Key result
Current smoking is associated with a ~4-fold higher risk of premature MI.
Why the study?
To evaluate the magnitude of the association between risk factors and premature myocardial infarction.
What is the magnitude of the association between various demographic, lifestyle, clinical, and biomarker risk factors and premature myocardial infarction?
Meta-Analysis (n=12,700,000)
What is the magnitude of the association between various demographic, lifestyle, clinical, and biomarker risk factors and premature myocardial infarction?
Major modifiable risk factors, including smoking, diabetes, dyslipidemia, and hypertension, as well as mild elevations in BMI and triglycerides, are strongly associated with premature MI, highlighting critical targets for early intervention.
Supports smoking cessation as priority in young adults; leaves open causal effects on premature MI pending trials.
ObjectiveTo evaluate the magnitude of the association between risk factors and premature myocardial infarction (MI) (men aged 18-55 years; women aged 18-65 years).Patients and MethodsWe searched MEDLINE and other databases from inception through April 30, 2020, as well as bibliography of articles selected for data extraction. We selected observational studies reporting the magnitude of the association of at least 1 risk factor (demographic characteristics, lifestyle factors, clinical risk factors, or biomarkers) with premature MI and a control group. Pooled risk estimates (random effects) from all studies unadjusted and adjusted for risk factors were reported as summary odds ratios (ORs) with 95% CIs.ResultsFrom 35,320 articles, we extracted data on 19 risk factors in 12.7 million participants from 77 studies across 58 countries. Men had a higher risk of premature MI (OR, 2.39; 95% CI, 1.71 to 3.35) than did women. Family history of cardiac disease was associated with a higher risk of premature MI (OR, 2.67; 95% CI, 2.29 to 3.27). Major modifiable risk factors associated with higher risk were current smoking (OR, 4.34; 95% CI, 3.68 to 5.12 vs no/former), diabetes mellitus (OR, 3.54; 95% CI, 2.69 to 4.65), dyslipidemia (OR, 2.94; 95% CI, 1.76 to 4.91), and hypertension (OR, 2.85; 95% CI, 2.48 to 3.27). Higher body mass index carried higher risk (OR, 1.46; 95% CI, 1.24 to 1.71 for ≥25 kg/m2 vs <25 kg/m2). Biomarkers associated with 2- to 3-fold higher risk were total cholesterol levels greater than 200 mg/dL, triglyceride levels higher than 150 mg/dL, and high-density lipoprotein cholesterol levels less than 60 mg/dL (to convert to mmol/L, multiply by 0.0259).ConclusionMajor risk factors for premature MI are mostly amenable to patient, population, and policy level interventions. Mild elevations in body mass index and triglyceride levels were associated with higher risk, which has implications for the growing worldwide epidemic of cardiometabolic diseases.
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Dugani et al. (2021) conducted a meta-analysis in Premature myocardial infarction (n=12,700,000). Current smoking vs. No or former smoking was evaluated on Premature myocardial infarction (OR 4.34, 95% CI 3.68 to 5.12). Current smoking was associated with a more than 4-fold higher risk of premature myocardial infarction (OR 4.34) compared to no or former smoking.
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