The Risk Factors of Acute Coronary Syndrome in Young Women: A Systematic Review and Meta-Analysis

Background and aims:

Acute coronary syndrome (ACS) has been one of the leading causes of mortality in the world. Despite common understanding regarding ACS as older population’s or man’s disease, the number of young women affected by this condition is increasing. Many studies had assessed the risk factors of ACS, but only a few studies focused on this subpopulation. Therefore, this systematic review and meta-analysis aims to evaluate the risk factors predisposing of ACS in the young women population.


Nine online databases were screened from the date of inception to September 2021, where the acquired studies were evaluated using the PRISMA statement. The inclusion criteria were case control study with women age cut-off of <50 years. The risk factors of acute coronary syndrome were analyzed using random-effect model, expressed as summary statistics of odds ratio (OR) for categorical variable and standard mean difference (SMD) for continuous data with normal distribution, with 95% confidence interval (CI). Quality assessment was conducted using the STROBE statement.


Seven studies with the total of 7042 patients met the inclusion criteria of this meta-analysis. Diabetes mellitus, high BMI, obesity, hypercholestrolemia, hypertension, smoking, and family history significantly increased acute coronary syndrome risk in young women. Other risk such as heavy alcohol consumption, oral contraceptive use, and postmenopausal state were associated with higher risk of ACS.


The independent risk factors which are strongly related to ACS in young women were diabetes mellitus, hypertension, and hypercholesterolemia with odd ratios of 6.21, 5.32, and 4.07. Other risk factors which may be associated with an increased risk of ACS in young women were heavy alcohol consumption, oral contraceptive use, and postmenopausal state. Health promotion and effective intervention on this specific population regarding these risk factors can decrease young female cardiovascular morbidity and mortality as well as improved quality of life of women.


Acute coronary syndrome; atherosclerosis; meta-analysis; risk factors; systematic review; young women.

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