AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Sex Differences in Lipid Trajectories and Clinical Outcomes During the First Year After Myocardial Infarction
By Marques Muller Pessoa C, Marques Muller Pessoa R, Corso L et al.
Background: The first year after myocardial infarction (MI) represents a critical period for secondary prevention, during which sex-related differences in cardiometabolic risk factor control may influence long-term outcomes. However, longitudinal sex-specific trajectories of cardiometabolic risk factors during structures follow-up programs remain insufficiently characterized. Research Question: To investigate sex differences in cardiometabolic trajectories and clinical outcomes during the first year after MI among patients enrolled in a structured follow-up program. Methods: This prospective cohort included 200 consecutive patients enrolled in a structured post-MI care pathway between June 2023 and June 2025. Clinical assessments were conducted at 1, 6, and 12 months. Baseline characteristics, lipid profile, glycated hemoglobin (HbA1c), blood pressure control, medication adherence, cardiovascular events, and mortality were evaluated. Longitudinal trajectories were analyzed using linear mixed-effects models incorporating time, sex, and time-by-sex interaction terms. Results: Women accounted 33% of the cohort and were older than men at presentation (65.8±12.6 vs. 61.7±12.1 years; p=0.030). Women had a higher prevalence of type 2 diabetes (48.4% vs. 27.6%; p=0.006) and higher baseline HbA1c levels (6.2% vs. 5.5%; p=0.001), whereas active smoking was more common among men (30.6% vs. 18.1%; p=0.007). A significant time-by-sex interaction was observed for LDL-C trajectories (p=0.006). Men experienced a substantial and sustained reduction in LDL-C from 116.8 mg/dL at baseline to 76.4 mg/dL at 12 months, whereas women demonstrated a partial loss of lipid control following the initial response, with LDL-C increasing from 80.3 mg/dL at 1 month to 84.1 mg/dL at 12 months. HbA1c remained consistently higher among women throughout follow-up (sex effect p=0.004), without a significant time-by-sex interaction. MACE incidence was similar between sexes (p=0.754). However, women exhibited significantly higher all-cause mortality (7.5% vs. 1.4%; OR 5.40, 95% CI 1.02-28.6; p=0.040). Conclusions: Despite similar rates of recurrent ischemic events, women exhibited persistently worse metabolic profiles and less favorable long-term lipid trajectories following MI. Higher mortality among women appeared to be driven primarily by a greater burden of baseline comorbidities rather than by recurrent cardiovascular events, underscoring the need for sex-responsive secondary prevention strategies after MI.