ST-elevation myocardial infarction risk in the very elderly
Alessandra M Campos1, Andrea Placido-Sposito2, Wladimir M Freitas2
1Cardiology Department, State University of Campinas (Unicamp), Campinas, SP, Brazil; Pharmaceutical Sciences Department, Faculty of Health Sciences, University of Brasília (UnB), Brasília, DF, Brazil.
Insights
In individuals aged 80+, low HDL-C, reduced GFR, male gender, smoking, and depression indicate higher risk for ST-segment elevation myocardial infarction (STEMI). Conventional factors like diabetes and hypertension are less significant in this age group.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- ST-segment elevation myocardial infarction (STEMI) has high incidence and mortality in the very elderly.
- Risk markers for STEMI in this population are poorly understood.
Purpose of the Study:
- To identify independent risk markers for STEMI in individuals aged 80 years or older.
Main Methods:
- A case-control study involving 50 STEMI patients and 207 healthy elderly individuals (≥80 years).
- Data collected included blood tests, medical, and psychological evaluations.
- Multivariate regression models were used to determine Odds Ratios (OR) and attributed risk (AR).
Main Results:
- Low glomerular filtration rate (GFR) [OR:4.41]
- Reduced high-density lipoprotein cholesterol (HDL-C) [OR:10.70]
- Male gender [OR:12.08]
- Moderate to severe depressive symptoms [OR:10.00]
- Prior [OR:2.00] and current smoking [OR:6.58] were significantly associated with STEMI.
- No association found with age, diabetes, hypertension, mild depressive symptoms, triglyceride, or LDL-C.
Conclusions:
- Low HDL-C, reduced GFR, male gender, smoking, and moderate to severe depressive symptoms are key STEMI risk markers in the very elderly.
- Attention should focus on these markers, rather than traditional factors like diabetes and hypertension, for STEMI risk assessment in individuals aged 80+.
Background:
Despite the high incidence and mortality of ST-segment elevation myocardial infarction (STEMI) among the very elderly, risk markers for this condition remain poorly defined. This study was designed to identify independent markers of STEMI among individuals carefully selected for being healthy or manifesting STEMI in < 24 h.
Methods:
We enrolled participants aged 80 years or older of whom 50 were STEMI patients and 207 had never manifested cardiovascular diseases. Blood tests, medical and psychological evaluations were obtained at study admission. Odds Ratio (OR) and attributed risk (AR) were obtained by multivariate regression models using STEMI as dependent variable.
Results:
Low glomerular filtration rate (GFR) [OR:4.41 (1.78-10.95); p = 0.001], reduced levels of HDL-C [OR:10.70 (3.88-29.46); p = 0.001], male gender [OR:12.08 (5.82-25.08); p = 0.001], moderate to severe depressive symptoms [OR:10.00 (2.82-35.50); p = 0.001], prior smoking [OR:2.00 (1.05-3.80); p = 0.034] and current smoking [OR:6.58 (1.99-21.70); p = 0.002] were significantly associated with STEMI. No association was found between STEMI and age, diabetes, hypertension, mild depressive symptoms, triglyceride or LDL-C.
Conclusions:
This is the first case-control study carried out with very elderlies to assess STEMI risk. Our findings indicate that reduced HDL-C, GFR, male gender, smoking habits and moderate to severe depressive symptoms are markers of STEMI in this age group.
General Significance:
In Individuals aged 80 or more years, a greater attention must be paid to low HDL-C and GFR at the expense of conventional STEMI risk factors for younger adults such as diabetes mellitus, hypertension and high LDL-C or triglyceride.
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