Trends in risk factor prevalence in young adults experiencing acute coronary syndrome
Authors: Segal O , Dobrecky-Mery I , Muslavi O , Meir Y , Koppel F 
Published: October 2024

Abstract

Introduction
While for many decades the prevalence of coronary artery disease (CAD) and acute coronary syndrome (ACS) has been declining, it seems as this trend has reached a plateau, mostly in developing countries, but also in developed countries due to reasons such as immigration and unhealthy lifestyle concomitant to the pandemic of obesity and metabolic syndrome. Still, CAD remains the leading cause of death globally. Preventive cardiology guidelines addressed adequate control of traditional risk factors in order to reduce CAD burden, mortality and morbidity but to lesser extent fewer resources were invested for the younger population in their third or fourth decade for implementing this practical guideline. As global obesity pandemic emerged over the past decades, it emphasizes the need to re-evaluating risk factors, particularly the role of obesity and metabolic syndrome, in contributing to the rising incidence of ACS among the younger population.

Purpose
The study aims to analyze trends in risk factors among young adult which presented with ACS from 2005 to 2022. Results may inform targeted interventions and deepen understanding of ACS pathophysiology and severity.

Methods
The study encompassed 712 patients hospitalized between 2005 and 2022. Comparable groups were analyzed, including temporal changes, ST-elevation myocardial infarction (STEMI) vs. non-ST-elevation myocardial infarction (NSTEMI), different age groups, and various ethnicities. Categorical values were thoroughly examined, yielding insightful results.

Results
Temporal changes revealed that patients presenting with ACS before 2014 exhibited a higher incidence of Dyslipidemia and familial history (p=0.002 and p=0.005). Conversely, in the latter period, overweight and diabetes were more significant (p&lt;0.001 and p=0.0176). In the STEMI vs. NSTEMI group, smoking was more prevalent in the STEMI group (p=0.0449), while diabetes, Dyslipidemia, and hypertension were more significant for the NSTEMI group (p=0.022, p=0.009, p&lt;0.001). For the age group, the only observed difference was in hypertension for the 40-45 and 45-50 age group (p=0.0463). In the ethnicity group, individuals of Arab origin exhibited higher rates of smoking and familial cardiac background (p&lt;0.001 and p=0.03), while in the non-Arab group, obesity was more significant (p&lt;0.001).

Conclusion
The observed changes in the distribution of risk factors among patients with CAD align with global trends, indicating an increase in obesity. Belonging to the overweight population, prior to obesity, pose a prominent risk factor for ACS. Smoking remains a significant factor, with higher rates in patients presenting with STEMI, aligning previous research and re-emphasize the importance of prevention. Different demographic groups may exhibit distinct risk factors contributing to the common endpoint of CAD. Tailored intervention strategies considering diverse risk profiles are essential for effective coronary disease prevention.