Premature Myocardial Infarction: A Community Study
Sagar B Dugani1, Matteo Fabbri2,3, Alanna M Chamberlain3
1Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Objective:
To evaluate the trends in incident premature myocardial infarction (MI) and prevalence of cardiac risk factors in a population-based cohort.
Methods:
We studied a population-based cohort of incident premature MIs among residents (MI in men aged 18-55 years and women aged 18-65 years) in Olmsted County, Minnesota, during a 26-year period from January 1, 1987 through December 31, 2012. Recurrent MI and death after incident premature MI were enumerated through September 30, 2018.
Results:
Of 3276 MI cases, 850 were premature events (37.9% [322/850] women). Age-adjusted premature MI incidence rates (2012 vs 1987) declined by 39% in men (rate ratio, 0.61; 95% CI, 0.46 to 0.81]) and 61% in women (rate ratio, 0.39; 95% CI, 0.27 to 0.57). Among men with premature MI, the prevalence of hypertension, diabetes, and hyperlipidemia increased over time, whereas in women, only the prevalence of hyperlipidemia increased. During a mean follow-up of 13.3 years, there was no temporal decline in recurrent MI in men and women. Women showed 66% decreased risk for mortality (hazard ratio, 0.34; 95% CI, 0.17 to 0.68) over time, whereas men showed no change.
Conclusion:
The incidence of premature MI declined over a 26-year period for both men and women. The risk factor profile of persons presenting with MI worsened over time, especially in men. Death following incident MI declined only in women. These results underscore the importance of primary prevention in young adults and of sex-specific approaches.
Insights
Premature myocardial infarction (MI) incidence declined in young adults, but risk factors worsened, especially in men. While women saw reduced mortality post-MI, men did not, highlighting the need for tailored prevention strategies.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Premature myocardial infarction (MI) affects younger populations, necessitating an understanding of evolving trends.
- Cardiac risk factors and their impact on premature MI require ongoing investigation.
Purpose of the Study:
- To evaluate temporal trends in the incidence of premature myocardial infarction (MI).
- To assess changes in the prevalence of cardiac risk factors among individuals experiencing premature MI.
- To examine trends in recurrent MI and mortality following a premature MI event.
Main Methods:
- A population-based cohort study was conducted in Olmsted County, Minnesota.
- Incident premature MIs were identified in men (18-55 years) and women (18-65 years) from 1987 to 2012.
- Recurrent MI and mortality were tracked through September 2018.
Main Results:
- Premature MI incidence decreased significantly: 39% in men and 61% in women.
- The prevalence of hypertension, diabetes, and hyperlipidemia increased in men with premature MI; hyperlipidemia increased in women.
- No decline in recurrent MI was observed; mortality post-MI decreased only in women.
Conclusions:
- Premature MI incidence has declined, but the associated risk factor profile has worsened, particularly in men.
- Primary prevention in young adults and sex-specific management strategies are crucial.
- Outcomes following premature MI differ significantly between men and women, necessitating tailored approaches.
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