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Background:Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support.Methods:There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models.Results:There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates (Figure). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant.Conclusion:Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.

Background:Perceived discrimination is associated with several risk factors for acute myocardial infarction (AMI), but little is known about the association between discrimination and health status outcomes post-AMI.Methods:We analyzed the 1- and 12-month health status of 2,670 young (≤ 55 years) adults recovering from an AMI enrolled in the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Perceived discrimination was assessed using the Everyday Discrimination Scale (EDS). General health status was measured using the Short Form 12 Physical and Mental Component Scores (PCS and MCS). Disease-specific health status was measured using the following domains of the Seattle Angina Questionnaire (SAQ): treatment satisfaction (TS), quality of life (QL) and dichotomous forms of the physical limitation and angina frequency domain scores (score < 100). Lower scores indicate worse health status. Multivariable linear regression of the PCS, MCS, TS, and QL scores and multivariable logistic regression of the dichotomous forms of physical limitation and angina frequency were used to assess their adjusted associations with perceived discrimination.Results:Nearly 35.0% of the cohort reported discrimination (EDS > 0). At 1-month post-AMI, increased EDS score was significantly associated with lower MCS, TS, and QL scores and higher odds of physical limitation and angina after adjustment (Figure). At 12-months post-AMI, increased EDS score retained its significant associations with lower MCS and QL scores and higher odds of physical limitation and angina, but not its association with TS (Figure). The EDS score was not associated with PCS at either 1- or 12-months post-AMI.Conclusions:Perceived discrimination was associated with worse mental health and disease-specific health status one year after AMI after adjusting important confounders. Further work to understand the source and how to mitigate perceived discrimination is needed.

Background:Psychosocial stress is associated with worse cardiac outcomes, but little is known about the prognostic impact of marital stress in young adults (≤55 years) with acute myocardial infarction (AMI). We investigated the association between marital stress and 1-year health outcomes in young AMI survivors.Methods:We used data from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled people aged 18-55 years with AMI (2008-2012). Marital stress was assessed among married/partnered participants at 1 month post-AMI using the Stockholm Marital Stress Scale, categorized as absent/mild, moderate, and severe. Main outcomes were physical/mental health status, generic/disease-specific quality of life, angina, depressive symptoms, and all-cause readmission at 1 year post-AMI. Linear and logistic regression models were sequentially adjusted for baseline health status, demographics, and socioeconomic factors (including education level, income level, employment status, and insurance status).Results:Among the 1593 married/partnered participants in our study, more women reported severe marital stress than men (39.4% vs 30.4%, p=0.001). Having severe marital stress was associated with worse physical and mental health, lower generic and cardiovascular-specific quality of life, more angina and depressive symptoms, and 1.48 times higher all-cause readmission at 1 year post-AMI. These associations remained significant after adjusting for baseline health score and patient demographics (Table Model 1), but they attenuated and became non-significant when further adjusting for socioeconomic factors (Model 2).Conclusion:Marital stress was associated with worse health outcomes in young AMI patients, which can be partially mediated by socioeconomic factors. Further research is needed to understand this complex relationship and potential causal pathway associated with these findings.

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Despite the excess risk of mortality in young women (55 years of age) after acute myocardial infarction (AMI), little is known about young women’s health status (symptoms, functioning, quality of life) during the first year of recovery after an AMI. We examined gender differences in health status over time from baseline to 12 months after AMI.

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Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a puzzling clinical entity with no previous evaluation of the literature. This systematic review aims to (1) quantify the prevalence, risk factors, and 12-month prognosis in patients with MINOCA, and (2) evaluate potential pathophysiological mechanisms underlying this disorder.

Background:Younger women (≤55 years) are at higher risk for readmission within one-year of hospitalization following acute myocardial infarction (AMI) compared to similarly aged men, yet there are no gender-specific risk prediction models for this population. Prior research suggests that gender-related factors more comprehensively explain sex-based differences in readmission risk. The objective was to develop and validate a risk prediction model of 1-year post-AMI readmission in young women considering demographic, clinical, and gender-related factors.Methods:We used data from women enrolled in the VIRGO study (n =2,007), a prospective observational study of young patients aged ≤55 years hospitalized with AMI in the US. Data were obtained from patient interviews, medical record abstraction, and adjudicated hospitalization records. Bayesian Model Averaging was used for model selection in a derivation cohort of 1338 women and subsequently validated in the remaining 669 women.Results:Within 1-year post-AMI, 684 (34.1%) women were readmitted at least once with a majority of readmissions due to cardiac causes (57.5%). The final model contained 9 predictors: experiencing any in-hospital complications, physical health at baseline (SF-12), disease-specific quality of life (Seattle Angina Questionnaire), diabetes, history of congestive heart failure, low income (≤30,000 USD), depression, length of hospital stay, and employment status (Figure). Of the 9 predictors, 5 were gender-related. The model was well calibrated (calibration plots) and exhibited modest discrimination (C statistic=0.66 in development and validation cohorts).Conclusions:Younger women with diabetes, depression, history of congestive heart failure, and longer hospital stays were more likely to be readmitted. While clinical factors were the strongest predictors of readmission within 1-year among younger women with AMI, gender-related variables were important complements.

Background:Cardiac rehabilitation (CR) is a core component of secondary prevention shown to improve quality of life and reduce all-cause mortality after myocardial infarction (MI). Depression is twice as prevalent among young women (18-44y) versus men with MI and is linked with worse post-MI outcomes, yet information on sex-specific associations of depression and CR attendance is limited, particularly among younger MI patients.Methods:Using data from the 2011, 2013, 2015, and 2017 self-reported US Behavioral Risk Factor Surveillance System (BRFSS) surveys, we assessed the association between depression and CR attendance in adults with MI using logistic regression adjusting for sociodemographic factors. We calculated CR rates by sex and age subgroups for MI patients with and without depression. BRFSS survey weighting was applied to all analyses.Results:The study included 12,252 MI patients (44.2% women). CR attendance was comparable between MI patients with and without depression (36.1% vs 37.4%, p=0.440) (Figure 1a), and the association between depression and CR remained nonsignificant after adjusting for age, sex, race, education, and household income (OR=1.16, 95% CI: 1.00-1.35). CR attendance ranged from 19.0% to 51.0% across age and sex subgroups, with the lowest rate seen among women 18-44y with depression (Figure 1b). Women who were 45-64y and 65+y were less likely to attend CR than similarly aged men, regardless of depression status.Conclusions:Overall, just over one-third of patients with MI participated in CR, and depression was not associated with CR attendance. We found marked heterogeneity by subgroups, with lower CR rates observed for women across age groups, potentially putting them at higher risk for subsequent adverse cardiac events. Further research is needed to identify barriers leading to sex- and age-specific CR disparities to optimize attendance of post-acute care among subgroups, especially among younger women with depression.