In the Journals

Acute MI hospitalizations increased in young patients

Sameer Arora
Sameer Arora

The number of young adults who were hospitalized for acute MI increased from 1995 to 2014, and this trend was more distinct in young women, according to a study published in Circulation.

“These observations from the ARIC Community Surveillance study have important health implications considering the increased disability-adjusted life-years associated with [acute] MI at a younger age,” Sameer Arora, MD, fellow in the division of cardiology at the University of North Carolina School of Medicine in Chapel Hill, and colleagues wrote. “There is an enduring need for effective preventive strategies to reduce the burden of cardiovascular disease in the young population, especially among young women.”

Researchers analyzed data from 28,732 hospitalizations for acute MI in patients aged 35 to 75 years from the ARIC study from 1995 to 2014. Young patients (n = 8,737), who were the major focus of this study, were defined as those aged 35 to 54 years.

Clinical and demographic data were obtained from hospital records. Other factors assessed were diabetes status, hypertension status, electrocardiography, chest pain, biomarkers, medications and procedures such as stress testing, echocardiography, revascularization and angiography.

Outcomes of interest were in-hospital mortality, in addition to 28-day and 1-year mortality.

During the study, young women had an increase in the annual incidence of acute MI hospitalizations, whereas young men had a decrease in acute MI hospitalizations.

The number of acute MI hospitalizations in young patients increased from 27% in 1995-1999 to 32% in 2010-2014 (P for trend = .002). During this time, there were also increases in young patients with a history of diabetes (25% to 35%; P for trend < .0001) and hypertension (59% to 73%; P < .0001).

Young women with acute MI were more often black (52% vs. 41%; P < .0001) and more likely to have a history of hypertension (71% vs. 64%; P = .0005), chronic kidney disease (24% vs. 19%; P = .07), diabetes (39% vs. 26%; P < .0001) and prior stroke (10% vs. 6%; P = .003) compared with young men.

After adjusting for year of admission, race and ARIC center, women had a lower probability of receiving non-aspirin antiplatelets (RR = 0.83; 95% CI, 0.75-0.91), lipid-lowering agents (RR = 0.87; 95% CI, 0.8-0.94) and beta-blockers (RR = 0.96; 95% CI, 0.91-0.99). In addition, women were also less likely to receive revascularization (RR = 0.79; 95% CI, 0.71-0.87) and angiography (RR = 0.93; 95% CI, 0.86-0.99).

The hazard of 1-year all-cause mortality was comparable for women vs. men after adjusting for hospital geographic location, race and year of admission (HR = 1.1; 95% CI, 0.83-1.45).

“Ongoing primordial, primary and secondary prevention efforts are urgently needed to promote uniform and guideline-based care targeting [acute] MI, associated cardiometabolic comorbidities and adverse health behaviors in the young population,” Arora and colleagues wrote. – by Darlene Dobkowski

Disclosures: The ARIC study was supported by the NHLBI. Arora reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Sameer Arora
Sameer Arora

The number of young adults who were hospitalized for acute MI increased from 1995 to 2014, and this trend was more distinct in young women, according to a study published in Circulation.

“These observations from the ARIC Community Surveillance study have important health implications considering the increased disability-adjusted life-years associated with [acute] MI at a younger age,” Sameer Arora, MD, fellow in the division of cardiology at the University of North Carolina School of Medicine in Chapel Hill, and colleagues wrote. “There is an enduring need for effective preventive strategies to reduce the burden of cardiovascular disease in the young population, especially among young women.”

Researchers analyzed data from 28,732 hospitalizations for acute MI in patients aged 35 to 75 years from the ARIC study from 1995 to 2014. Young patients (n = 8,737), who were the major focus of this study, were defined as those aged 35 to 54 years.

Clinical and demographic data were obtained from hospital records. Other factors assessed were diabetes status, hypertension status, electrocardiography, chest pain, biomarkers, medications and procedures such as stress testing, echocardiography, revascularization and angiography.

Outcomes of interest were in-hospital mortality, in addition to 28-day and 1-year mortality.

During the study, young women had an increase in the annual incidence of acute MI hospitalizations, whereas young men had a decrease in acute MI hospitalizations.

The number of acute MI hospitalizations in young patients increased from 27% in 1995-1999 to 32% in 2010-2014 (P for trend = .002). During this time, there were also increases in young patients with a history of diabetes (25% to 35%; P for trend < .0001) and hypertension (59% to 73%; P < .0001).

Young women with acute MI were more often black (52% vs. 41%; P < .0001) and more likely to have a history of hypertension (71% vs. 64%; P = .0005), chronic kidney disease (24% vs. 19%; P = .07), diabetes (39% vs. 26%; P < .0001) and prior stroke (10% vs. 6%; P = .003) compared with young men.

After adjusting for year of admission, race and ARIC center, women had a lower probability of receiving non-aspirin antiplatelets (RR = 0.83; 95% CI, 0.75-0.91), lipid-lowering agents (RR = 0.87; 95% CI, 0.8-0.94) and beta-blockers (RR = 0.96; 95% CI, 0.91-0.99). In addition, women were also less likely to receive revascularization (RR = 0.79; 95% CI, 0.71-0.87) and angiography (RR = 0.93; 95% CI, 0.86-0.99).

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The hazard of 1-year all-cause mortality was comparable for women vs. men after adjusting for hospital geographic location, race and year of admission (HR = 1.1; 95% CI, 0.83-1.45).

“Ongoing primordial, primary and secondary prevention efforts are urgently needed to promote uniform and guideline-based care targeting [acute] MI, associated cardiometabolic comorbidities and adverse health behaviors in the young population,” Arora and colleagues wrote. – by Darlene Dobkowski

Disclosures: The ARIC study was supported by the NHLBI. Arora reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.