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Published on: July 3, 2018
Standard modifiable cardiovascular risk factors and coronary artery disease severity in adults with myocardial
Si-Qi Tang1, Xin-Long Zhao2, Quan Li3
1Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Background:
Myocardial infarction (MI) in individuals ≤35 years is poorly characterized. The prevalence of standard modifiable cardiovascular risk factors (SMuRFs) and their associations with CAD severity at the index presentation and with post-index outcomes remain unclear.
Aims:
We profiled SMuRFs in MI patients ≤35 years and assessed their association with CAD severity at the index MI and post-index outcomes.
Methods:
This retrospective, two-center cohort study included index MI patients aged ≤35 years admitted to Beijing Anzhen Hospital and Peking Union Medical College Hospital between December 2011 and December 2021, and followed through February 2024. SMuRFs included hypertension, diabetes, hypercholesterolemia, and smoking. CAD severity was defined by the count of epicardial vessels with ≥50 % stenosis. Post-index event was major adverse cardiovascular and cerebrovascular events (MACCE).
Results:
Among 776 patients (median age 33 years; 94 % male), 10 % had no SMuRFs, and 54 % had ≥2 SMuRFs. Smoking (74 %) and hypercholesterolemia (41 %) were most prevalent. Angiography revealed single-vessel disease in 47 %, two-vessel disease in 129 (17 %), and three-vessel disease in 194 (25 %); 11 % had no obstructive lesion. Each additional SMuRF increased the adjusted odds of more extensive CAD by 1.66-fold (95 % CI, 1.43-1.94). Diabetes, hypercholesterolemia, and hypertension were independently associated with multivessel disease, whereas smoking was not. Over a median follow-up of 5.6 years, 22.4 % experienced post-index MACCE, with higher incidence among patients with ≥3 SMuRFs.
Conclusions:
Very young MI patients carry a high burden of SMuRFs, which correlate with greater CAD severity at the index presentation and worse post-index outcomes.
Insights
Young adults experiencing myocardial infarction (MI) often have multiple cardiovascular risk factors, which are linked to more severe coronary artery disease (CAD) and poorer outcomes. Early identification and management of these risk factors are crucial.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Myocardial infarction (MI) in individuals under 35 years old is not well understood.
- The prevalence of standard modifiable cardiovascular risk factors (SMuRFs) and their impact on coronary artery disease (CAD) severity and patient outcomes in this age group are unclear.
Purpose of the Study:
- To investigate the prevalence of SMuRFs in young MI patients (≤35 years).
- To assess the association between SMuRFs and CAD severity at the time of MI.
- To evaluate the relationship between SMuRFs and post-MI outcomes.
Main Methods:
- A retrospective cohort study of 776 patients aged ≤35 years admitted with MI between 2011 and 2021.
- Data collected on SMuRFs (hypertension, diabetes, hypercholesterolemia, smoking), CAD severity (number of stenosed vessels), and major adverse cardiovascular and cerebrovascular events (MACCE).
- Statistical analysis to determine associations between SMuRFs, CAD severity, and MACCE.
Main Results:
- 54% of young MI patients had two or more SMuRFs, with smoking and hypercholesterolemia being most common.
- Each additional SMuRF increased the odds of more extensive CAD by 66%.
- Diabetes, hypercholesterolemia, and hypertension were linked to multivessel disease; smoking was not.
- Over 5.6 years, 22.4% experienced MACCE, with higher rates in those with three or more SMuRFs.
Conclusions:
- Young patients with MI have a significant burden of SMuRFs.
- These risk factors are associated with increased CAD severity and worse long-term outcomes.
- Targeting SMuRFs in young individuals is essential for improving cardiovascular health and preventing future events.
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