Key result
Current smoking linked to ~296% higher risk of premature ACS in women.
Why the study?
Premature ischemic heart disease mortality in South Eastern Europe is approximately twice the Western European average, but the reasons are not completely recognized.
Do traditional cardiovascular risk factors reduce the age of onset of acute coronary syndrome and increase 30-day mortality in patients in South Eastern Europe?
Cohort (n=70,953)
Yes
Do traditional cardiovascular risk factors reduce the age of onset of acute coronary syndrome and increase 30-day mortality in patients in South Eastern Europe?
Traditional risk factors, particularly smoking and hypercholesterolemia, significantly reduce the age of first acute coronary syndrome presentation, while diabetes strongly predicts 30-day mortality in premature ACS.
Background: The age-standardized death rates under 65 years from ischemic heart disease in South Eastern Europe are approximately twice as high than the Western Europe average, but the reasons are not completely recognized. The aim of the present study was to address this issue by collecting and analyzing data from a large, multinational cohort. Methods: We enrolled 70,953 Caucasian patients with first acute coronary syndrome, from 36 urban hospital in 7 South Eastern European countries and assessed their life expectancy free of acute coronary syndrome and mortality within 30 days after hospital admission from acute coronary syndrome as estimated in relation to dichotomous categories of traditional risk factors (current smoking, hypertension, diabetes and hypercholesterolemia) stratified according to sex. Findings: = -0.096; p < 0.001). Premature acute coronary syndrome (women <67 years and men <63 years) was remarkably related to current smoking and hypercholesterolemia among women (RRs: 3.96; 95% CI: 3.72-4.20 and 1.31; 95% CI: 1.25-1.38, respectively) and men (RRs: 2.82; 95% CI: 2.71-2.93 and 1.39; 95% CI: 1.34-1.45, respectively). Diabetes was most strongly associated with death from premature acute coronary syndrome either in women (RR: 1.52; 95% CI: 1.29-1.79) or men (RR: 1.63; 95% CI: 1.41-1.89). Interpretation: Public health policies in South Eastern Europe should place significant emphasis on the four traditional risk factors and the associated lifestyle behaviors to reduce the epidemic of premature ischemic heart disease.
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Bugiardini et al. (2024) conducted a cohort in First acute coronary syndrome (n=70,953). Current smoking (traditional risk factor) vs. Absence of current smoking was evaluated on Premature acute coronary syndrome in women (<67 years) (RR 3.96, 95% CI 3.72-4.20, p=<0.0001). Current smoking was the predominant risk factor for premature acute coronary syndrome, increasing the risk by nearly 4-fold in women (RR 3.96) and nearly 3-fold in men (RR 2.82).
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