<b>Contributing Risk Factors Before Myocardial Infarction in Men and Women Presenting to Tertiary Care Hospital: A Multicenter Cross-Sectional Study</b>

Background: Myocardial infarction (MI) remains a leading cause of death worldwide, with South Asian populations experiencing earlier onset and higher prevalence compared with other regions. Traditional risk factors such as smoking, hypertension, diabetes, dyslipidemia, obesity, and sedentary lifestyle, alongside psychosocial stressors including anxiety and depression, are recognized contributors. However, gender-specific differences in these determinants remain insufficiently explored in the Pakistani context. Objective: To identify and compare the contributing risk factors for MI in men and women presenting to tertiary care hospitals in Khyber Pakhtunkhwa, Pakistan, and to evaluate the relative strength of their associations. Methods: An analytical cross-sectional study was conducted between June and November 2023 at Ayub Teaching Hospital, Abbottabad, and Lady Reading Hospital, Peshawar. A total of 385 patients with confirmed acute MI were consecutively recruited. Data on demographic, clinical, lifestyle, and psychosocial risk factors were collected using structured questionnaires and validated tools. Statistical analysis was performed using chi-square tests and multivariable logistic regression to assess associations and estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Smoking was significantly associated with MI, conferring a 17-fold increased risk (OR 17.03, 95% CI 6.72–43.18, p<0.001), particularly among men. Hypertension (OR 2.10, 95% CI 1.40–3.20, p<0.001), obesity (OR 2.11, 95% CI 1.33–3.36, p=0.001), elevated lipid profile (OR 1.66, 95% CI 1.05–2.16, p=0.030), sedentary lifestyle (OR 1.89, 95% CI 1.22–2.91, p=0.004), and anxiety (OR 1.90, 95% CI 1.33–2.80, p<0.001) were also significant predictors, with anxiety and obesity disproportionately affecting women. Diabetes was prevalent (44.9%) but showed no gender-based difference. Conclusion: Smoking is the strongest predictor of MI among men, while women face greater risks related to obesity, inactivity, and anxiety. Hypertension and dyslipidemia were significant across both sexes. These findings emphasize the need for gender-specific preventive strategies in clinical practice and underscore the importance of addressing psychosocial as well as metabolic risk factors in MI prevention.