Patients presenting with STEMI younger, more obese in recent years

CHICAGO — Despite increased awareness of heart disease risk factors and prevention, STEMI is occurring in younger patients, those who are more obese and those who are more likely to have preventable risk factors such as chronic obstructive pulmonary disease, diabetes, hypertension and smoking.

The data come from an analysis of CV risk factors among 3,912 consecutive patients who presented with STEMI at the Cleveland Clinic from 1995 through 2014. The prevalence of CV risk factors were studied in the entire cohort and in patients with a prior diagnosis of CAD (n = 1,325; 24%).

During the 20-year period, the following trends were observed:

The mean age at STEMI presentation decreased from 65 years to 60 years.
The prevalence of obesity increased from 31% to 40%.
The proportion of STEMI patients with diabetes increased from 24% to 31%.
The proportion of STEMI patients with hypertension increased from 55% to 77%.
The proportion of STEMI patients with COPD increased from 5% to 12%.

These changes were all statistically significant, Samir R. Kapadia, MD, director of the Sones Cardiac Catheterization Laboratories and section head of invasive and interventional cardiology at Cleveland Clinic, said during a briefing.

Samir R. Kapadia

“We found that patients presenting with STEMI were getting younger. The average age was decreased by almost 3 years over this 20-year period, which was … unexpected. We thought we were doing better prevention and should not find younger people presenting with MI,” Kapadia said.

Another “striking finding,” according to Kapadia, was a rise in the number of STEMI patients who reported smoking: 28% in 1995 to 46% in 2014. This finding is in contrast to U.S. trends, which reflect an overall decline in smoking rates during the past 2 decades, he said.

In addition, the number of patients with STEMI with three or more major CV risk factors rose from 65% to 85% during the study period.

These trends were similar across the entire cohort and the CAD cohort. “People who knew they had CAD had a similar increase in risk factors when they presented with STEMI,” Kapadia said.

The researchers noted a possible limitation of this analysis. During the study period, helicopter transports brought a greater number of patients with STEMI to the Cleveland Clinic. The observed trends may reflect changes in the overall patient population at this center.

“On the whole, the medical community has done an outstanding job of improving treatments for heart disease, but this study shows that we have to do better on the prevention side. … Prevention must be kept in the forefront of primary care. Cardiac health is not just dependent on the cardiologist. The primary care physicians and the patient need to take ownership of this problem,” he said. – by Katie Kalvaitis

Reference:

Mentias AG, et al. Poster 1248-002. STEMI: Pre-Hospital Care, Diagnosis and Treatment. Presented at: American College of Cardiology Scientific Session; April 2-4, 2016; Chicago.

Disclosure: Kapadia reports financial relationships with Abbott Laboratories, Boston Scientific, Claret, Edwards Lifesciences and St. Jude Medical.