To the Editor: In a study analyzing data from the National Registry of Myocardial Infarction, Dr Canto and colleagues1 emphasized sex differences in the presentation of MI without chest pain. However, 64.5% presented with chest pain (69.3% of men and 58.0% of women). In both sexes, chest pain/discomfort remains the most common presentation.2
Canto et al1 identified a significant interaction between age and sex for chest pain at presentation. In other words, age is an important modifier of sex differences in chest pain presentation and therefore the results cannot be summarized without taking age into account.3 While the odds ratio for chest pain in men was greatest in the youngest age group, this does not imply that the youngest women are the least likely to present with chest pain. Chest pain was actually more common in the youngest women (81.5%) than in women in any other age group. Importantly, differences were more pronounced across age groups than between the sexes. The difference between women younger than 45 years compared with those aged 75 years or older was 31.9%. In contrast, the largest between-sex difference was only 7.1% in those aged 55 to 64 years.
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