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Modifiable risk factors prevalent in young patients with MI
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Among patients who had their first MI before age 60 years, modifiable risk factors were common and increased in prevalence over time, researchers reported.
The researchers conducted a retrospective cohort study of 1,462,168 adults younger than 60 years (mean age, 50 years; 72% men; 58% white) documented in the National Inpatient Sample as having a first MI between 2005 and 2015.
The risk factors of interest were hypertension, diabetes, obesity, smoking, dyslipidemia and drug abuse. For each, the researchers calculated prevalence rates, race and sex differences and temporal trends in the study population.
Risk factors often present
Among the 19.2% of patients aged 18 to 44 years, the most prevalent modifiable risk factors were smoking (56.8%), dyslipidemia (51.7%) and hypertension (49.8%), with at least one of the modifiable risk factors documented in 90.3%, Srikanth Yandrapalli, MD, from the division of cardiology in the department of medicine at Westchester Medical Center and New York Medical College, and colleagues wrote.
“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,” the researchers wrote. “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.”
Among the 80.8% of patients aged 45 to 59 years, the most prevalent modifiable risk factors were hypertension (59.8%), dyslipidemia (57.5%) and smoking (51.9%), with 92% having at least one modifiable risk factor, according to the researchers.
Among the full cohort, diabetes, hypertension and obesity were more common in women, whereas dyslipidemia, drug abuse and smoking were more common in men (P < .001 for all), Yandrapalli and colleagues wrote.
In both age brackets, risk factor prevalence varied by race, with diabetes highest in Hispanic patients; dyslipidemia highest in Asian-Pacific Islander patients; hypertension, obesity and drug abuse highest in black patients; and smoking highest in white patients (P < .001 for all).
All six risk factors increased in prevalence between 2005 and 2015 (P for trend for all < .001), although dyslipidemia declined in 2015 compared with 2012 and 2013, the researchers wrote.
“These data can be used to plan appropriate preventative strategies in select populations to help reduce the burden of CHD,” Yandrapalli and colleagues wrote.
Consider nontraditional factors
In a related editorial, Basmah Safdar, MD, MSc, from the department of emergency medicine at Yale University, wrote: “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.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures. Safdar reports she received an institutional research grant from OrthoClinical.
Perspective
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Carl J. Pepine, MD, MACC
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. This emphasizes that we must pay more attention to BP and other modifiable risk factors and also begin modification at earlier ages.
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