Trends in Modifiable Risk Factors Amongst First Presentation ST Elevation Myocardial Infarction Patients in a Large
Samia N Kazi1, Amy Von Huben2, Simone Marschner2
1Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Insights
The risk factors for ST-elevation myocardial infarction (STEMI) are shifting, with increasing diabetes and fewer traditional risk factors like smoking. This suggests changing mechanisms in STEMI development, requiring further research for cardiovascular disease prevention.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Emerging evidence indicates a changing risk factor landscape for ST-elevation myocardial infarction (STEMI).
- Understanding these shifts is crucial for effective cardiovascular disease prevention strategies.
Purpose of the Study:
- To investigate the evolution of cardiovascular risk factors in patients experiencing their first STEMI event.
- To determine if cardiometabolic factors are increasingly prevalent in the STEMI population.
Main Methods:
- Analysis of a STEMI registry from a tertiary referral percutaneous coronary intervention center.
- Examined trends in modifiable risk factors: hypertension, diabetes, smoking, and hypercholesterolemia.
- Included consecutive first-presentation STEMI patients from 2006 to 2018.
Main Results:
- Hypertension (47%), hypercholesterolemia (47%), smoking (42%), and diabetes (27%) were common risk factors.
- Diabetes prevalence increased from 20% to 26% (p<0.001).
- Prevalence of no modifiable risk factors rose from 9% to 17% (p<0.001), while hypercholesterolemia and smoking decreased.
Conclusions:
- The risk factor profile for first STEMI presentations has evolved, marked by reduced smoking and increased cases with no traditional risk factors.
- These changes suggest a potential shift in STEMI etiology.
- Further research into underlying causal factors is essential for advancing cardiovascular disease prevention and management.
Background:
Recent studies suggest that the risk factor profile of patients presenting with ST elevation myocardial infarction (STEMI) is changing.
Aim:
The aim is to determine if there has been a shift of cardiovascular risk factors to cardiometabolic causes in the first presentation STEMI population.
Method:
We analysed data from a STEMI registry from a large tertiary referral percutaneous coronary intervention centre to determine the prevalence and trends of the modifiable risk factors of hypertension, diabetes, smoking and hypercholesterolaemia.
Participants:
Consecutive first presentation STEMI patients between January 2006 to December 2018.
Results:
Among the 2,366 patients included (mean age 59, SD 12.66, 80% male) the common risk factors were hypertension (47%), hypercholesterolaemia (47%) current smoking (42%) and diabetes (27%). Over the 13 years, patients with diabetes (20% to 26%, OR 1.09 per year, CI 1.06-1.11, p<0.001) and patients with no modifiable risk factors increased (9% to 17%, OR 1.08, CI 1.04-1.11, p<0.001). Concurrently there was a fall in prevalence of hypercholesterolaemia, (47% to 37%, OR 0.94 per year, CI 0.92-0.96, p<0.001) and smoking (44% to 41%, OR 0.94, CI 0.92-0.96, p<0.001) but no significant change in rates of hypertension (53% to 49%, OR 0.99, CI 0.97-1.01, p=0.25).
Conclusion:
The risk factor profile of first presentation STEMI has changed over time with a reduction in smoking and a concurrent rise in patients with no traditional risk factors. This suggests the mechanism of STEMI may be changing and further investigation of potential causal factors is warranted for the prevention and management of cardiovascular disease.
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