Clinical characteristics and statin eligibility of patients under 50 with ST-elevation myocardial infarction
Ayman Haq1,2, Evan Walser-Kuntz2, Abdulrahman Gamam2
1Division of Cardiovascular Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Younger adults experiencing ST-elevation myocardial infarction (STEMI) have significant risk factors like smoking and low preventative medication use. Many do not qualify for statin therapy, highlighting a gap in cardiovascular care for this demographic.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) in younger adults (<50 years) presents unique clinical challenges.
- Understanding the specific risk factors and treatment needs of this population is crucial for effective cardiovascular disease management.
- Current guidelines for cardiovascular risk assessment and statin eligibility may not fully capture the needs of younger STEMI patients.
Purpose of the Study:
- To investigate the clinical characteristics of younger adults presenting with STEMI.
- To identify prevalent cardiovascular risk factors in this demographic.
- To assess statin eligibility based on established guidelines for younger STEMI patients.
Main Methods:
- Retrospective analysis of a prospective cohort of STEMI patients under 50 years old.
- Evaluation of baseline characteristics, medical history, drug use, and lipid profiles.
- Calculation of 10-year ASCVD risk using Pooled Cohort Equations and determination of statin eligibility per ACC/AHA and USPSTF guidelines.
Main Results:
- The study included 635 younger adults (median age 46.9), predominantly men (82.4%) and white (89%).
- High prevalence of current smoking (59%), hyperlipidemia (44%), and hypertension (37%) was observed.
- Low use of preventative medications (aspirin 14%, statins 11%) and low HDL-C (36.4 mg/dL) were noted. Statin eligibility varied significantly between ACC/AHA (45.5% recommended) and USPSTF (29% recommended) guidelines.
Conclusions:
- Younger adults with STEMI exhibit a high burden of modifiable risk factors, particularly tobacco use.
- There is a low utilization of evidence-based preventative medications in this cohort.
- A substantial proportion of younger STEMI patients do not meet current guideline criteria for statin therapy, indicating a potential need for revised risk assessment strategies.
Aims:
This study seeks to understand the clinical characteristics, risk factors, and statin eligibility of younger adults who present with STEMI.
Methods:
We performed a retrospective analysis of a prospective cohort of STEMI patients <50 years. Baseline characteristics, medical history, prior medications, drug use, lipid profiles, cardiovascular risk factors were examined. Ten-year ASCVD risk was calculated utilizing the Pooled Cohort Equations. Statin eligibility was determined according to the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) and the 2022 US Preventive Services Task Force (USPSTF) guidelines.
Results:
Six hundred and thirty-five individuals were included, the majority were men (82.4%) and white (89%), with a median age was 46.9 [42.0-48.0]. The most prevalent risk factors were current smoking (59%), hyperlipidemia (44%), and hypertension (37%). Drug use was rare (8.3%). Preventative medication use was low, aspirin was the most common (14%), followed by ACE inhibitors/ARBs (12%), statins (11%), and beta-blockers (9.1%). Mean HDL-C was low at 36.4 ± 12.0 mg/dL, while mean LDL was unremarkable at 112.4 ± 37.9 mg/dL. According to the 2019 ACC/AHA guidelines, 45.5% were classified as statin recommended, 8.7% were classified as statin considered, and 45.8% were classified as statin not recommended. According to the 2022 USPSTF guidelines, 29% were classified as statin recommended, 12.4% were classified as statin considered, and 58.6% were classified as statin not recommended.
Conclusions:
Younger adults with STEMI exhibit high rates of tobacco use and low rates of preventative medications use. Approximately half of the cohort did not meet criteria for statin initiation.
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