Cardiovascular risk factors and clinical presentation in acute coronary syndromes
A Rosengren1, L Wallentin, M Simoons
1Department of Medicine, Sahlgrenska University Hospital/Ostra, SE-416 85 Goteborg, Sweden. Annika.Rosengren@hjl.gu.se
Insights
Smoking increases the risk of severe acute coronary syndromes (ACS), while hypertension and high BMI in women are associated with less severe ACS. These findings are independent of prior disease and medication.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Acute coronary syndromes (ACS) represent a spectrum of myocardial infarction.
- ST-elevation ACS is a marker of severe myocardial infarction.
- Understanding the differential risk factors for ACS severity is crucial for targeted prevention and treatment.
Purpose of the Study:
- To investigate the hypothesis that risk factors are differentially related to the severity of acute coronary syndromes (ACS).
- To determine the association between ST-elevation ACS and various risk factors, including smoking, hypertension, and body mass index (BMI).
Main Methods:
- A cross-sectional study involving 10,253 patients diagnosed with ACS across 103 hospitals in 25 European and Mediterranean countries.
- Data collected through the Euro Heart Survey of ACS.
- ST-elevation ACS served as the primary outcome measure for severe ACS.
Main Results:
- Smokers had a significantly increased risk of presenting with ST-elevation ACS (age-adjusted OR 1.84).
- Hypertension (OR 0.65) and high BMI were associated with a reduced risk of ST-elevation ACS.
- Obesity was independently associated with a lower risk of ST-elevation ACS in women but not in men, after adjusting for covariates.
Conclusions:
- ST-elevation ACS is strongly associated with smoking.
- Hypertension and high BMI in women are independently associated with a lower risk of ST-elevation ACS.
- These findings highlight the complex interplay between traditional risk factors and ACS severity.
Objective:
To investigate the hypothesis that risk factors may be differently related to severity of acute coronary syndromes (ACS), with ST elevation used as a marker of severe ACS.
Design:
Cross sectional study of patients with ACS.
Setting:
103 hospitals in 25 countries in Europe and the Mediterranean basin.
Patients:
10,253 patients with a discharge diagnosis of ACS in the Euro heart survey of ACS.
Main Outcome Measures:
Presenting with ST elevation ACS.
Results:
Patients with ACS who were smokers had an increased risk to present with ST elevation (age adjusted odds ratio (OR) 1.84, 95% confidence interval (CI) 1.67 to 2.02). Hypertension (OR 0.65, 95% CI 0.60 to 0.70) and high body mass index (BMI) (p for trend 0.0005) were associated with less ST elevation ACS. Diabetes mellitus was also associated with less ST elevation, but only among men. Prior disease (infarction, chronic angina, revascularisation) and treatment with aspirin, beta blockers, or statins before admission were also associated with less ST elevation. After adjustment for age, sex, prior disease, and prior medication, smoking was still significantly associated with increased risk of ST elevation (OR 1.53, 95% CI 1.38 to 1.69), whereas hypertension was associated with reduced risk (OR 0.75, 95% CI 0.69 to 0.82). Obesity (BMI > 30 kg/m2 versus < 25 kg/m2) was independently associated with less risk of presenting with ST elevation among women, but not among men.
Conclusion:
Among patients with ACS, presenting with ST elevation is strongly associated with smoking, whereas hypertension and high BMI (in women) are associated with less ST elevation, independently of prior disease and medication.
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