Sex disparities in young adults aged 20–40 with acute coronary syndrome

Sex disparities in young adults aged 20–40 with acute coronary syndrome (ACS) are rarely known in China. We aimed to explore these sex-based differences, using a nationwide, population-based database. Clinical data of patients with ACS (n = 89,772) registered in the Chinese Cardiovascular Association (CCA) Database–Chest Pain Centre were analyzed, including ST-elevation myocardial infarction (STEMI, 57.7%), non-ST-elevation myocardial infarction (NSTEMI, 20.7%), and unstable angina (UA, 21.5%) across males (94.0%) and females (6.0%). Young males show a significantly higher rate of diagnostic assessment ( P < 0.05) and receive approximately a 2-fold higher treatment rate than females. Young males observe a higher risk (adjusted odds ratio [aOR] 2.74, 95%CI: 2.40, 3.14) of STEMI than females. Young males aged below 24 years show a 2-fold higher in-hospital mortality (IHM) than females. Young females show a higher risk (aOR 3.23, 95%CI: 2.84, 3.67) of UA compared with males. Hypertension is associated with a higher risk of NSTEMI and UA in young males. Young females and modifiable risk factors show a positive interaction effect on the risk of STEMI and NSTEMI, whereas young males and modifiable risk factors show a positive interaction effect on the risk of UA. Young males with ACS show higher access to medical care and a higher risk of STEMI, while young females have a higher risk of UA. Furthermore, males below 24 years have higher IHM compared to age-matched females. These disparities underscore the need for sex-specific interventions to reduce ACS incidence and improve early outcomes in young patients.