Prevalence of standard modifiable cardiovascular risk factors in patients with ST segment elevation myocardial infarction and its relation with outcomes
Date Issued
2022-10-01
Author(s)
Bergami, M
Simovic, S
Cenko, E
Davidovic, G
Zdravkovic, M
Vasiljevic, Z
Mendieta, G
Milicic, D
Badimon, L
Manfrini, O
Bugiardini, R
DOI
10.1093/eurheartj/ehac544.2261
Abstract
Background: It has been recently suggested that more than 15% of patients
with ST-segment–elevation myocardial infarction (STEMI) lack any of
the standard modifiable risk factors (cigarette smoking, diabetes, hyperlipidemia,
and hypertension -SMuRFs). This claim implies that other factors
play a significant role in development of STEMI and has led to considerable
interest in genetic causes of coronary heart disease including family
history (FHx)
Purpose: To investigate whether FHx may be a significant driver for STEMI
in patients without SMuRFs.
Methods: We analyzed 11,840 patients with ACSs, without evidence of
prior cardiovascular disease (CVD) enrolled in the ISACS-TC (International
Survey of Acute Coronary Syndromes in Transitional Countries) registry
between January 2010 to January 2021. Main outcome measures were the
adjusted rates of STEMI and 30-day mortality from STEMI using multivariable
logistic regression models. Patients presenting with non-ST elevation
acute coronary syndromes served as controls.
Results: Among patients with STEMI, at least 1 of the 4 conventional risk
factors was present in 88.1% of women and 86.7% of men. Overall, 3,194
patients (27.0%) self-reported a FHx of CV disease, defined as a firstdegree
relative with premature CV events (men, age <55 years; women,
age <65 years). There were 261 (8.2%) patients with FHx but without
SMuRFs and 2,933 (91.8%) patients with FHx and SMuRFs. After adjusting
for age, and standard risk factors, FHx was associated with a significantly
lower incidence of STEMI in patients with SMuRFs, but not in those
without SMuRFs (ORs: 0.87; 95% Cl: 0.79 to 0.97 vs 0.80; 95% Cl: 0.58
to 1.12). Prior use of evidence-based medications (aspirin, beta-blockers,
ACE inhibitors/ARBs and statins) did not consistently change prior estimates
on FHx and SMuRFs (OR: 0.82 95% Cl: 0.71 to 0.96 and OR 0.89
95% CI: 0.54–1.47). Patients who presented with STEMI had a 46% excess
risk of 30-day mortality (OR: 1.46; 95% CI: 1.11 to 1.91; p<0.001)
compared with controls
Conclusions: In direct contrast with recent findings, almost 90% of patients
with STEMI have SMuRFs. Self-reported FHx is not a significant risk
factor for development of STEMI and related high rate of CV mortality in
patients without SMuRFs. Although research on genetic causes of heart
disease is important, public health policies, and research efforts should
place significant emphasis on the 4 SMuRFs and the lifestyle behaviors
causing them to reduce the epidemic of STEMI.
with ST-segment–elevation myocardial infarction (STEMI) lack any of
the standard modifiable risk factors (cigarette smoking, diabetes, hyperlipidemia,
and hypertension -SMuRFs). This claim implies that other factors
play a significant role in development of STEMI and has led to considerable
interest in genetic causes of coronary heart disease including family
history (FHx)
Purpose: To investigate whether FHx may be a significant driver for STEMI
in patients without SMuRFs.
Methods: We analyzed 11,840 patients with ACSs, without evidence of
prior cardiovascular disease (CVD) enrolled in the ISACS-TC (International
Survey of Acute Coronary Syndromes in Transitional Countries) registry
between January 2010 to January 2021. Main outcome measures were the
adjusted rates of STEMI and 30-day mortality from STEMI using multivariable
logistic regression models. Patients presenting with non-ST elevation
acute coronary syndromes served as controls.
Results: Among patients with STEMI, at least 1 of the 4 conventional risk
factors was present in 88.1% of women and 86.7% of men. Overall, 3,194
patients (27.0%) self-reported a FHx of CV disease, defined as a firstdegree
relative with premature CV events (men, age <55 years; women,
age <65 years). There were 261 (8.2%) patients with FHx but without
SMuRFs and 2,933 (91.8%) patients with FHx and SMuRFs. After adjusting
for age, and standard risk factors, FHx was associated with a significantly
lower incidence of STEMI in patients with SMuRFs, but not in those
without SMuRFs (ORs: 0.87; 95% Cl: 0.79 to 0.97 vs 0.80; 95% Cl: 0.58
to 1.12). Prior use of evidence-based medications (aspirin, beta-blockers,
ACE inhibitors/ARBs and statins) did not consistently change prior estimates
on FHx and SMuRFs (OR: 0.82 95% Cl: 0.71 to 0.96 and OR 0.89
95% CI: 0.54–1.47). Patients who presented with STEMI had a 46% excess
risk of 30-day mortality (OR: 1.46; 95% CI: 1.11 to 1.91; p<0.001)
compared with controls
Conclusions: In direct contrast with recent findings, almost 90% of patients
with STEMI have SMuRFs. Self-reported FHx is not a significant risk
factor for development of STEMI and related high rate of CV mortality in
patients without SMuRFs. Although research on genetic causes of heart
disease is important, public health policies, and research efforts should
place significant emphasis on the 4 SMuRFs and the lifestyle behaviors
causing them to reduce the epidemic of STEMI.
Subjects
File(s)![Thumbnail Image]()
Loading...
Name
Prevalence of standard modifiable cardiovascular risk factors in patients with ST segment elevation myocardial infarction and its relation with outcomes.pdf
Size
80.88 KB
Format
Adobe PDF
Checksum
(MD5):e45d48608124eb7cf8ac462959a94239