Sex-Related Differences in Predictors of Acute Coronary Syndrome in Kosovo: A Cross-Sectional Study

<b>Background/Objectives</b>: Acute coronary syndrome (ACS) in old people is a growing global health problem, with high incidence and mortality. The aim of this study was to assess the cardiovascular risk factors in older patients with ACS, with particular emphasis on sex differences. <b>Methods</b>: We retrospectively analyzed 1482 patients with ACS (1184 old patients; men ≥ 55 years and women ≥ 65 years) and 298 young ACS patients (men ≤ 55 years and women ≤ 65 years) from University Clinical Centre of Kosovo. Data on cardiovascular risk factors, echocardiographic, electrocardiographic, angiographic indices and medications were collected from medical records. <b>Results</b>: Old ACS patients had higher prevalence of diabetes (50.1 vs. 34.6%; <i>p</i> < 0.001), hypertension (79.8 vs. 42.8; <i>p</i> < 0.001), multivessel coronary artery disease (88.6 vs. 22.1%; <i>p</i> < 0.001) but less prevalent hypercholesterolemia (31.5 vs. 48.2; <i>p</i> < 0.001), smoking, family history of coronary artery disease and other noncardiac risk factors compared with young ACS patients (<i>p</i> < 0.05, for all). Older women smoked less (26.3 vs. 41.1; <i>p</i> < 0.001) and drank less alcohol (0.8 vs. 6.8%; <i>p</i> < 0.001) but had higher prevalence of uncontrolled diabetes, arterial hypertension and hypercholesterolemia (<i>p</i> < 0.05 for all) compared with older males. Family history for coronary artery disease (CAD) was not significant between groups. Multivariate analysis revealed uncontrolled diabetes (OR = 2.26; 95% CI: 1.104-3.989; <i>p</i> < 0.001) and having three or more cardiac risk factors (OR = 3.141; 95% CI: 2.166-4.406; <i>p</i> < 0.001) as the strongest independent predictors of ACS in old patients. These associations remained significant when stratified by gender, with even stronger impact in female (uncontrolled diabetes OR = 2.942, 95% CI: 1.644-4.890; <i>p</i> < 0.001; ≥3 risk factors OR = 2.821; 95% CI: 1.782-4.436; <i>p</i> < 0.001) and in males who smoked (OR: 2.381, 95% CI: 1.109-2.981; <i>p</i> < 0.001). <b>Conclusions</b>: Uncontrolled diabetes and multiple cardiovascular risk factors are key contributors to ACS in older adults. Early identification and management of these risk factors are essential in reducing the burden of CAD older patients.