Pronounced increase in risk of acute ST-segment elevation myocardial infarction in younger smokers
Amelia Lloyd1, Lloyd Steele1, James Fotheringham2
1The University of Sheffield, Sheffield, UK.
Insights
Smoking significantly increases the risk of ST-segment elevation myocardial infarction (STEMI), especially in younger individuals. Targeted smoking cessation interventions are crucial for reducing STEMI incidence in all age groups.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Previous research indicates smokers experience ST-segment elevation myocardial infarction (STEMI) approximately 10 years earlier than non-smokers.
- Population smoking trends have not been adequately considered in relation to STEMI incidence.
Purpose of the Study:
- To analyze the association between smoking and STEMI incidence.
- To quantify the relative risk of STEMI in smokers across different age groups, accounting for population smoking trends.
Main Methods:
- Utilized admission data from 1795 acute STEMI patients undergoing percutaneous coronary intervention.
- Integrated demographic data from the Office for National Statistics for the South Yorkshire population (2009-2012).
- Calculated incidence rates and rate ratios (RR) to assess the relative risk of STEMI associated with smoking status and age.
Main Results:
- Smokers constituted 48.5% of the STEMI patient cohort.
- The incidence of STEMI was substantially higher in smokers across all age groups compared to ex-smokers and never-smokers.
- Smokers under 50 years old had an 8.47-fold increased rate of STEMI compared to non-smokers of the same age.
Conclusions:
- Smoking is strongly associated with an increased risk of acute STEMI, particularly in younger adults.
- An eightfold increased risk of STEMI was observed in younger smokers compared to their non-smoking counterparts.
- Emphasizes the need for intensified smoking reduction efforts, especially among the youth, to mitigate STEMI risk.
Objectives:
Previous studies have shown that smokers presented with ST-segment elevation myocardial infarction (STEMI) a decade earlier than non-smokers. However, no account has been made for population smoking trends, an important deficit addressed by this study.
Methods:
The combination of admission data on patients with acute STEMI undergoing percutaneous coronary intervention and demographic data supplied by the Office for National Statistics for the South Yorkshire population between 2009-2012 were analysed to generate incidence rates and rate ratios (RR) to quantify the relative risk of STEMI from smoking, overall and by age group.
Results:
There were 1795 STEMI patients included of which 72.9% were male. 68 patients were excluded as they had no smoking status recorded, leaving 48.5% of the remaining population as current smokers, 27.2% ex-smokers and 24.3% never smokers. Smokers were over-represented with overall smoking prevalence in South Yorkshire calculated at 22.4%. The incidence of STEMI in smokers aged under 50, 50-65 and over 65 years was 59.7, 316.9 and 331.0 per 100 000 patient years at risk compared to 7.0, 60.9 and 106.8 for the combined group of ex- and never smokers. This gave smokers under the age of 50 years an 8.47 (95% CI 6.80 to 10.54) increase in rate compared to non-smokers of the same age, with the 50-65 and over 65 age groups having RRs of 5.20 (95% CI 4.76 to 5.69) and 3.10 (95% CI 2.67 to 3.60), respectively.
Conclusions:
Smoking was associated with an eightfold increased risk of acute STEMI in younger smokers, when compared to ex- and never smokers. Further efforts to reduce smoking in the youngest are needed.
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