Women are 31% more likely than men to have Type 2 myocardial infarction (OR 0.69; 95% CI 0.63-0.74; P<0.001) according to meta-analysis of 3.3 million patients.
Are there sex-based differences in the incidence, comorbidities, clinical management, and outcomes of Type 2 myocardial infarction?
This meta-analysis demonstrates that Type 2 myocardial infarction is significantly more prevalent in women than men, with notable sex-based differences in comorbidities, angiographic findings, and mortality.
Abstract Background Worldwide, cardiovascular disease remains a primary cause of death, with notable differences between sexes. While sex differences in Type 1 myocardial infarction (T1MI) are well recognized, those in Type 2 myocardial infarction (T2MI) are less understood and may influence clinical practice and provide valuable prognostic insights. Purpose We aimed to provide a comprehensive overview of sex-based differences in incidence, comorbidities, clinical management, and outcomes of T2MI. Methods A systematic-scoping review of retrospective and prospective studies examining the differences in T2MI by sex was conducted by three-independent reviewers. Six databases were included in the search strategy (Web of Science, OVID, SCOPUS, EMBASE, CINAHL, PUBMED), and were last searched on November 29, 2024. Pooled odds ratios (OR) with 95% confidence interval (CI) of T2MI gender differences were calculated using aggregated meta-analyses in Stata. Results The search strategy resulted in 1388 articles and 28 studies were included after the full-text screening (Figure 1). Thirteen of these were included in the meta-analysis on the likelihood of T2MI by gender, with 3,292,727 participants in total (618,535 T2MI, of which 47.5% were female). Meta-analysis displayed that men were significantly less likely than women to have T2MI (OR 0.69; 95% CI, 0.63-0.74; P0.001) (Figure 2). Women with T2MI were generally older and had a higher prevalence of hypertension than men (n=5). While some studies found higher diabetes rates in men (n=2), others reported a greater history of prior PCI or CABG in this group (n=4). Coronary artery disease (CAD) was less frequently observed on angiography in women (n=3) compared to men. Mortality, both short- and long-term, was higher in men (n=4), though one study contradicted this finding (n=1). Although data on treatment differences were limited, some evidence suggested greater ASA use in men (n=2). Conclusion This is the first comprehensive overview of sex-based differences in T2MI. Our study demonstrated that T2MIs are more prevalent in females, highlighting key differences among genders. In sum, data is limited, and further research is needed on gender-specific factors in T2MI to improve diagnosis, management, and mortality rates.Figure 1:PRISMA Diagram Figure 2:Forest plot of unadjusted odd
Lalani et al. (2025) studied this question. Women are 31% more likely than men to have Type 2 myocardial infarction (OR 0.69; 95% CI 0.63-0.74; P<0.001) according to meta-analysis of 3.3 million patients.