Role of Sex Difference in Modifiable Risk Factors After Acute Myocardial Infarction

gressive vascular disease.5 It is also pointed out that women are less likely to present with typical ischemic symptoms compared with men, resulting in delays in diagnosis and treatment and leading to more severe CAD.6 Systematic research on sex differences has been also conducted in Japan.The Japanese Acute Coronary Syndrome Study (JACSS), which incorporated 1,925 Japanese patients with first AMI, first reported a sex difference in the relative importance of each risk factor in the development of AMI in Japan.7 In JACSS, hypertension, smoking, diabetes, and family history were consistent risk factors in both men and women across different geographic regions of Japan, whereas hypercholesterolemia was an independent risk factor for AMI only in men.Another report from JACSS observed that women, compared with men, were significantly older, had worse clinical profiles on admission, had higher rates of in-hospital death, but female sex itself was not independently associated with increased in-hospital death after adjustment for baseline difference.8 A past report from K-ACTIVE (Kanagawa-ACuTe cardIoVascular rEgistry) that included 2,491 patients with ST-segment elevation MI (STEMI) reported that percentages of prehospital 12-lead ECG, reperfusion therapy and achievement of door-to-device time ≤90 min were similar between men and women.9 As a result, in-hospital mortality rates were similar between the sexes, suggesting that guidelinebased treatment might have attenuated the sex difference in in-hospital death.The J-MINUET (Japan Registry of Acute Myocardial Infarction Diagnosed by Universal Definition) study enrolled 3,283 patients with AMI within 48 h of onset and investigated the association between age and sex difference in long-term outcomes.10 The study found a higher crude incidence of 3-year major adverse cardiac events (MACE) in women than in men, but analysis by age showed no significant sex difference in each group.It is against this background that we read with great interest the study in this issue of the Journal by Hoshi and colleagues.11 The authors used a Japanese nationwide administrative database (J-PCI OUTCOME Registry) to investigate the impact of sex difference on post-discharge