Characterizing premature myocardial infarction: clinical, lipid, and behavioral insights from the FRENCHIE Cohort

Abstract Background Premature myocardial infarction (MI) is a poorly define clinical entity that represents a significant proportion of coronary artery disease (CAD) burden and warrants further exploration. Methods We conducted a comprehensive analysis of the FRENCHIE cohort, a prospective, multicenter observational study including 11,233 patients admitted for a first acute MI across 32 French hospitals. Patients were categorized into three age groups: 45 years, 45–55 years and 55 years. We assessed traditional and nontraditional cardiovascular risk factors, lipid profiles (LDL, HDL, triglycerides (TG), and remnant cholesterol), genetic predisposition inferred from family history of CAD, and behavioral risk factors (smoking, drug use, and social deprivation). Clinical presentation, in-hospital management, and outcomes (MACE) were analyzed. Results Among 11,233 patients, premature MI (55 years) occurred in 3,672 (32.7%) patients, with 944 (8.4%) 45 years and 2,728 (24.3%) between 45–55 years, and 7,561 (67.3%) were 55 years. Younger MI patients had a higher prevalence of familial history of CAD (36.2% vs. 30.6% vs. 20.9%), higher average levels of LDL-C(140 mg/dL vs. 137 mg/dL vs. 126 mg/dL) with higher rate of patients 190mg/dl (12.6% vs. 9.1% vs. 6.0% ), TG (172 mg/dL vs. 171 mg/dL vs. 135 mg/dL), remnant cholesterol (31 mg/dL vs. 31 mg/dL vs. 26 mg/dL) and lower HDL-C (41 mg/dL vs. 43 mg/dL vs. 48 mg/dL), all p0.0001. Behavioral risk factors such as active smoking (73.4% vs. 62.4% vs. 26.7%) and cannabis use (17.3% vs. 5.0% vs. 0.7%) were significantly more prevalent in younger patients. Social deprivation indicators, characterized by unemployment (12.8% vs. 9.4% 3.0%) or invalidity (4.2% vs. 4.5% vs 2.5%), were also more common in younger individuals; p0.0001. Premature MI patients (55 years old) had a lower risk of in-hospital MACE as compared to older patients (2.75% vs 4.3%, p0.0001). The risks factors in premature acute MI patients as a first atherosclerotic events in the FRENCHIE Cohort as summarized in the figure. Conclusions Premature MI is associated with a distinct phenotype combining genetic predisposition, lipid abnormalities and frequent exposomic risk factors. Early lipid profiling, subclinical atherosclerosis screening and treatment strategies, alongside aggressive behavioral modification interventions, could play a crucial role in the prevention of premature CAD and need to be evaluated.