Standard modifiable cardiovascular risk factors and coronary artery disease severity in adults with myocardial infarction ≤ 35

Background: Myocardial infarction (MI) in individuals ≤35 years is poorly characterized. The prevalence of standard modifiable cardiovascular risk factors (SMuRFs) and their associations with CAD severity at the index presentation and with post-index outcomes remain unclear. Aims: We profiled SMuRFs in MI patients ≤35 years and assessed their association with CAD severity at the index MI and post-index outcomes. Methods: This retrospective, two-center cohort study included index MI patients aged ≤35 years admitted to Beijing Anzhen Hospital and Peking Union Medical College Hospital between December 2011 and December 2021, and followed through February 2024. SMuRFs included hypertension, diabetes, hypercholesterolemia, and smoking. CAD severity was defined by the count of epicardial vessels with ≥50 % stenosis. Post-index event was major adverse cardiovascular and cerebrovascular events (MACCE). Results: Among 776 patients (median age 33 years; 94 % male), 10 % had no SMuRFs, and 54 % had ≥2 SMuRFs. Smoking (74 %) and hypercholesterolemia (41 %) were most prevalent. Angiography revealed single-vessel disease in 47 %, two-vessel disease in 129 (17 %), and three-vessel disease in 194 (25 %); 11 % had no obstructive lesion. Each additional SMuRF increased the adjusted odds of more extensive CAD by 1.66-fold (95 % CI, 1.43-1.94). Diabetes, hypercholesterolemia, and hypertension were independently associated with multivessel disease, whereas smoking was not. Over a median follow-up of 5.6 years, 22.4 % experienced post-index MACCE, with higher incidence among patients with ≥3 SMuRFs. Conclusions: Very young MI patients carry a high burden of SMuRFs, which correlate with greater CAD severity at the index presentation and worse post-index outcomes.