Younger, Fatter, Sicker: New Heart Attack Data from Cleveland

MARCH 31, 2016
Megan Daily
Alarming data suggesting severe heart attacks are occuring more frequently in younger patients will be presented Monday April 4, 2016, at the American College of Cardiology’s 65th Annual Scientific Session in Chicago.  
 
 Amgad Mentias, MD and fellow researchers at Cleveland Clinic, Cleveland, OH analyzed data on nearly four thousand patients treated at their hospital for ST-elevation myocardial infarction (STEMI) between 1994 and 2015.
 
They found these patients showed an increased tendency toward obesity, smoking, chronic obstructive pulmonary disease (COPD), hypertension, and diabetes as well. 
 
Presenting An Alarming Trend: Change in Risk Profile of Patients with ST Elevation Myocardial Infarction over the Last Two Decades in a pre-conference briefing on behalf of all of his fellow authors Samir Kapadia, MD, said their findings were unexpected.
 
“Very amazingly, what we found was that the patients presenting with myocardial infarction were getting younger,” he said. 
 
Drawing on patient records from 3912 consecutive STEMI cases presenting to the tertiary referral center from January 1995 to December 2014 the study looked at risk factors for age, gender, diabetes mellitus, hypertension, smoking, hyperlipidemia, chronic renal impairment (serum creatinine ≥1.5 mg/dl), and obesity (Body Mass Index ≥30 kg/m2).  Records were divided into four 5-year quartiles.
Prevalence of risk factors were studied in the entire cohort and patients with prior diagnosis of CAD (n=1325, 34%)
 
Results showed the average age of STEMI patients decreased from 64 to 60, and the prevalence of obesity increased from 31% to 40% from the first to the second quartile.   The proportion of patients with diabetes increased from 24% to 31%. In addition, the proportion with high blood pressure grew from 55% to 77%, and the proportion with chronic obstructive pulmonary disease rose from 5% to 12% percent over the same period.  
 
 In a finding counter to national trends the percentage of smokers jumped a surprising 60%. 
 
The study also revealed a significant increase in the proportion of patients who have three or more major risk factors, which grew from 65% to 85%. Kapadia said the findings carry strong messages for both the medical community and the general public.
 
“Prevention must be kept in the forefront of primary care,” Kapadia said, “Cardiac health is not just dependent on the cardiologist--the primary care physicians and the patient need to take ownership of this problem.”
 
The team made it clear the study did not account for socioeconomic indicators, and noted that helicopter transports brought patients to Cleveland Clinic from surrounding rural areas during the course of the study period. It is possible that the observed trends reflect changes in the hospital’s patient population.  

Asked whether the team was looking at demographic factors in these patients to see if they are representative, Kapadia told MD Magazine the team hopes to have complementary socioeconomic research completed in a month or so. 


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