Pattern of Standard Modifiable Risk Factors and Outcomes in Very Young Patients with Myocardial Infarction
Authors: Tang Si-qi , Zhao Xin-long , Li Quan , Liu Yan-bo , Han Yi-tao , Chen Yu-xiong , Lei Jin-yan , Zhao Ya-kun , Fan Zhong-jie , Ruan Yan-ping 
Published: November 2024

Background

The incidence of myocardial infarction (MI) is rising among young individuals. This study aimed to identify the profile of standard modifiable risk factors (SMuRFs) and their impact on long-term survival in very young MI patients (≤35 years).

Methods

The VYTAL-MI study (Very Young Tracking and Analysis of Long-term Myocardial Infarction Outcomes) is a retrospective cohort analysis of MI patients aged ≤35 years, admitted to Beijing Anzhen Hospital and Peking Union Medical College Hospital between December 11920, 2011, and December 11920, 2021. SMuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were documented. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, recurrent MI, ischemia-driven revascularization, and ischemic stroke. Cox proportional hazard models were used to assess associations between SMuRFs and outcomes.

Results

Among 690 patients (median age 33 years [interquartile range, IQR: 30-34]; 95% male), only 8% had no SMuRFs. Smoking was most common (76%), followed by hypercholesterolemia (43%), hypertension (40%), and diabetes (12%). The most frequent combination was smoking and hypercholesterolemia (16.4%). Over a median follow-up of 6.3 years (IQR: 4.0-8.6), MACCE occurred in 165 patients (23.9%). Patients with ≥3 SMuRFs had significantly higher cumulative hazards (P=0.003). Hypertension (hazard ratio, HR: 1.50; 95% confidence interval, CI: 1.09-2.06;P=0.014) and diabetes (HR: 1.67; 95% CI: 1.10-2.54;P=0.016) were independently associated with increased risk, while hypercholesterolemia (HR: 1.24; 95% CI: 0.91-1.68;P=0.177) and smoking (HR: 1.06; 95% CI: 0.72-1.55;P=0.776) showed no significant association.

Conclusions

Very young MI patients exhibited a high burden of SMuRFs, particularly smoking. Hypertension and diabetes increased long-term event risk. Targeted SMuRF management is essential to improve survival in this population.

What is known

Targeting standard modifiable cardiovascular risk factors, including hypertension, diabetes, hypercholesterolemia, and smoking, is crucial for improving outcomes in myocardial infarction.

Limited data exist on the pattern of standard modifiable risk factors in very young myocardial infarction patients aged ≤35 years, and how these factors influence long-term outcomes.

What the study adds

Very young myocardial infarction patients exhibited a substantial burden of standard modifiable risk factors, with smoking being notably prevalent.

Increased standard modifiable risk factors exposure was associated with an elevated risk of major adverse cardiovascular and cerebrovascular events

Hypertension and diabetes were linked to a higher risk of major adverse cardiovascular and cerebrovascular events, while smoking and hypercholesterolemia did not show a significant independent effect.

Registration:URL:http://www.chictr.org.cn; Unique identifier: ChiCTR2400085600.