Sex-Specific Risk Factors Associated With First Acute Myocardial Infarction in Young Adults

Adherence to statins and development of atherosclerosis-related events. A systematic review and meta-analysis

BACKGROUND

Adherence to lipid-lowering treatment (LLT) is of paramount importance for the prevention of atherosclerosis-related events (ASCVD). The threshold for someone to be adherent is ≥80 % of the total prescribed medication. We conducted a meta-analysis to assess how adherence to LLT affects the development of ASCVD.

METHODS

We searched PubMed (up to February 2025) for randomized controlled trials, cohorts and nested case control studies that assessed adherence to LLT. We performed random effects meta-analysis with primary outcome the development of ASCVD based on the level of adherence to LLT.

RESULTS

We included 66 articles corresponding to 3,345,718 individuals. All studies evaluated statins as LLT. Good vs. poor statin adherence reduced by 35 % the risk for all-cause mortality (RR:0.65; 95%CI: 0.56-0.76; I2 = 98 %), 24 % for any cardiovascular (CV) event (RR:0.76; 95%CI: 0.72-0.80; I2 = 90 %), 30 % for myocardial infarction (MI) (RR:0.70; 95%CI: 0.62-0.80; I2 = 90 %) and 32 % for stroke (RR:0.68; 95%CI: 0.58-0.79; I2 = 81 %). For participants without established ASCVD, statin adherence reduced by 32 % the risk for any CV event (RR:0.68; 95%CI: 0.46-1.00; I2 = 97 %). For those with established ASCVD, statin adherence reduced by 25 % the risk for any CV event (RR:0.75; 95%CI: 0.64-0.88; I2 = 64 %), 51 % for MI (RR:0.49; 95%CI: 0.32-0.73; I2 = 80 %) and 50 % for stroke (RR:0.50; 95%CI: 0.26-0.97; I2 = 87 %). Statin discontinuation increased by 90 % the mortality risk (RR:1.90; 95%CI: 1.33-2.71; I2 = 87 %). Even good vs. intermediate adherence (40 %-79 %) decreased by 32 % the risk for any CV event (RR:0.68; 95%CI: 0.60-0.76; I2 = 94 %). Sensitivity analyses including studies with different than the standard (≥80 %) threshold did not differ from the main results.

CONCLUSION

Statin adherence is of paramount importance to reduce ASCVD risk and mortality. Understanding adherence patterns or barriers and ensuring consistent adherence to LLT by tailored interventions should be a key priority in clinical practice and healthcare policies.

Multimorbidity Patterns and In-Hospital Outcomes in Chinese Young Women (Aged <55 Years) Presenting with ST-Segment-Elevation Myocardial Infarction

BACKGROUND

Recent evidence highlights an increasing incidence of myocardial infarction in young women. Identifying clinical multimorbidity patterns in this population may improve therapeutic strategies and clinical care.

METHODS AND RESULTS

We identified multimorbidity patterns in 9570 young women with ST-segment-elevation myocardial infarction (median age, 50 years [range, 47.0-53.0 years]) admitted to the China Chest Pain Center Database between 2016 and 2021. Hierarchical clustering of 15 medical conditions was performed to derive multimorbidity patterns. The primary outcome was a composite of in-hospital adverse events. Associations between multimorbidity patterns and outcomes were evaluated using multivariable-adjusted logistic regression models. Among 9570 patients, 50% (n=4789) had multimorbidity. Six multimorbidity patterns were identified, including 4 specific patterns: (1) pattern 1, cerebrovascular cluster (histories of cerebrovascular disease and hypertension); (2) pattern 2, traditional cardiovascular disease risk factors cluster (histories of hyperlipidemia, obesity, and diabetes, and family history of cardiovascular disease and smoking); (3) pattern 3, coronary-heart failure cluster (histories of heart failure, coronary artery disease, peripheral arterial disease, and thyroid dysfunction); and (4) pattern 4, anemia-renal dysfunction cluster (histories of atrial fibrillation, anemia, chronic kidney disease, and peptic ulcer). Compared with patients without multimorbidity, those with pattern 1 (odds ratio [OR], 2.29 [95% CI, 1.49-3.52]), pattern 2 (OR, 1.52 [95% CI, 1.24-1.86]), and pattern 4 (OR, 2.25 [95% CI, 1.10-4.61]) exhibited higher risks for composite outcomes.

CONCLUSIONS

Specific multimorbidity patterns in young women with ST-segment-elevation myocardial infarction were associated with distinct in-hospital outcomes in a nationwide registry, providing proof-of-concept evidence to guide future therapeutic approaches.

Insights From m6A RNA Methylation: Biomarkers for Diagnosis of Acute Myocardial Infarction

Purpose

Acute myocardial infarction (AMI) is a major contributor to death. The purpose of this study is to explore circulating biomarkers for AMI diagnosis from the perspectives of immunological microenvironment and N6-methyladenosine (m6A) RNA methylation regulation.

Patients and Methods

The GSE59867 dataset was used to download platform and probe data for conducting differential analysis of m6A regulators. A diagnostic nomogram was created utilizing the random-forest method and evaluated for predictive power. m6A-related gene patterns were identified, and their immune microenvironment characteristics were analyzed. Peripheral blood samples were obtained for validation in patient-based investigations using RT-qPCR. The association between m6A regulators and clinical parameters was examined via Spearman correlation analysis.

Results

With a predictive nomogram model developed using key m6A regulators, two distinct m6A subtypes were identified, showing significant variations in infiltrating immunocyte abundance. In confirmation of the model prediction, examination of patient blood identified METTL3, WTAP, RBM15, ALKBH5, FTO, and FMR1 as novel circulating biomarkers for AMI diagnosis. METTL3 and FTO were identified as promising biomarkers for AMI given that they showed a positive correlation with left ventricular ejection fraction.

Conclusion

The study identified six m6A regulators as circulating biomarkers for AMI diagnosis and suggested a potential role for m6A-mediated immune cell infiltration in the pathogenesis of AMI.

Injured Myocardium-Targeted Theranostic Nanoplatform for Multi-Dimensional Immune-Inflammation Regulation in Acute Myocardial Infarction

Pyroptosis is a key mode of programmed cell death during the early stages following acute myocardial infarction (AMI), driving immune-inflammatory responses. Cardiac resident macrophages (CRMs) are the primary mediators of cardiac immunity, and they serve a dual role through their shaping of both myocardial injury and post-AMI myocardial repair. To appropriately regulate AMI-associated inflammation, HM4oRL is herein designed, an innovative bifunctional therapeutic nanoplatform capable of inhibiting cardiomyocyte pyroptosis while reprogramming inflammatory signaling. This HM4oRL platform is composed of a core of 4-Octyl itaconate (4-OI)-loaded liposomes, a middle layer consisting of a metal-polyphenol network (MPN) film, and an optimized outer hybrid immune-cell membrane layer. The unique properties of this hybrid membrane layer facilitated HM4oRL targeting to the injured myocardium during early-stage AMI in mice, whereupon the release of 4-Ol and modified MPN synergistically inhibited cardiomyocyte pyroptosis while suppressing inflammatory monocytes/macrophage responses at the infarcted site. Mechanistically, HM4oRL preserved cardiac metabolic homeostasis through AMPK signaling activation, establishing favorable microenvironmental conditions for the reprogramming of CRM-mediated inflammation. Ultimately, HM4oRL treatment is able to resolve inflammation, enhance neovascularization, and suppress myocardial fibrosis, reducing the infarct size and enhancing post-AMI cardiac repair such that it is an innovative approach to the targeted treatment of AMI.

Traditional and Non-Traditional Risk Factors of Acute Coronary Syndrome in Young Women: Evidence from the ANCORS-YW Study

Purpose

Young women are at risk of acute coronary syndrome (ACS). They represent a unique population exposed to traditional cardiovascular risk factors and female sex-specific, non-traditional risk factors. The current study aimed to describe traditional and non-traditional risk factors of ACS in young women from the Middle East.

Patients and Methods

The present study used data from the Jordanian, nationwide, multicenter, case-control study, ANCORS-YW. Bivariate analyses and logistic regression models were used to predict independent risk factors of ACS using adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results

The study included 572 young women (≤50-years) with a median age of 45-years, divided into an ACS group (n=154, 26.9%) and a control group with no atherosclerotic cardiovascular disease (n=418, 73.1%). The most common presentation of ACS was non-ST-elevation ACS (n=98, 64%). The ACS group, compared to control group, had higher proportions of type-2 diabetes (41.6%vs.11.7%, p<0.001), hypertension (53.9%vs.23.4%, p<0.001), tobacco use (37.7%vs.24.2%, p=0.001), family history of cardiovascular disease (53.2%vs.23.4%, p<0.001), metabolic syndrome (14.3%vs.2.4%, p<0.001), and preterm delivery (24.7%vs.16.7%, p=0.032). ACS group had nonsignificantly greater proportions of hypertensive disorders of pregnancy (29.2%vs.22.7%, p=0.109) and gestational diabetes (15.6%vs.10.3%, p=0.081). Multivariable logistic regression analyses identified five independent predictors of ACS: type-2 diabetes (AOR, 95% CI: 3.45, 1.98─5.99), family history of cardiovascular disease (3.33, 2.15─5.17), tobacco use (2.01, 1.26─3.21), hypertension (1.72, 1.07─2.78), and metabolic syndrome (4.35, 1.72─11.03).

Conclusion

Modifiable risk factors play an important role in ACS risk among young women. Efforts should be made to improve primordial and primary prevention in this population.

Coronary Artery Disease in Very Young Women: Risk Factors and Prognostic Insights from Extended Follow-Up

Coronary artery disease (CAD) is usually associated with the elderly, but an increase in its incidence has been recently reported among young people, including very young women. The aim of this study is to assess the associations between different clinical variables and the risk of early CAD and occurrence of major adverse cardiovascular events (MACEs) during follow-up. Our cohort consists of women ≤40 years referred for coronary angiography due to suspicion of CAD; a nested case-control study was conducted among these patients. In total, 19,321 coronary angiographies were performed between 2006 and 2015, of which 2.6% were in patients ≤40 years old; 52 women were finally included. Family history of CAD was strongly associated with the early onset of the disease [OR 5.94, 95%CI (1.13-31.15); p = 0.035] in young women. The incidence of MACE was also associated with depression [HR 8.20 95%CI (1.03-65.17); p = 0.047] and Castelli Index [HR 11.49, 95%CI (1.40-94.51); p = 0.023]. Primary prevention focused on genetic analysis for high-risk women with a family history of CAD and secondary prevention, targeting a better cholesterol management and mental health assistance must be considered.

Long-term patient outcomes from a multidisciplinary cardiac rehabilitation programme with integrated nurse specialist support: A retrospective cohort study

BACKGROUND

Cardiac rehabilitation programmes, while demonstrating benefits, face challenges in universal adoption, particularly in New Zealand. This study evaluates the long-term impact of cardiac rehabilitation participation and attendance on survival and readmission rates in the Auckland Health District.

OBJECTIVE

To examine the impact of patient participation in nurse-led lifestyle rehabilitation and physiotherapy exercise rehabilitation on key outcomes, including all-cause mortality, and all-cause, cardiac-specific, and kidney disease readmission rates.

DESIGN

Retrospective cohort study.

SETTING

Auckland Health District, New Zealand.

PARTICIPANTS

3331 patients registered in the Auckland cardiac rehabilitation programme between 2016 and 2020.

METHODS

Data analysis included examining associations between attendance at nurse-led lifestyle and physiotherapy-led exercise sessions and outcomes at 12, 24 months, and 2022 year-end, including all-cause mortality, all-cause readmission, and cardiac-specific readmission rates. Analysis methods included survival analysis, Cox proportional regression, and logistic binary regression, controlling for confounders using propensity score weights and baseline factors.

RESULTS

1363 (40.9 %) patients attended at least one lifestyle rehabilitation session (average 5.0 ± 2.9 sessions), 1121 (33.7 %) patients attended at least one exercise rehabilitation session (average 6.8 ± 7.4 sessions), and 649 (19.5 %) patients attended at least one lifestyle and one exercise rehabilitation session. Increased likelihood of participation in rehabilitation was explained by ethnicity, while current and historical tobacco use, history of heart failure, receiving an angiogram, PCI, or other treatment such as medical management or implantable devices were associated with lower odds of participation. Participation in rehabilitation (average 7.9 ± 6.1 sessions) was associated with a higher mean survival estimate (7.6 years vs. 6.4 years, p < 0.001) while Cox proportional hazard regression, controlling for baseline factors and propensity score weights showed that a single session of rehabilitation attended had a 2.1 % decreased risk of mortality (hazard ratio = 0.98, 95 % CI: 0.96 to 0.99, p = 0.29). The cumulative hazard ratio for average attendance (7.9 ± 6.1 sessions) was 0.85 (95 % CI: 0.83 to 0.86, p < 0.001) indicating a 15 % decreased risk of mortality during follow-up. 20 % lower kidney disease readmission rates were observed among participants over the next 24 months (p < 0.05). However, no differences in all-cause or cardiac-specific readmission rates were observed.

CONCLUSIONS

The study supports the effectiveness of cardiac rehabilitation in improving long-term survival for Auckland Health District patients. The positive impact of nurse-led interventions and integrated support throughout the cardiac rehabilitation process highlights the need for translating this model to other health districts in New Zealand to optimise patient care and outcomes.

Risk factor assessment for post-thrombolytic coronary angiogram normalcy in young myocardial infarction patients

OBJECTIVES

Acute myocardial infarction is a critical medical condition that poses a significant risk to life. It is distinguished by the abrupt cessation of blood flow to a specific segment of the cardiac muscle. Acute myocardial infarction accounts for more than 15 % of global mortality annually.

METHODS AND RESULTS

A total of 433 young patients admitted with acute coronary syndrome - myocardial infarction underwent thrombolysis with fibrin specific agents followed by underwent diagnostic coronary angiogram between 01.09.2021 and 31.10.2022. The odds ratio showed a value of 1.973, which is much higher than the individuals with diabetes (0.306). Young individuals (25.9 %) with hypertension have a greater chance of recovery by thrombolysis.

CONCLUSIONS

The factors that contribute for the myocardial infarction should be recognized and addressed. Recognizing and addressing these risk factors through education, lifestyle modifications, and early intervention are crucial for preventing myocardial infarction and promoting good health.

Global burden of heart failure in children and adolescents from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019

BACKGROUND

Heart failure (HF) significantly impacts the cardiovascular health of children and adolescents. This study aims to assess epidemiologic trends in HF across sex, age, region, and time period.

METHODS

The number and age-standardized rate (ASR) of prevalence and years lived with disability (YLDs) were derived from the Global Burden of Disease Study 2019. We applied descriptive estimates, correlation analysis, and joinpoint linear regression to determine the trends in HF burden and its etiologies across different dimensions.

RESULTS

Globally, the number of children and adolescent HF patients exceeded 640,000 in 2019. A positive association was found between sociodemographic index (SDI) levels and HF burden, with higher SDI regions showing the greatest impact, especially in the 15-19-year-old group. The prevalence declined from 57.86 per 100,000 in 1990 to 56.17 in 2019, and YLDs decreased from 5.35 to 5.20 per 100,000 over the same period. Temporal burden trends varied among different SDI regions in the first two decades. Overall, children under 10 years old suffered a heavier burden and presented a more evident increasing trend compared to those aged 10-19 years. Males had a more severe HF burden than females across most regions, age groups, and underlying diseases. When exploring HF-related causes, congenital birth defects, cardiomyopathy and myocarditis were the most common etiologies of cardiac dysfunction.

CONCLUSION

Prompt and effective implementation of preventive and management policies worldwide among children and adolescents aged 0-19 years is a top priority to help curb the increasing burden of HF.

Hypertensive Disorders of Pregnancy Increase the Risk for Myocardial Infarction: A Population-Based Study

BACKGROUND

Angiographic evidence of the anatomy of coronary arteries and the type of coronary artery lesions in women with a history of hypertensive disorders of pregnancy (HDP) are poorly documented.

OBJECTIVES

This study sought to determine the role of a history of HDP as a unique risk factor for early coronary artery disease (CAD) and type of acute coronary syndrome (ACS) (ie, atherosclerotic vs myocardial infarction with nonobstructive coronary arteries [MINOCA]) in women who underwent coronary angiography.

METHODS

This study used a population-based cohort of parous female patients with incident CAD who underwent coronary angiography and age-matched control subjects. The SYNTAX (Synergy between PCI [percutaneous coronary intervention] with TAXUS [Boston Scientific] and Cardiac Surgery) score was assessed to determine the complexity and degree of CAD; MINOCA was diagnosed in the presence of clinical acute myocardial infarction in the absence of obstructive coronary disease.

RESULTS

A total of 506 parous female Olmsted County, Minnesota (USA) residents had incident CAD and angiographic data from November 7, 2002 to December 31, 2016. Women with HDP were younger than normotensive women at the time of the event (median: 64.8 years vs 71.8 years; P = 0.030). There was a strong association between HDP and ACS (unadjusted P = 0.018). Women with HDP compared with women with normotensive pregnancies were more likely to have a higher SYNTAX score (OR: 2.28; 95% CI: 1.02-5.12; P = 0.046), and MINOCA (OR: 2.08; 95% CI: 1.02-4.25; P = 0.044).

CONCLUSIONS

A history of HDP is associated with CAD earlier in life and with a future risk for myocardial infarction with both obstructive and nonobstructive coronary arteries. This study underscores the need for timely detection and treatment of nonobstructive disease, in addition to traditional risk factors.

Call to action for acute myocardial infarction in women: international multi-disciplinary practical roadmap

Cardiovascular diseases are the leading cause of death among women, and the incidence among younger women has shown the greatest increase over the last decades, in particular for acute myocardial infarction (AMI). Moreover, the prognosis of women post-AMI is poor when compared with men of similar ages. Since the 1990s, an abundant literature has highlighted the existing differences between sexes with regard to presentation, burden, and impact of traditional risk factors and of risk factors pertaining predominantly to women, the perception of risk by women and men, and the pathophysiological causations, their treatment, and prognosis. These data that have been accumulated over recent years highlight several targets for improvement. The objective of this collaborative work is to define the actions required to reverse the growing incidence of AMI in women and improve the patient pathway and care, as well as the prognosis. We aim to provide practical toolkits for different health professionals involved in the care of women, so that each step, from cardiovascular risk assessment to symptom recognition, to the AMI pathway and rehabilitation, thus facilitating that from prevention to intervention of AMI, can be optimized.

Characteristics of Young Women Presenting With Acute Myocardial Infarction: The Prospective, Multicenter, Observational Young Women Presenting Acute Myocardial Infarction in France Study

BACKGROUND

The percentage of women <50 years of age hospitalized with myocardial infarction is increasing. We describe the clinical, morphological, and biological characteristics, as well as the clinical outcomes of this population.

METHODS AND RESULTS

This prospective, observational study included consecutive women <50 years of age admitted for myocardial infarction at 30 centers in France (May 2017-June 2019). The primary outcome was the composite of net adverse clinical events: all-cause death, cardiovascular death, recurrent myocardial infarction, stent thrombosis, any stroke, or major bleeding occurring during hospitalization with a 12-month follow up. Three hundred fourteen women were included. The mean age was 43.0 (±5.7) years, 60.8% presented with ST-segment-elevation myocardial infarction, 75.5% were current smokers, 31.2% had a history of complicated pregnancy, and 55.1% reported recent emotional stress. Most (91.6%) women presented with typical chest pain. Of patients on an estrogen-containing contraceptive, 86.0% had at least 1 contraindication. Of patients with ST-segment-elevation myocardial infarction, 17.8% had myocardial infarction with nonobstructive coronary arteries and 14.6% had spontaneous coronary artery dissection, whereas 29.3% presented with multivessel vessel disease. During hospitalization, 11 net adverse clinical events occurred in 9 (2.8%) women, but no deaths or stent thromboses occurred. By 12 months, 14 net adverse clinical events occurred in 10 (3.2%) women; 2 (0.6%) died (from progressive cancer) and 25 (7.9%) had an ischemia-driven repeat percutaneous coronary intervention.

CONCLUSIONS

Most young women with myocardial infarction reported typical chest pain and had modifiable cardiovascular risk factors. History of adverse pregnancy outcomes and prescription of combined oral contraceptive despite a contraindication were prevalent, emphasizing the need for comprehensive cardiological and gynecological evaluation and follow-up.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03073447.

Young Women and Myocardial Infarction: Unveiling Clinical Patterns and Prognostic Outcomes

Background Myocardial infarction (MI) remains a critical emergency with an increasing incidence among young women exposed to various risk factors. Despite extensive data on MI, there is limited information on premature coronary artery disease in women under the age of 50 years. This study describes the clinical, paraclinical, and angiographic characteristics of MI in young women compared to older women and determines the prognosis. Methods This is a single-center retrospective study including women hospitalized between July 2019 and December 2021 in the cardiology department for the evaluation of MI. The population was divided into two groups based on age: women under 50 years, classified as young women, and those aged 50 years and above. A comparison was made between these two groups. Results A total of 197 women were included in our study. Forty-four women under 50 and 153 over 50 years were included. The mean age of young women was 44 ± 6 years. The main cardiovascular (CV) risk factors in young women were smoking (46%), hypertension (53%), diabetes (44%), and family history of coronary artery disease (21%). Autoimmune disease was present in 11%. Of the young women, 34% were admitted for ST-elevation myocardial infarction (STEMI), with 47% consulting late (>12 hours). The majority (91%) presented with typical chest pain. Monovessel disease was observed in 57% of young women. The left anterior descending artery was the most affected at 55%. Atherosclerosis was the most noted etiology (66%), followed by spontaneous coronary artery dissection (SCAD) (16%). The comparative study showed that young women had fewer overall CV risk factors but a higher prevalence of smoking, familial history of coronary artery disease, and autoimmune disease. Young women presented more frequently with non-ST elevation myocardial infarction (NSTEMI). Monovessel disease was more common, and they required less myocardial revascularization by percutaneous intervention. Young women presented more with SCAD and less with atherosclerotic MI. The in-hospital follow-up showed that young women experienced fewer major cardiac and cerebrovascular events (MACCE) compared to older women, with no in-hospital deaths recorded among young women. Long-term follow-up revealed a lower incidence of MACCE among young women (11% vs. 32.7% in older women) and a similar low mortality rate. Survival analysis showed that young women had a longer event-free survival time for MACCE (91.3 months) compared to older women (65.5 months). Conclusions The incidence of MI in young women is increasing. Smoking and hypertension are major risk factors. Hospital complications are rare, and prognosis is generally good, with low mortality rates.

Age and sex differences in the impact of common comorbidities on stroke and myocardial infarction: results from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project

OBJECTIVES

This study aims to evaluate the age- and sex-specific associations of comorbidities with stroke and MI and further calculate the population-attributable fractions (PAFs) of five comorbid diseases for stroke and myocardial infarction (MI) by age and sex.

STUDY DESIGN

This is a prospective cohort study.

METHODS

This study leveraged data from a sub-cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project. Participants aged 35-75 years without a prevalent stroke and MI were enrolled from January 2016 to December 2020, with follow-up through December 2021. Five common comorbidities were collected at baseline, and the study outcome was hospitalization for stroke and MI identified from the Inpatients Registry.

RESULTS

Of 100,873 participants, the mean age was 54.2 (±10.2) years, 34.2% were ≥60 years old, and 60.8% were women. After a median follow-up of 3.52 years, 4156 participants had stroke/MI. The strengths of the associations between hypertension, diabetes, and obesity with stroke/MI were higher in younger individuals than in seniors, and obesity had a more hazardous impact on stroke/MI in men than in women. The five comorbidities collectively explained a higher population attributable fraction (PAF) for stroke/MI in the young group (51.5[46.9, 55.7] %) than in the senior group (41.3[37.0, 45.4] %), in men (45.6[40.9, 49.9] %) than in women (41.1[36.1, 45.7] %).

CONCLUSIONS

Most of the common comorbidities were significantly associated with stroke and MI. Several age and sex differences in the impacts of comorbidities on stroke/MI were observed, highlighting the importance of age- and sex-specific preventive strategies to reduce premature stroke and MI.

Risk Factors, Use of Revascularization, and Outcomes in Young Adults With ST-Elevation Myocardial Infarction

The incidence of acute myocardial infarction is increasing in younger age groups, with differences in treatment and outcomes based on gender. ST-elevation myocardial infarction (STEMI) in young adults, however, is incompletely understood as most of the current studies were performed in homogenous populations, did not focus on STEMI, and lack direct comparisons with older adults. We performed a retrospective observational study using the Statewide Planning And Research Cooperative System for all admissions in New York State with a principal diagnosis of STEMI from 2011 to 2018. There were 58,083 STEMIs with the majority being male (68.2%) and non-Hispanic White (64.8%), with an average age of 63.9 ± 13.9 years. Of these, 8,494 (14.6%) occurred in patients aged <50 years. The proportion of STEMIs in women increased with age, from 19.2% in the <50-year-old age group to 48.9% in the ≥70-year-old age group. Young adults with STEMI had greater prevalence of obesity, current tobacco use, other substance use, and major psychiatric disorders, were more likely to receive revascularization, and had lower 1-year mortality than older age groups. Revascularization was associated with at least a 3 times lower odds ratio of 1-year mortality in all age groups. In conclusion, young adults with STEMI had a unique set of risk factors and co-morbidities and were more likely to undergo revascularization than older age groups. In all age groups, female gender was associated with a higher burden of co-morbidities, decreased use of revascularization, and increased 1-year mortality.

Lipoprotein Metabolism, Dyslipidemia, and Lipid-Lowering Therapy in Women: A Comprehensive Review

Lipid-lowering therapy (LLT) is a cornerstone of atherosclerotic cardiovascular disease prevention. Although LLT might lead to different reductions in low-density lipoprotein cholesterol (LDL-C) levels in women and men, LLT diminishes cardiovascular risk equally effectively in both sexes. Despite similar LLT efficacy, the use of high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors is lower in women compared to men. Women achieve the guideline-recommended LDL-C levels less often than men. Greater cholesterol burden is particularly prominent in women with familial hypercholesterolemia. In clinical practice, women and men with dyslipidemia present with different cardiovascular risk profiles and disease manifestations. The concentrations of LDL-C, lipoprotein(a), and other blood lipids differ between women and men over a lifetime. Dissimilar levels of LLT target molecules partially result from sex-specific hormonal and genetic determinants of lipoprotein metabolism. Hence, to evaluate a potential need for sex-specific LLT, this comprehensive review (i) describes the impact of sex on lipoprotein metabolism and lipid profile, (ii) highlights sex differences in cardiovascular risk among patients with dyslipidemia, (iii) presents recent, up-to-date clinical trial and real-world data on LLT efficacy and safety in women, and (iv) discusses the diverse medical needs of women and men with dyslipidemia and increased cardiovascular risk.

VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION REDUCES MYOCARDIAL AND MITOCHONDRIAL DAMAGE IN ACUTE MYOCARDIAL INFARCTION

ABSTRACT

Background: Myocardial infarction (MI) is a common cardiovascular disease with a high fatality rate once accompanied by cardiogenic shock. The efficacy of extracorporeal membrane oxygenation (ECMO) in treating MI is controversial. Methods: MI was induced by ligating the left anterior descending artery (LAD) in adult male rats. Groups were defined as follows: MI group, reperfusion for 90 min after 30 min of LAD occlusion; MI + ECMO group, reperfusion and ECMO were performed for 90 min immediately after 30 min of LAD occlusion; prolonged MI + ECMO group, ECMO was used immediately after 30 min of occlusion with persistent occlusion of the LAD for an additional 30 min, followed by 90 min of reperfusion. The myocardial infarct size and mitochondrial morphology and function data were collected and compared of each group. Results: The ECMO groups had a smaller myocardial infarct size and larger percentage ejection fraction. Compared with the prolonged MI + ECMO group, the immediate reperfusion group had a lower percentage of infarct size (63.28% vs. 17.97% vs. 31.22%, MI vs. MI + ECMO vs. prolonged MI + ECMO). Mitochondria isolated from the ischemic zone showed an intact mitochondrial structure, including fewer voids and broken cristae, and preserved activity of mitochondrial complex II and complex IV in ECMO groups. Conclusions: ECMO support in MI can reduce myocardial injury despite delayed coronary reperfusion.

Sex in cardiovascular disease: Why this biological variable should be considered in in vitro models

Cardiovascular disease (CVD), the world's leading cause of death, exhibits notable epidemiological, clinical, and pathophysiological differences between sexes. Many such differences can be linked back to cardiovascular sexual dimorphism, yet sex-specific in vitro models are still not the norm. A lack of sex reporting and apparent male bias raises the question of whether in vitro CVD models faithfully recapitulate the biology of intended treatment recipients. To ensure equitable treatment for the overlooked female patient population, sex as a biological variable (SABV) inclusion must become commonplace in CVD preclinical research. Here, we discuss the role of sex in CVD and underlying cardiovascular (patho)physiology. We review shortcomings in current SABV practices, describe the relevance of sex, and highlight emerging strategies for SABV inclusion in three major in vitro model types: primary cell, stem cell, and three-dimensional models. Last, we identify key barriers to inclusive design and suggest techniques for overcoming them.

Risk factors for incident cardiovascular events and their population attributable fractions in rural India: The Rishi Valley Prospective Cohort Study

OBJECTIVE

We prospectively determined incident cardiovascular events and their association with risk factors in rural India.

METHODS

We followed up with 7935 adults from the Rishi Valley Prospective Cohort Study to identify incident cardiovascular events. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) with 95% confidence intervals (95% CI) for associations between potential risk factors and cardiovascular events. Population attributable fractions (PAFs) for risk factors were estimated using R ('averisk' package).

RESULTS

Of the 4809 participants without prior cardiovascular disease, 57.7% were women and baseline mean age was 45.3 years. At follow-up (median of 4.9 years, 23,180 person-years [PYs]), 202 participants developed cardiovascular events, equating to an incidence of 8.7 cardiovascular events/1000 PYs. Incidence was greater in those with hypertension (hazard ratio [HR] [95% CI] 1.73 [1.21-2.49], adjusted PAF 18%), diabetes (1.96 [1.15-3.36], 4%) or central obesity (1.77 [1.23, 2.54], 9%) which together accounted for 31% of the PAF. Non-traditional risk factors such as night sleeping hours and number of children accounted for 16% of the PAF.

CONCLUSIONS

Both traditional and non-traditional cardiovascular risk factors are important contributors to incident cardiovascular events in rural India. Interventions targeted to these factors could assist in reducing the incidence of cardiovascular events.

Gender Differences in Trends in Incidence and Mortality of Acute Myocardial Infarction in the Small Island Developing State of Barbados

Objective To determine trends, identify predictors of acute myocardial infarction (AMI) incidence and mortality, and explore performance metrics for AMI care in Barbados. Methods Data on all cases diagnosed with AMI were collected by the Barbados National Registry for Non-Communicable Diseases (BNR) from the island's only tertiary hospital, the Queen Elizabeth Hospital, and the National Vital Registration Department. Participants who survived hospital admission were then followed up at 28 days and one year post event via telephone survey and retrieval of death certificates. Age-standardized incidence and mortality rates were calculated. Determinants of mortality at 28 days were examined in multivariable logistic regression models. Median and interquartile ranges (IQR) were calculated for performance metrics (e.g., time from pain onset to reperfusion). Results In a 10-year period between 2010 and 2019, 4,065 cases of myocardial infarction were recorded. The median age of the sample was 73 years (IQR: 61,83), and approximately half (47%) were female. Over a 10-year period, standardized incidence increased in women on average yearly by three per 100,000 (95% CI: 1 to 6; p=0.02), while in men, the average increase per year was six per 100,000 (95% CI: 4 to 8; p<0.001). There was no increase in 28-day mortality in women; mortality in men increased each year by 2.5 per 100,000 (95% CI: 0.4 to 4.5; p=0.02). The time from arrival at the hospital to the ECG was 44 minutes IQR (20,113). Conclusion AMI incidence and mortality are increasing in Barbados, and men have a higher velocity of mortality rate increase than women, which contradicts global data.

Impact of subcutaneous belimumab on disease activity, patient satisfaction, and metabolic profile in long-lasting systemic lupus erythematosus

OBJECTIVE

Atherosclerosis is a major complication of systemic lupus erythematosus (SLE) and is exacerbated by the disease itself, drug toxicity, and metabolic syndrome. Although belimumab (BEL) can ameliorate disease activity and reduce prednisolone (PSL) dose in SLE, its effect on metabolic profiles is obscure. We aimed to assess the effects of subcutaneous BEL on disease activity and metabolic profiles.

METHODS

A total of 106 patients with SLE who received subcutaneous BEL were included, and 76 patients who started BEL treatment at least 1 year prior were evaluated. Clinical information, including retention rate, disease activity, renal outcome, patient satisfaction, and metabolic profiles, were retrospectively analysed.

RESULTS

The retention rate of BEL was > 80% after 2 years, and ineffectiveness and pain were the major reasons for discontinuation of BEL treatment. Satisfaction with side effects was higher in the BEL group than that in the PSL group. Belimumab significantly improved disease activity, lupus nephritis, and PSL dosage, with a median reduction of 4 mg/day. These effects were observed in active disease and positive C1q-binding immune complex, and PSL reduction ≥ 5 mg was achievable in such cases. Patients with PSL reduction of ≥ 5 mg showed significantly lower blood low-density lipoprotein and triglyceride by 13 and 17 mg/dL, respectively, while those with PSL reduction of < 5 mg remained unaltered.

CONCLUSION

Subcutaneous BEL was effective in improving disease activity and proteinuria in patients with chronic disease while reducing PSL. Reduction in PSL by BEL also improved lipid status, which could synergistically reduce cardiovascular risk in SLE. Key Points • Significant reduction of disease activity, proteinuria, and prednisolone was observed in patients using subcutaneous belimumab. • Patient satisfaction was higher in terms of side effects in subcutaneous belimumab compared with prednisolone. • Reduction in prednisolone by belimumab contributed to the improvement of lipid status and would reduce the cardiovascular risk.

Sex-based differences in risk factors for incident myocardial infarction and stroke in the UK Biobank

AIM

This study examined sex-based differences in associations of vascular risk factors with incident cardiovascular events in the UK Biobank.

METHODS

Baseline participant demographic, clinical, laboratory, anthropometric, and imaging characteristics were collected. Multivariable Cox regression was used to estimate independent associations of vascular risk factors with incident myocardial infarction (MI) and ischaemic stroke for men and women. Women-to-men ratios of hazard ratios (RHRs), and related 95% confidence intervals, represent the relative effect-size magnitude by sex.

RESULTS

Among the 363 313 participants (53.5% women), 8470 experienced MI (29.9% women) and 7705 experienced stroke (40.1% women) over 12.66 [11.93, 13.38] years of prospective follow-up. Men had greater risk factor burden and higher arterial stiffness index at baseline. Women had greater age-related decline in aortic distensibility. Older age [RHR: 1.02 (1.01-1.03)], greater deprivation [RHR: 1.02 (1.00-1.03)], hypertension [RHR: 1.14 (1.02-1.27)], and current smoking [RHR: 1.45 (1.27-1.66)] were associated with a greater excess risk of MI in women than men. Low-density lipoprotein cholesterol was associated with excess MI risk in men [RHR: 0.90 (0.84-0.95)] and apolipoprotein A (ApoA) was less protective for MI in women [RHR: 1.65 (1.01-2.71)]. Older age was associated with excess risk of stroke [RHR: 1.01 (1.00-1.02)] and ApoA was less protective for stroke in women [RHR: 2.55 (1.58-4.14)].

CONCLUSION

Older age, hypertension, and smoking appeared stronger drivers of cardiovascular disease in women, whereas lipid metrics appeared stronger risk determinants for men. These findings highlight the importance of sex-specific preventive strategies and suggest priority targets for intervention in men and women.

Development and Validation of the American Heart Association's PREVENT Equations

BACKGROUND

Multivariable equations are recommended by primary prevention guidelines to assess absolute risk of cardiovascular disease (CVD). However, current equations have several limitations. Therefore, we developed and validated the American Heart Association Predicting Risk of CVD EVENTs (PREVENT) equations among US adults 30 to 79 years of age without known CVD.

METHODS

The derivation sample included individual-level participant data from 25 data sets (N=3 281 919) between 1992 and 2017. The primary outcome was CVD (atherosclerotic CVD and heart failure). Predictors included traditional risk factors (smoking status, systolic blood pressure, cholesterol, antihypertensive or statin use, and diabetes) and estimated glomerular filtration rate. Models were sex-specific, race-free, developed on the age scale, and adjusted for competing risk of non-CVD death. Analyses were conducted in each data set and meta-analyzed. Discrimination was assessed using the Harrell C-statistic. Calibration was calculated as the slope of the observed versus predicted risk by decile. Additional equations to predict each CVD subtype (atherosclerotic CVD and heart failure) and include optional predictors (urine albumin-to-creatinine ratio and hemoglobin A1c), and social deprivation index were also developed. External validation was performed in 3 330 085 participants from 21 additional data sets.

RESULTS

Among 6 612 004 adults included, mean±SD age was 53±12 years, and 56% were women. Over a mean±SD follow-up of 4.8±3.1 years, there were 211 515 incident total CVD events. The median C-statistics in external validation for CVD were 0.794 (interquartile interval, 0.763-0.809) in female and 0.757 (0.727-0.778) in male participants. The calibration slopes were 1.03 (interquartile interval, 0.81-1.16) and 0.94 (0.81-1.13) among female and male participants, respectively. Similar estimates for discrimination and calibration were observed for atherosclerotic CVD- and heart failure-specific models. The improvement in discrimination was small but statistically significant when urine albumin-to-creatinine ratio, hemoglobin A1c, and social deprivation index were added together to the base model to total CVD (ΔC-statistic [interquartile interval] 0.004 [0.004-0.005] and 0.005 [0.004-0.007] among female and male participants, respectively). Calibration improved significantly when the urine albumin-to-creatinine ratio was added to the base model among those with marked albuminuria (>300 mg/g; 1.05 [0.84-1.20] versus 1.39 [1.14-1.65]; P=0.01).

CONCLUSIONS

PREVENT equations accurately and precisely predicted risk for incident CVD and CVD subtypes in a large, diverse, and contemporary sample of US adults by using routinely available clinical variables.

Long-term prognostic importance of high levels of sST2 in patient with AMI: a meta-analysis

OBJECTIVE

This meta-study aimed to assess the connection between soluble suppression of tumorigenicity 2 (sST2) and extended clinical outcomes in individuals diagnosed with acute myocardial infarction (AMI).

METHODS

We systematically collected pertinent literature from PubMed, Embase and Web of Science. The primary effect measures employed in this research were the hazard ratio and 95% confidence intervals. The quality and publication bias of included studies were evaluated. Subgroup analysis was conducted to explore the diversity in study outcomes.

RESULTS

This comprehensive meta-analysis ultimately encompassed thirteen studies, involving a total of 11,571 patients. Elevated levels of sST2 were identified as an adverse prognostic indicator, demonstrating a substantial association not only with overall mortality (combined HR 2.4, 95% CI 1.6-3.5, P < 0.01) but also with major adverse cardiovascular events (MACEs) (HR 2.5, 95% CI 1.5-4.2, P < 0.01). Subgroup analyses revealed that increased sST2 levels were linked to higher rates of all-cause mortality and MACEs in patients with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and other unselected subcategories of AMI.

CONCLUSION

Increased sST2 could predict the long-term prognosis in patients suffering from AMI.

Association between Psychiatric Disorders and the Incidence of Heart Failure in Women

BACKGROUND

Depression and anxiety occur more frequently in women and are associated with an increased risk of cardiovascular disease.

OBJECTIVES

Data on the association between these psychiatric conditions and the incidence of acute heart failure (HF) and how they influence heart failure outcomes in women are lacking. We investigated this potential relationship using data from the National Inpatient Sample.

METHODS

We used ICD-10 codes to extract encounters for acute heart failure and/or the acute exacerbation of chronic heart failure, anxiety, and depression from the discharge data of the NIS from 2019 to 2020. We compared baseline characteristics and length of stay (LOS), cost of care (COC) and acute HF by depression/anxiety status for males and females and employed regression models to assess the influence of these psychiatric conditions on the outcomes.

RESULTS

There were 6,394,136 encounters involving females, which represented 56.6% of the sample. The prevalence of depression and anxiety were 15.7% and 16.8%, respectively. Among females, the occurrence of acute CHF did not differ by depression or anxiety status. However, Takostubo cardiomyopathy was more prevalent in those with depression (0.3% vs. 0.2%, p = 0.003) and anxiety (0.3% vs. 0.2%, p = 0.03) compared to those without these conditions. Among those with depression, LOS was significantly longer (3 days IQR: 2-6, vs. 3 days IQR:2-5 days, p < 0.001). The COC was USD 1481 more in patients with depression. On the contrary, LOS and COC were significantly lower in those without anxiety.

CONCLUSIONS

Depression was associated with an increased LOS among both men and women and an increased cost of care among women. Anxiety was associated with a decreased LOS and cost of care among women, which may be related to an increased rate of against medical advice (AMA) discharges among this population. Further research is necessary to identify optimal management strategies for depression and anxiety among patients hospitalized with HF.

[Benefits of an observatory for myocardial infarction in women under 50 : The WAMIF study]

The WAMIF study was conducted from 2017 to 2019 to include 314 patients in 30 French investigative centers in France. We have systematically collected the clinical, morphological and biological characteristics of cases of myocardial infarction affecting women under 50 years of age and evaluated their short-term (intra-hospital) and mid-term (at 12 months) prognosis. . The main results were: a particularly high incidence of modifiable risk factors affecting 86% of patients with smoking in the first place in 75% of them. The clinical presentation revealed chest pain in more than 90% of cases. The pathophysiological forms of acute coronary syndrome identified the culprit artery in 90% of cases, MI without obstruction (MINOCA) was found in 17.8% of the ST elevation MI (STEMI), spontaneous dissection in 14.6% of STEMI and 16.3% of NSTEMI. Hospital events included 3 strokes, 3 cases of bleeding and no deaths. At 12 months, follow-up showed no cardiovascular deaths. The results of this study allow us to better understand the particularities of cardiovascular diseases in women and thus to develop targeted strategies for prevention and improvement of their management.

Effect of Comprehensive Psychological Intervention on Negative Emotions and Quality of Life in Patients with Acute Myocardial Infarction

Although acute myocardial infarction (AMI) currently has a high survival rate, the treatment and prognosis are still diffuse negative life events for patients, which will affect their quality of life (QOL) and psychological health. Based on an integrated physiological-psychological-social-medical model, it is necessary to design an intervention program for safeguarding the physical and mental health of AMI patients.This study aimed to explore the influence of psychological intervention on negative emotions and QOL of AMI patients using a randomized controlled trial (RCT) design.Based on convenience sampling and double-blinded group assignment, 101 patients from August 2019 to January 2020 were randomly divided into 2 groups. An intervention group received comprehensive psychological intervention, while a control group received general supportive nursing. Both groups answered questionnaires before and after the intervention, including assessments of anxiety, depression, and QOL.Before the intervention, there were no significant differences between the groups. After intervention, anxiety and depression in the intervention group (n = 48) were significantly lower (P < 0.001) and QOL was markedly improved (P < 0.05) compared to that of the control group (n = 53).Comprehensive psychological intervention contributed to ameliorate negative emotions, enhance confidence in treatment, and improve the QOL of AMI patients.

Correlation between dietary inflammation and mortality among hyperlipidemics

BACKGROUND AND OBJECTIVE

Although the the Dietary Inflammatory Index (DII) serves to be one of the reliable indicator for hyperlipidaemia, there is still uncertainty about its relationship to prognosis in the hyperlipidaemic population. In current study, the DII levels were analyzed in relation to the mortality risk among among the hyperlipidaemic individuals with the aim of determining any prospective correlation.

METHODS

14,460 subjects with hyperlipidaemia from the 10-year (2001-2010) National Health and Nutrition Examination Survey (NHANES) were chosen for this study. The endpoint event for follow-up was all-cause mortality, and subjects were tracked for up to December 31, 2019, or death, whichever occurred first. The tertiles of the DII levels were utilized for categorizing the study population into three groups. Survival curves, Cox proportional hazards regression models, restricted cubic spline (RCS), subgroup and interaction analyses, and sensitivity analyses were employed sequentially for the purpose of evaluating the association of the DII with mortality.

RESULTS

3170 (21.92%) all-cause deaths were recorded during an average 148-month follow-up period. Kaplan-Meier survival curves indicated that the survival rate of participants divided into the low DII group was substantially improved compared to that of those in the higher DII group (log-rank P < 0.001). After controlling for confounders, higher levels of DII were observed to be meaningfully linked to an elevated risk of death, no matter whether DII was specified for the continuous (hazard ratio (HR): 1.06; 95% confidence interval (CI): 1.04-1.08) or the categorical variable (HR: 1.22; 95% CI: 1.11-1.33). The DII and mortality displayed a linear association, according to the RCS. Stratified and sensitivity analyses reinforced the proof that these findings were reliable.

CONCLUSION

Among patients with hyperlipidaemia, the risk of death was positively and linearly linked with DII levels.

First myocardial infarction in patients with premature coronary artery disease: insights into patient characteristics and outcome after treatment with contemporary stents

AIMS

Patients with premature coronary artery disease (CAD) have a higher incidence of myocardial infarction (MI) than patients with non-premature CAD. The aim of the present study is to asess differences in clinical outcome after a first acute MI, percutaneously treated with new-generation drug-eluting stents between patients with premature and non-premature CAD.

METHODS AND RESULTS

We pooled and analysed the characteristics and clinical outcome of all patients with a first MI (and no previous coronary revascularization) at time of enrolment, in four large-scale drug-eluting stent trials. Coronary artery disease was classified premature in men aged <50 and women <55 years. Myocardial infarction patients with premature and non-premature CAD were compared. The main endpoint was major adverse cardiac events (MACE): all-cause mortality, any MI, emergent coronary artery bypass surgery, or clinically indicated target lesion revascularization. Of 3323 patients with a first MI, 582 (17.5%) had premature CAD. These patients had lower risk profiles and underwent less complex interventional procedures than patients with non-premature CAD. At 30-day follow-up, the rates of MACE [hazard ratio (HR): 0.22, 95% confidence interval (CI): 0.07-0.71; P = 0.005), MI (HR: 0.22, 95% CI: 0.05-0.89; P = 0.020), and target vessel failure (HR: 0.30, 95% CI: 0.11-0.82; P = 0.012) were lower in patients with premature CAD. At 1 year, premature CAD was independently associated with lower rates of MACE (adjusted HR: 0.50, 95% CI: 0.26-0.96; P = 0.037) and all-cause mortality (adjusted HR: 0.24, 95% CI: 0.06-0.98; P = 0.046). At 2 years, premature CAD was independently associated with lower mortality (adjusted HR: 0.16, 95% CI: 0.05-0.50; P = 0.002).

CONCLUSIONS

First MI patients with premature CAD, treated with contemporary stents, showed lower rates of MACE and all-cause mortality than patients with non-premature CAD, which is most likely related to differences in cardiovascular risk profile. TWENTE trials: TWENTE I, clinicaltrials.gov: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).

Age and gender-based categorization of very premature, premature, and non-premature acute myocardial infarction: A comparison of clinical and angiographic profile and in-hospital outcomes

BACKGROUND

In this study, we aimed to assess and compare the distribution of demographic and clinical characteristics and composite adverse clinical outcomes after primary percutaneous coronary intervention (PCI) among "very premature", "premature", and "non-premature" patients with "ST-segment elevation acute coronary syndrome (STE-ACS)" presented at a tertiary care center.

METHODS

We included consecutive patients diagnosed with STE-ACS undergoing primary PCI. The "very premature" was defined as ≤40 years for males and ≤ 45 years for females, "premature" as <55 years for males and < 65 years for females, and "non-premature" as ≥55 years for males and ≥ 65 years for females. Clinical characteristics, angiographic patterns, and hospital course were compared among the three groups.

RESULTS

In a sample of 4686 patients, 78.8%(3691) were male, and the average age was 55.6 ± 11 years. In total, 12%(561) were categorized as very premature, 38.3%(1797) as premature, and 49.7%(2328) as non-premature. The distribution of clinical characteristics in very premature, premature, and non-premature groups were as follows; hypertension in 44.6% vs. 53.5% vs. 54.9%; p < 0.001, diabetes in 30.3% vs. 36.8% vs. 35.5%; p = 0.018, smoking in 29.6% vs. 23.3% vs. 26.3%; p = 0.005, obesity in 19.4% vs. 18.4% vs. 15.3%; p = 0.008, single vessel diseases in 58.8% vs. 37.8% vs. 28.8%; p < 0.001, and composite adverse clinical outcomes in 14.1% vs. 16.7% vs. 21.8%; p < 0.001, respectively.

CONCLUSION

In conclusion, we have a substantial burden of premature STE-ACS. Very premature STE-ACS was found to be associated with a better prognosis, but a substantial burden of composite adverse clinical outcomes was also observed.

Sex Moderates the Relationship Between Social Support and Cardiovascular Prevention Behaviors in Middle-aged and Older Adults

BACKGROUND

Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women.

PURPOSE

We investigated whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample.

METHODS

Participants were 17,287 adults (n = 10,264 middle-aged adults 40-64 years old and n = 7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity.

RESULTS

Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged men (screening: B = 0.13, 95% CI [0.06-0.20], p < .001; behaviors: B = 0.33 [0.26-0.41], p < .001) and older men (screening: B = 0.10 [0.04-0.17], p = .001; behaviors: B = 0.16 [0.08-0.25], p < .001), whereas older women had comparatively high adherence, which was unrelated to social support (screening: B = 0.02 [-0.03 to 0.08], p = .433; behaviors: B = 0.03 [-0.03 to 0.10], p = .342).

CONCLUSIONS

Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.

Impact of premature coronary artery disease on adverse event risk following first percutaneous coronary intervention

Objectives

We assessed differences in risk profile and 3-year outcome between patients undergoing percutaneous coronary intervention (PCI) for premature and non-premature coronary artery disease (CAD).

Background

The prevalence of CAD increases with age, yet some individuals develop obstructive CAD at younger age.

Methods

Among participants in four randomized all-comers PCI trials, without previous coronary revascularization or myocardial infarction (MI), we compared patients with premature (men <50 years; women <55 years) and non-premature CAD. Various clinical endpoints were assessed, including multivariate analyses.

Results

Of 6,171 patients, 887 (14.4%) suffered from premature CAD. These patients had fewer risk factors than patients with non-premature CAD, but were more often smokers (60.7% vs. 26.4%) and overweight (76.2% vs. 69.8%). In addition, premature CAD patients presented more often with ST-segment elevation MI and underwent less often treatment of multiple vessels, and calcified or bifurcated lesions. Furthermore, premature CAD patients had a lower all-cause mortality risk (adj.HR: 0.23, 95%-CI: 0.10-0.52; p < 0.001), but target vessel revascularization (adj.HR: 1.63, 95%-CI: 1.18-2.26; p = 0.003) and definite stent thrombosis risks (adj.HR: 2.24, 95%-CI: 1.06-4.72; p = 0.034) were higher. MACE rates showed no statistically significant difference (6.6% vs. 9.4%; adj.HR: 0.86, 95%-CI: 0.65-1.16; p = 0.33).

Conclusions

About one out of seven PCI patients was treated for premature CAD. These patients had less complex risk profiles than patients with non-premature CAD; yet, their risk of repeated revascularization and stent thrombosis was higher. As lifetime event risk of patients with premature CAD is known to be particularly high, further efforts should be made to improve modifiable risk factors such as smoking and overweight.

TWENTE trials

(TWENTE I, clinicaltrials.gov: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).

Clinical presentation and angiographic findings of acute myocardial infarction in young adults in Jazan region

BACKGROUND

There is a paucity of information about the clinical features and angiographic findings in young patients with acute myocardial infarction (MI), especially in the Arab Peninsula countries.

OBJECTIVE

The aim of this study was to assess the proposed risk factors, clinical presentation, and angiographic findings of acute myocardial infarction in young adults.

METHODS

This prospective study included young (range, 18 to 45 years) patients who presented with acute MI based on clinical evaluation, laboratory investigation, and electrocardiogram, and they underwent a coronary angiography procedure.

KEY FINDINGS

Data of 109 patients with a diagnosis of acute MI were collected. Patients' mean age was 39.98 ± 7.52 years (range, 31 to 45 years), and 92.7% (101) were male. Smoking was the highest risk factor in 67% of patients, obesity and overweight in 66%, sedentary lifestyle in 64%, dyslipidaemia in 33%, and hypertension in 28%. Smoking was the most common risk factor for acute MI in males (p = 0.009), whereas sedentary lifestyle was the most common risk factor in females (p = 0.028). Chest pain typical of acute MI was the most common presenting symptom in 96% of patients (p < 0.001). On admission, 96% of patients were conscious, and 95% were oriented. On angiography, the left anterior descending artery (LAD) was affected in 57%, the right coronary artery (RCA) was affected in 42%, and the left circumflex artery (LCX) was affected in 32% of patients. The LAD was severely affected in 44%, the RCA was severely affected in 25.7%, and the LCX was severely affected in 19.26% of patients (p < 0.001).

CONCLUSION

Smoking, obesity, sedentary lifestyle, dyslipidaemia, and hypertension were the most common risk factors for acute MI. Smoking was the most common risk factor in males and sedentary lifestyle in females. The LAD was the most commonly affected coronary artery, followed by the RCA and LCX arteries, with the same order for severity of stenosis.

An In-Depth Prospective Comprehensive View on Myocardial Infarction (MI) in Young Adults

Due to major advancements in myocardial infarction (MI) prevention and effective medical treatment, the death rate and incidence of MI have dropped considerably. We know that their risk factors and prognosis may differ; therefore, increasing primary and secondary prevention activities among young people is crucial. Multiple studies have found that MI is the deadliest form of coronary heart disease (CHD). As a result, we made an effort to illuminate MI in young people in our review of the literature. We found that young people, particularly women, are developing MI. Smoking is a key risk factor that should be targeted in an effort to minimize youth MI rates. It is thus important to create superior methods for measuring risk in young people, which may combine both standard and nonconventional risk factors, such as genetic rate scores and coronary artery calcium testing. Henceforth, addressing modifiable risk factors at a younger age has the greatest impact.

Abnormalities of glucose and lipid metabolism in myocardial ischemia-reperfusion injury

Myocardial ischemia-reperfusion injury is a common condition in cardiovascular diseases, and the mechanism of its occurrence involves multiple complex metabolic pathways and signaling pathways. Among these pathways, glucose metabolism and lipid metabolism play important roles in regulating myocardial energy metabolism. Therefore, this article focuses on the roles of glucose metabolism and lipid metabolism in myocardial ischemia-reperfusion injury, including glycolysis, glucose uptake and transport, glycogen metabolism and the pentose phosphate pathway; and triglyceride metabolism, fatty acid uptake and transport, phospholipid metabolism, lipoprotein metabolism, and cholesterol metabolism. Finally, due to the different alterations and development of glucose metabolism and lipid metabolism in myocardial ischemia-reperfusion, there are also complex interregulatory relationships between them. In the future, modulating the equilibrium between glucose metabolism and lipid metabolism in cardiomyocytes and ameliorating aberrations in myocardial energy metabolism represent highly promising novel strategies for addressing myocardial ischemia-reperfusion injury. Therefore, a comprehensive exploration of glycolipid metabolism can offer novel theoretical and clinical insights into the prevention and treatment of myocardial ischemia-reperfusion injury.

Bardoxolone Methyl Ameliorates Myocardial Ischemia/Reperfusion Injury by Activating the Nrf2/HO-1 Signaling Pathway

Background

Myocardial ischemia/reperfusion (I/R) injury is a severe heart problem resulting from restoring coronary blood flow to the myocardium after ischemia. This study is aimed at ascertaining the therapeutic efficiency and action mechanism of bardoxolone methyl (BARD) in myocardial I/R injury.

Methods

In male rats, myocardial ischemia was performed for 0.5 h, and then, reperfusion lasted for 24 h. BARD was administrated in the treatment group. The animal's cardiac function was measured. Myocardial I/R injury serum markers were detected via ELISA. The 2,3,5-triphenyltetrazolium chloride (TTC) staining was used to estimate the infarction. H&E staining was used to evaluate the cardiomyocyte damage, and Masson trichrome staining was used to observe the proliferation of collagen fiber. The apoptotic level was assessed via the caspase-3 immunochemistry and TUNEL staining. Oxidative stress was measured through malondialdehyde, 8-hydroxy-2'-deoxyguanosine, superoxide dismutase, and inducible nitric oxide synthases. The alteration of the Nrf2/HO-1 pathway was confirmed via western blot, immunochemistry, and PCR analysis.

Results

The protective effect of BARD on myocardial I/R injury was observed. In detail, BARD decreased cardiac injuries, reduced cardiomyocyte apoptosis, and inhibited oxidative stress. For mechanisms, BARD treatment significantly activates the Nrf2/HO-1 pathway.

Conclusion

BARD ameliorates myocardial I/R injury by inhibiting oxidative stress and cardiomyocyte apoptosis via activating the Nrf2/HO-1 pathway.

Sex Differences in Adiposity and Cardiovascular Diseases

Body fat distribution is a well-established predictor of adverse medical outcomes, independent of overall adiposity. Studying body fat distribution sheds insights into the causes of obesity and provides valuable information about the development of various comorbidities. Compared to total adiposity, body fat distribution is more closely associated with risks of cardiovascular diseases. The present review specifically focuses on the sexual dimorphism in body fat distribution, the biological clues, as well as the genetic traits that are distinct from overall obesity. Understanding the sex determinations on body fat distribution and adiposity will aid in the improvement of the prevention and treatment of cardiovascular diseases (CVD).