Key result
In very young patients with myocardial infarction, hypertension (HR 1.50) and diabetes (HR 1.67) were independently associated with an increased risk of major adverse cardiovascular events.
Why the study?
The incidence of MI is rising among young individuals, but data on the profile and long-term impact of standard modifiable risk factors in patients aged 35 years or younger are limited.
Does the presence of standard modifiable risk factors increase the risk of major adverse cardiovascular and cerebrovascular events in very young patients (≤35 years) with myocardial infarction?
Cohort (n=690)
Yes
Does the presence of standard modifiable risk factors increase the risk of major adverse cardiovascular and cerebrovascular events in very young patients (≤35 years) with myocardial infarction?
Hazard Ratio: 1.5 (95% CI 1.09–2.06)
p-value: p=0.014
Very young MI patients (≤35 years) have a high burden of standard modifiable risk factors, particularly smoking, and the presence of hypertension and diabetes independently increases their long-term risk of major adverse cardiovascular events.
Background The incidence of myocardial infarction (MI) is rising among young individuals. This study aimed to identify the profile of standard modifiable risk factors (SMuRFs) and their impact on long-term survival in very young MI patients (≤35 years). Methods The VYTAL-MI study (Very Young Tracking and Analysis of Long-term Myocardial Infarction Outcomes) is a retrospective cohort analysis of MI patients aged ≤35 years, admitted to Beijing Anzhen Hospital and Peking Union Medical College Hospital between December 1 1920 , 2011, and December 1 1920 , 2021. SMuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were documented. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, recurrent MI, ischemia-driven revascularization, and ischemic stroke. Cox proportional hazard models were used to assess associations between SMuRFs and outcomes. Results Among 690 patients (median age 33 years [interquartile range, IQR: 30-34]; 95% male), only 8% had no SMuRFs. Smoking was most common (76%), followed by hypercholesterolemia (43%), hypertension (40%), and diabetes (12%). The most frequent combination was smoking and hypercholesterolemia (16.4%). Over a median follow-up of 6.3 years (IQR: 4.0-8.6), MACCE occurred in 165 patients (23.9%). Patients with ≥3 SMuRFs had significantly higher cumulative hazards ( P =0.003). Hypertension (hazard ratio, HR: 1.50; 95% confidence interval, CI: 1.09-2.06; P =0.014) and diabetes (HR: 1.67; 95% CI: 1.10-2.54; P =0.016) were independently associated with increased risk, while hypercholesterolemia (HR: 1.24; 95% CI: 0.91-1.68; P =0.177) and smoking (HR: 1.06; 95% CI: 0.72-1.55; P =0.776) showed no significant association. Conclusions Very young MI patients exhibited a high burden of SMuRFs, particularly smoking. Hypertension and diabetes increased long-term event risk. Targeted SMuRF management is essential to improve survival in this population. What is known Targeting standard modifiable cardiovascular risk factors, including hypertension, diabetes, hypercholesterolemia, and smoking, is crucial for improving outcomes in myocardial infarction. Limited data exist on the pattern of standard modifiable risk factors in very young myocardial infarction patients aged ≤35 years, and how these factors influence long-term outcomes. What the study adds Very young myocardial infarction patients exhibited a substantial burden of standard modifiable risk factors, with smoking being notably prevalent. Increased standard modifiable risk factors exposure was associated with an elevated risk of major adverse cardiovascular and cerebrovascular events Hypertension and diabetes were linked to a higher risk of major adverse cardiovascular and cerebrovascular events, while smoking and hypercholesterolemia did not show a significant independent effect. Registration: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR2400085600.
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Zhao et al. (2024) conducted a cohort in Myocardial Infarction (n=690). Hypertension (Standard modifiable risk factor) vs. Absence of hypertension was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) (HR 1.50, 95% CI 1.09-2.06, p=0.014). In very young patients with myocardial infarction, hypertension (HR 1.50) and diabetes (HR 1.67) were independently associated with an increased risk of major adverse cardiovascular events.
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