Although heart disease in young women causes many deaths, it has been virtually ignored by the medical profession because it represents only a small fraction of the total incidence of atherosclerotic heart disease. However, young women who suffer an acute myocardial infarction (AMI) have a mortality risk markedly higher than that of young men, and the limited data on young women from minority groups in the USA suggest that this population may have the highest risk of any young subgroup. There have been no large, prospective studies of ischemic heart disease in young women, even though the death toll is comparable to that due to breast cancer. Findings from the small number of studies that have been published suggest that the biology, epidemiology, care, and outcomes of heart disease in women differ from those of men. The IMJOVEN study is the Spanish counterpart of the VIRGO study, an NIH-sponsored investigation led by Harlan Krumholz of Yale University into the excess risk in young women with AMI.

The specific aims of VIRGO and IMJOVEN are as follows:

1. To characterize sex differences after hospitalization for AMI for a broad range of outcomes including mortality, all-cause readmission, rehospitalization for cardiovascular causes, and adverse health status.
2. To evaluate the influence of demographic, clinical, metabolic, biochemical, genetic, psychosocial, and lifestyle factors on outcomes for young women and men with AMI and to examine whether sex-based variation in these factors is associated with variation in outcomes.
3. To compare the clinical treatment of young men and women who present at hospital with AMI and determine whether differences in quality of care may be associated with differences in outcome.
4. To describe the relationship of female-specific factors—including genetic variants, sex hormones, reproductive history, prior use of estrogens and menstrual cycle history—with disease outcomes for women.
5. To develop comprehensive prognostic scores to stratify risk in this young population and identify predictors of early (within 1 month of discharge) and longer-term (1 year) outcomes.
6. To create a blood and DNA repository as a resource for future studies.
7. To partner with national and international organizations to disseminate study findings in order to improve the prevention, care, and outcomes for young patients with AMI.

Our aim with IMJOVEN is to study 450 patients (300 women and 150 men) with a previous history of AMI, using the same protocol as the VIRGO study. We have already recruited 395 patients in 24 hospitals in Spain, and we are well on our way to completing recruitment on schedule. IMJOVEN is coordinated by the Department of Translational Research at the CNIC, the Spanish Society of Cardiology and the RECAVA and Heracles networks. Funding comes from a FIS grant, the NIH and the CNIC.