ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1481917
Sex-Related Differences in Acute Coronary Syndrome: Insights from an Observational Study in A Yemeni Cohort
Provisionally accepted
- 1Al-Razi University, Sana'a, Yemen
- 2Department of Community Health and Clinical Nutrition, College of Medicine and Health Sciences, Al-Razi University, Sana’a, Yemen
- 3Faculty of Medicine and Health Sciences, Sana'a University, Sana’a, Yemen
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Background: Acute coronary syndrome (ACS) presents with significant sex-related differences globally, yet research within Yemen remains limited. This study investigates these differences in the clinical presentation, management, and outcomes of Yemeni patients with ACS.Methods: A retrospective cohort study was conducted at six tertiary care centers, including 1743 patients (1379 men and 364 women) hospitalized with ACS between January 2020 and December 2023.Results: On average, women were generally older than men (59.4 ± 11.7 vs. 57.9 ± 12.7 years, P = 0.031) and more frequently diagnosed with non-ST elevation ACS (35.2% vs. 28.9%, P = 0.021). Women also exhibited higher rates of traditional cardiovascular risk factors, including diabetes mellitus (31.9% vs. 20.8%, P < 0.001) and hypertension (44.5% vs. 32.0%, P < 0.001), but had a lower prevalence of atrial fibrillation (0.8% vs. 2.5%, P = 0.033) and less likely to engage in ACS lifestyle risk behaviors like smoking (31.0% vs. 83.0%, P < 0.001) and khat chewing (53.3% vs. 83.7%, P < 0.001). Women were less likely to receive coronary angiography (47.5% versus 61.3%, P < 0.001) or percutaneous coronary intervention (33.8% vs. 46.6%, P < 0.001) and were discharged with fewer guideline-recommended therapies for secondary prevention. Women experienced worse in-hospital outcomes, with a significantly higher inhospital mortality rate (12.6% vs. 7.6%, P = 0.002), especially among those with ST-elevation myocardial infarction (STEMI), which remained significant even after adjustment for all clinical confounding factors (adjusted odds ratio, 1.80; 95% CI, 1.16-2.78, P = 0.008). However, the one-year mortality rate showed no significant difference between genders.Yemeni women with ACS experience disparities in treatment and worse in-hospital outcomes, especially in STEMI cases. Addressing gender biases through public health education, healthcare provider training, and infrastructure improvements is essential to improving outcomes.
Keywords: Acute Coronary Syndrome, sex differences, gender bias, In-hospital mortality, Women's Health
Received: 16 Aug 2024; Accepted: 19 May 2025.
Copyright: © 2025 Al-Habeet, Muammar, Aljaber, Al Nono and Al-Motarreb. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Abdulhafeedh Al-Habeet, Al-Razi University, Sana'a, Yemen
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