Modifiable risk factors growing more common in young AMI patients

A new study of young heart attack sufferers revealed a sobering, albeit unsurprising, finding: More than 90 percent had at least one modifiable risk factor. What’s equally concerning, according to the authors, is the prevalence of most of these risk factors increased over the decade-long study.

The research was published online Feb. 4 in the Journal of the American College of Cardiology and looked at patient characteristics and risk factors of more than 1.4 million adults aged 18 to 59 who were hospitalized for a first acute myocardial infarction (AMI) from 2005 to 2015. Overall, 91.7 percent of patients had at least one risk factor. The prevalence of each studied risk factor (RF) was:

  • Diabetes: 27.4 percent
  • Dyslipidemia: 56.8 percent
  • Hypertension: 57.9 percent
  • Obesity: 17.8 percent
  • Smoking: 52.8 percent
  • Drug abuse: 5.5 percent

While more than 9 in 10 had one risk factor, 70.1 percent had at least two risk factors and 39.4 percent had at least three of those factors. Each one other than dyslipidemia increased in prevalence from 2005 to 2015, with the slight decline in high cholesterol later in the study period possibly linked to an increase in statin therapy.

“During a first AMI in young adults in whom preventive measures are more likely to be effective, modifiable RFs were highly prevalent and progressively increased over time,” wrote lead author Srikanth Yandrapalli, MD, with Westchester Medical Center and New York Medical College, and colleagues. “Significant sex and racial disparities were observed for individual RFs.”

Yandrapalli et al. found women had a higher prevelance of diabetes, hypertension and obesity, while men were more likely to smoke, abuse drugs or have dyslipidemia. Blacks were particularly affected by hypertension, obesity and drug abuse, whites had higher rates of smoking and Hispanics were most likely to have diabetes.

Differences by age were noted as well, with the younger AMI patients (those aged 18 to 44) being more likely to smoke, abuse drugs or be obese than those in the 45 to 59 age range. The other RFs were more prevalent in the older group.

“Over time, the sex gap narrowed for smoking, hypertension, and drug abuse. These findings suggest that the baseline risk in younger women having a first AMI event is increased with age and also over time, highlighting the need for appropriate primordial, primary, and secondary prevention strategies in women,” the researchers wrote, adding that their data can be used to plan preventive strategies in other select populations as well.

Basmah Safdar, MD, MSc, wrote in a related editorial many of the young patients in the study may have been passed over for preventive management because traditional risk scores tend to heavily weigh age into their predictions—even though age “remains a poor surrogate for atherosclerotic burden.”

“Thus, in the presence of risk factors, incorporation of other biomarkers such as coronary calcium score, blood biomarkers, nontraditional risk factors, and polygenic risk scores including 30-year Framingham risk estimation may allow more accurate risk estimation in young patients,” wrote Safdar, with the department of emergency medicine at Yale University.