Key result
Modifiable risk factors were highly prevalent among young adults with a first AMI, with 90.3% of those aged 18-44 and 92% of those aged 45-59 having at least one risk factor.
Why the study?
Modifiable risk factors play an important role in AMI, prompting an investigation into their prevalence rates, sex and race differences, and temporal trends in U.S. young adults presenting with a first AMI.
Cohort (n=1,462,168)
Yes
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Although younger patients (18 to 44 years) with [acute] MI typically have a strong family history, 90% of such patients in our study had at least one modifiable [risk factor], most commonly dyslipidemia. These findings highlight the alarming rates of modifiable [risk factors] in a subset of U.S. young adults who are at a very high risk for CHD and atherosclerotic cardiovascular disease.”
“These data about modifiable risk factors are critically important for all practitioners. It is also unclear what BP definition was used for hypertension, but it is likely that it was not adjusted for the 2017 American Heart Association/American College of Cardiology guideline definition, since these data were obtained from 2005 to 2015. Thus, the hypertension prevalence by our current definition is actually considerably higher.”
“Although this study fills an important gap in our knowledge of young patients with incident [acute] MI, the data could be enriched further by providing us information about the nontraditional modifiable risk factors such as diet, exercise habits, psychosocial risks or conditions more recently associated with [acute] MI such as autoimmune, hypercoagulable states, hypothyroidism and even pregnancy-related complications such as preeclampsia or gestational diabetes. All these factors have variable risk for obstructive or nonobstructive types of [acute] MI.”
Supports modifiable risk targeting post-MI in young adults; leaves open whether interventions reduce events in prospective trials.
BACKGROUND Modifiable risk factors (RFs) play an important role in the development and prognosis of acute myocardial infarction (AMI). OBJECTIVES This study sought to study the prevalence rates of modifiable RFs during a first AMI, sex/race differences, and temporal trends in U.S. young adults. METHODS This was a retrospective cohort analysis of the U.S. National Inpatient Sample years 2005 and 2015 to identify adults 18 to 59 years of age hospitalized for a first AMI. Prevalence rates, race and sex differences, and temporal trends of hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, and drug abuse were analyzed in these patients. RESULTS The authors' study included 1,462,168 young adults with a first AMI (mean age 50 ± 7 years, 71.5% men, 58.3% white) of whom 19.2% were 18 to 44 years of age, and 80.8% were 45 to 59 years of age. In the 18- to 44-year group, smoking (56.8%), dyslipidemia (51.7%), and hypertension (49.8%) were most prevalent, and 90.3% of patients had at least 1 RF. In the 45- to 59-year group, hypertension (59.8%), dyslipidemia (57.5%), and smoking (51.9%) were most prevalent, and 92% patients had at least 1 RF. Significant sex and racial disparities were observed in the prevalence of individual RFs. Women had a higher prevalence of diabetes mellitus, hypertension, and obesity, and men had a higher prevalence of dyslipidemia, drug abuse, and smoking. The prevalence of all these RFs increased temporally except for the rate of dyslipidemia, which decreased more recently. Trends were generally consistent across sex and racial groups. CONCLUSIONS During a first AMI in young adults in whom preventive measures are more likely to be effective, modifiable RFs were highly prevalent and progressively increased over time. Significant sex and racial disparities were observed for individual RFs.
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Yandrapalli et al. (2019) conducted a cohort in First acute myocardial infarction (n=1,462,168). Modifiable risk factors was evaluated on Prevalence rates of modifiable risk factors. Modifiable risk factors were highly prevalent among young adults with a first AMI, with 90.3% of those aged 18-44 and 92% of those aged 45-59 having at least one risk factor.
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