (95% CI, –0.27 to 0.24).
“The study adds epidemiological evidence for an underlying pathophysiological difference between sexes in regard to the development of heart attacks,” Madssen told Cardiology Today. “Our study supports that in middle-age dyslipidemia is much more detrimental for men than for women. This is new knowledge. Our study suggests that preventing dyslipidemia in middle-aged males has a greater potential to reduce the occurrence of myocardial infarction that what was previously known. We argue for an increased focus on prevention of dyslipidemia in middle-aged men especially.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.