Surprising risk factors may predict heart attacks in young women

A new Yale-led study has identified for the first time which risk factors are more likely to trigger a heart attack or acute myocardial infarction (AMI) for men and women age 55 and younger.

Researchers discovered significant sex differences in the strength of associations between risk factors associated with AMI and young adults, suggesting the need for a sex-specific preventive strategy. For example, high blood pressure, diabetes, depression and poverty had a stronger association with AMI in women than in men, they found.

The study was published on 3 May Jama Networks open.

While heart attacks are more often associated with older adults, this population-based case–control study examined the relationship between a wide range of risk factors related to AMI among young adults. Researchers used data from 2,264 AMI patients from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) study and 2,264 population-based controls for age, sex and race from the National Health and Nutrition Examination. matched. Survey (NHANES).

The main finding is that young men and women often have different risk factors. Seven risk factors – including diabetes, depression, hypertension or high blood pressure, current smoking, family history of AMI, low household income and high cholesterol – were associated with a greater risk of AMI in women. The highest association was diabetes, followed by current smoking, depression, high blood pressure, low household income and family history of AMI. In men, current smoking and family history of AMI were major risk factors.

Yuan Lu, an assistant professor at Yale School of Medicine and lead author of the study, said rates of AMI among young women have increased in recent years.

“Young women with AMI have an abnormal or extreme phenotype because of their age,” she said. “In the past, we found that younger women, but also older women, have twice the risk of dying after an AMI than men of the same age. In this new study, we now compared risk factor profiles with AMI by sex. and identified significant differences in risk factor associations.”

The analysis of risk due to population was used to measure the effect of various risk factors at the population level. The study found that seven risk factors, many potentially modifiable, collectively accounted for the overall risk of AMI in young women (83.9%) and young men (85.1%). Some of these factors — including high blood pressure, diabetes, depression and poverty — appear to have a greater impact on young women than younger men, Lu and colleagues found.

“This study specifically speaks to the importance of studying young women with heart attacks, a group that has been largely neglected in many studies and yet as many as the number of young women diagnosed with breast cancer. Big,” Dr. Harlan M. Krumholz, Harold H. Hines Jr., professor of medicine at Yale, director of the Center for Outcome Research and Evaluation (CORE), and senior author of the paper.

The first step is to raise awareness among physicians and young patients, the researchers said. She added that national initiatives such as the American Heart Association’s “Go Red for Women” campaign should be expanded to raise awareness of the risk of heart disease among young women. Health care providers also need to identify effective strategies to improve the optimal delivery of evidence-based guidelines for preventing AMI. For example, risk prediction tools for individual patients can help clinicians identify which individuals are most at risk and develop treatment strategies.

Accounting for AMI subtypes can also be effective. The researchers found that several traditional risk factors, including high blood pressure, diabetes and high cholesterol, are more prevalent in type-1 AMI, while various AMI subtypes – including type-2 AMI (a subtype associated with higher mortality) – are less common. .

“We are moving towards a precision medicine approach, where we are not treating each patient the same, but recognizing that there are many different subtypes of AMI,” Lu said. “Individual-level interventions are needed to maximize health benefits and prevent AMI.”

This study is the first and largest study in the United States to comprehensively evaluate the associations between a wide range of risk factors and incident AMI in young women and a comparable sample of young men. The study design also included a comparative population-based control group from the National Health and Nutrition Examination Survey, a program to assess demographic, socioeconomic, dietary and health information.

A longitudinal study has traditionally been used to assess AMI risk in a younger population. Because the incidence rate is low in young people, however, it takes a long time for the disease to appear. So researchers often don’t have enough AMI programs to make inferences about risk factors and their relative importance in young women and men, Lu said.

“Here we used a novel study design with a large cohort of patients with AMI and then we identified age-sex-race matched population controls from a national population survey to compare this, and we used this to evaluate the association.” used a case-control design for those with AMI of these risk factors,” Lu said. “This is one of the first and largest studies to comprehensively address this issue.”

In the United States, hospitalization rates for heart attacks have been declining over time, according to research in the journal JAMA Cardiology.

“However, if you analyze the proportion of these patients by age, you will find that the proportion of young people who are hospitalized for heart attacks is increasing,” Lu said. “So it seems that there is a general tendency for AMI to occur earlier in life, making heart attack prevention particularly important in young people.”

Young women represent about 5% of all heart attacks in the US each year. “This small percentage affects a large number of people because there are so many AMIs in the US each year,” she said. “About 40,000 AMIs are hospitalized in young women each year, and heart disease is the leading cause of death in this age group.”

Lu emphasized the importance of education. “When we talk about heart attacks in young women, people are often not aware of it,” she said. “If we can prevent women from having heart attacks the results will be better.”

Raising awareness about the incidence of heart attacks among young women is an important part of the strategy, he added. The next frontier in the prevention of heart disease in young women may be better understanding the role of women-related factors.

Previous studies have suggested that women-related factors may be associated with heart attack risk, but there is limited data on women under the age of 55. “We hope to explore factors related to menopausal history, pregnancy, menstrual cycle, and women. Other factors that pertain specifically to women and analyze whether this is contributing to heart attack risk.” is,” she said.

The study team included Shu-Xia Li, Yutian Liu, Rachel P. Dreyer, Rohan Khera, Karthik Murugia, Gail D’Onofrio, Erica S. from Yale. Spatz was also involved; Fatima Rodriguez from Sandford University; From the University of California, Los Angeles, Karol E. Watson; and Frederick A. from Ascension Healthcare. Masoodi. The VIRGO study was funded by the US National Institutes of Health.

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