Young women with an acute myocardial infarction (AMI) represent an extreme phenotype in ischemic heart disease risk and, at the same time, constitute a large understudied group with excess mortality risk compared with similarly aged men. This combination of adverse risk and inadequate investigation provides a critically important opportunity to address the care and outcomes of young women with AMI to uncover key biological and environmental determinants of their prognosis. Accordingly, we propose the first large, comprehensive, observational study of young women with AMI (YWAMI). YWAMI will include 2,000 women, 18-55 years of age, with AMI and a comparison cohort of 1,000 men enrolled over 3 years from 88 hospitals across the United States and in Canada. To accomplish these aims we have assembled a team of leading researchers in sex disparities in cardiovascular disease, outcomes research, epidemiology, statistics, genetics, biomarker research, health status measurement, psychosocial research, cardiology, and emergency medicine.
Our Specific Aims are to: 1) characterize sex differences in outcomes following AMI (including mortality, hospitalization and health status); 2) determine sex differences in the prevalence of demographic, clinical, and psychosocial risk factors; 3) determine sex differences in quality of care; and 4) determine sex differences in the prevalence of selected biological factors (including sex hormones, biomarkers and genetic variations). We will characterize these differences in great detail and elucidate the biological and environmental factors that are responsible for disparities in outcomes. The analyses from all four aims will be used to develop clinically useful risk-stratification models for young AMI patients, explain sex differences in outcomes and identify targets for intervention. We will also bank serum and DMA from each subject, creating a resource for anticipated future studies of the molecular biology of AMI in young women and men. We will work with the American College of Cardiology, the American Heart Association and VHA, Inc. to disseminate findings from this study that can be used to improve the prevention, care, and outcomes for young women and men with AMI. Public Health Implications: Overall, although heart disease in young women accounts for as many deaths as breast cancer, few studies have addressed the biological, environmental and social factors that influence their outcome. Young women with heart attacks have a higher risk of dying than similarly aged men. We propose to conduct the largest, most comprehensive study of young women with heart attacks to identify the key determinants of their recovery and discover knowledge that will assist us in improving their care. ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL081153-01A1
Application #
7265684
Study Section
Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Nelson, Cheryl R
Project Start
2007-09-01
Project End
2011-05-31
Budget Start
2007-09-01
Budget End
2008-05-31
Support Year
1
Fiscal Year
2007
Total Cost
$2,471,501
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Lichtman, Judith H; Leifheit, Erica C; Safdar, Basmah et al. (2018) Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction: Evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation 137:781-790
Safdar, Basmah; Spatz, Erica S; Dreyer, Rachel P et al. (2018) Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. J Am Heart Assoc 7:
Emdin, Connor A; Khera, Amit V; Chaffin, Mark et al. (2018) Analysis of predicted loss-of-function variants in UK Biobank identifies variants protective for disease. Nat Commun 9:1613
Pokharel, Yashashwi; Sharma, Puza P; Qintar, Mohammed et al. (2017) High-sensitivity C-reactive protein levels and health status outcomes after myocardial infarction. Atherosclerosis 266:16-23
Lu, Yuan; Zhou, Shengfan; Dreyer, Rachel P et al. (2017) Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study. Am Heart J 183:74-84
Smolderen, Kim G; Spertus, John A; Gosch, Kensey et al. (2017) Depression Treatment and Health Status Outcomes in Young Patients With Acute Myocardial Infarction: Insights From the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation 135:1762-1764
Lu, Yuan; Zhou, Shengfan; Dreyer, Rachel P et al. (2017) Sex Differences in Inflammatory Markers and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) Study. Circ Cardiovasc Qual Outcomes 10:e003470
Minges, Karl E; Strait, Kelly M; Owen, Neville et al. (2017) Gender differences in physical activity following acute myocardial infarction in adults: A prospective, observational study. Eur J Prev Cardiol 24:192-203
Qintar, Mohammed; Sharma, Puza P; Pokharel, Yashashwi et al. (2017) Prevalence and predictors of elevated high-sensitivity C-reactive protein in post-myocardial infarction patients: Insights from the VIRGO and TRIUMPH registries. Clin Cardiol 40:1205-1211
Xu, Xiao; Bao, Haikun; Strait, Kelly M et al. (2017) Perceived Stress After Acute Myocardial Infarction: A Comparison Between Young and Middle-Aged Women Versus Men. Psychosom Med 79:50-58

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