Increase In Risk Of Acute Myocardial Infarction Research Articles

Abstract 12358: Epidemiology of Acute Myocardial infarction in Systemic Sclerosis: Incidence and Outcomes

Introduction: Risk of acute myocardial infarction (AMI) in inflammatory arthritides like rheumatoid arthritis (RA) is elevated. However, in autoimmune disorders with microvascular dysfunction, like systemic sclerosis (SS), the risk of AMI and its outcomes are not known. Methods: In the National Inpatient Sample (2003-2012), we used ICD9 codes to identify patients (≥18 years) with a primary diagnosis of AMI and a concurrent diagnosis of SS. We estimated population of SS at risk for AMI during each year by multiplying the previously reported stable SS prevalence of 276/million by the US adult population for the corresponding year. We used survey-analysis to generate national estimates for incident AMI and calculated incidence of AMI among SS patients by dividing the number of AMI patients during each year by the at-risk SS population. Characteristics and outcomes of AMI in SS were compared to those with RA and those without rheumatologic disease. Results: During 2003-2012, there were 4570 admissions for AMI in patients with SS in the US for an average of 63,121 at-risk SS patients each year. The incidence of AMI in patients with SS was 721/100,000 at-risk SS patients, which is 3-fold higher compared to incidence of AMI in the general population and remained elevated during 2003-12 (Figure). AMI patients with SS were younger, more likely to be female but were less likely to present as STEMI compared to RA or those with no rheumatologic disease (Table). They were also less likely to undergo PCI than either group. In-hospital AMI mortality in SS was higher than RA or those without rheumatologic disease (risk-adjusted odds ratio 1.65, 95%CI 1.28, 2.11, Table). Conclusions: There is a three-fold increase in risk of AMI in SS compared to the general population. Among AMI patients, in-hospital mortality is significantly higher in SS patients, compared to patients with RA or without rheumatologic disease. Further investigation is warranted to further assess measures to mitigate this risk.

The Co-Existence of the IL-18+183 A/G and MMP-9 -1562 C/T Polymorphisms Is Associated with Clinical Events in Coronary Artery Disease Patients

ObjectiveInterleukin (IL)-18 has been associated with severity of atherosclerosis and discussed to predict cardiovascular (CV) events. We have previously shown that the IL-18+183 G-allele significantly reduces IL-18 levels. This study was aimed to investigate the prognostic significance of the IL-18+183 A/G polymorphism (rs5744292), single and in coexistence with the matrix metalloproteinase (MMP)-9 -1562 C/T (rs3918242) polymorphism, in patients with stable coronary artery disease (CAD). Serum levels of IL-18, MMP-9 and tissue inhibitor of matrix metalloproteinase (TIMP)-1 were additionally assessed.Methods1001 patients with angiographically verified CAD were genotyped and the biomarkers were measured accordingly. After two years follow-up, 10.6% experienced new clinical events; acute myocardial infarction (AMI), stroke, unstable angina pectoris and death.ResultsThe IL-18+183 G-allele associated with 35% risk reduction in composite endpoints after adjusting for potential covariates (p = 0.044). The IL-18+183 AA/MMP-9 -1562 CT/TT combined genotypes associated with a significant increase in risk of composite endpoints (OR = 1.87; 95% CI = 1.13–3.11, p = 0.015, adjusted). Patients with clinical events presented with significantly higher IL-18 levels as compared to patients without (p = 0.011, adjusted). The upper tertile of IL-18 levels associated with an increase in risk of AMI as compared to lower tertiles (OR = 2.36; 95% CI = 1.20–4.64, p = 0.013, adjusted).ConclusionThe IL-18+183 A/G polymorphism, single and in combination with MMP-9 genotypes, may influence the risk of clinical events in stable CAD patients.

Insomnia and the Risk of Acute Myocardial Infarction

Background— Few prospective studies have investigated insomnia in relation to risk for coronary heart disease. We assessed insomnia symptoms and risk of acute myocardial infarction (AMI) in a large, population-based study. Methods and Results— A total of 52 610 men and women were followed up for a first AMI, and 2368 incident AMIs occurred during 11.4 years of follow-up, either identified at hospitals or by the National Cause of Death Registry. In our analyses, we adjusted for age, sex, marital status, education, shift work, blood pressure, lipids, diabetes mellitus, body mass index, physical activity, smoking, and alcohol consumption. Difficulties initiating and maintaining sleep and having a feeling of nonrestorative sleep were associated with a moderate increase in AMI risk. The multiadjusted hazard ratios for AMI were 1.45 (95% confidence interval 1.18–1.80) for people with difficulties initiating sleep almost every night, 1.30 (1.01–1.68) for those with difficulties maintaining sleep almost every night, and 1.27 (1.03–1.57) for those with a feeling of nonrestorative sleep more than once a week compared with people who never experienced these sleep difficulties. When we combined the symptoms, a dose-dependent association was seen between the number of insomnia symptoms and AMI risk ( P for trend 0.003). Alternative multivariable models and different sensitivity analyses suggest that the results were robust, especially concerning difficulties initiating sleep. Conclusions— Insomnia is associated with a moderately increased risk for AMI.

Statin discontinuation and risk of acute myocardial infarction in patients with rheumatoid arthritis: a population-based cohort study

ObjectivesScreening for cardiovascular risk factors and treating hyperlipidaemia with statins are recommended to reduce the increased cardiovascular risk in individuals with rheumatoid arthritis (RA). However, poor compliance with statins may...

Estimated Personal Soot Exposure Is Associated With Acute Myocardial Infarction Onset in a Case-Crossover Study

The current study investigates the association of estimated personal exposure to traffic-related air pollution and acute myocardial infarction (AMI). Cases of AMI were interviewed in the Augsburg KORA Myocardial Infarction Registry from February 1999 through December 2003, and 960 AMI survivors were included in the analyses. The time-varying component of daily personal soot exposure (the temporally variable contribution due to the daily area level of exposure and daily personal activities) was estimated using a linear combination of estimated mean ambient soot concentration, time spent outdoors, and time spent in traffic. The association of soot exposure with AMI onset was estimated in a case-crossover analysis controlling for temperature and day of the week using conditional logistic regression analyses. Estimated personal soot exposure was associated with AMI (relative risk, 1.30 per 1.1 m −1 × 10 −5 [95% confidence interval, 1.09-1.55]). Estimated ambient soot and measured ambient PM 2.5 particulate matter 2.5 µm and smaller in aerodynamic diameter were not significantly associated with AMI onset. Our results suggest that an increase in risk of AMI in association with personal soot exposure may be in great part due to the contribution of personal soot from individual times spent in traffic and individual times spent outdoors. As a consequence, estimates calculated based on measurements at urban background stations may be underestimations. Health effects of traffic-related air pollution may need to be updated, taking into account individual time spent in traffic and outdoors, to adequately protect the public.

Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417 734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS)

Few studies have simultaneously analysed the influence of elevated serum uric acid (UA) on acute myocardial infarction (AMI), ischaemic and haemorrhagic stroke (IS, HS) and congestive heart failure (CHF) in large healthy populations. We, here, examine UA as a risk factor for AMI, stroke and CHF by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study. Prospective study (11.8 years, range 7-17) of fatal and nonfatal acute myocardial infarction, stroke and CHF through linkage with Swedish hospital discharge and mortality registers. Measurements of uric acid in 417,734 men and women from health check-ups in Stockholm area. There was a gradual increase in risk of AMI, stroke and CHF by increasing UA levels. Women had a stronger relationship between UA and both AMI and IS than men. Predictions of AMI were at least as powerful in the elderly as in the young, but not so for IS. Associations were markedly attenuated when adjusted for total cholesterol, triglycerides, hospital hypertension and diabetes status. The association between UA and HS was U-shaped in both genders. CHF was more strongly related to UA than AMI and stroke and less affected by the adjustment factors. Already moderate levels of UA appear to be associated with an increased incidence of AMI, stroke and CHF in middle-aged subjects without prior cardiovascular disease. These associations seem to increase gradually from lower to higher levels of UA. UA may be an important complementary indicator of cardiovascular risk in the general population.

Cardiovascular Effect of Bans on Smoking in Public Places: A Systematic Review and Meta-Analysis

A systematic review and a meta-analysis were performed to determine the association between public smoking bans and risk for hospital admission for acute myocardial infarction (AMI). Secondhand smoke (SHS) is associated with a 30% increase in risk of AMI, which might be reduced by prohibiting smoking in work and public places. PubMed, EMBASE, and Google Scholar databases plus bibliographies of relevant studies and reviews were searched for peer-reviewed original articles published from January 1, 2004, through April 30, 2009, using the search terms "smoking ban" and "heart" or "myocardial infarct." Investigators supplied additional data. All published peer-reviewed original studies identified were included. Incidence rates of AMI per 100,000 person-years before and after implementation of the smoking bans and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. Random effects meta-analyses estimated the overall effect of the smoking bans. Funnel plot and meta-regression assessed heterogeneity among studies. Using 11 reports from 10 study locations, AMI risk decreased by 17% overall (IRR: 0.83, 95% CI: 0.75 to 0.92), with the greatest effect among younger individuals and nonsmokers. The IRR incrementally decreased 26% for each year of observation after ban implementation. Smoking bans in public places and workplaces are significantly associated with a reduction in AMI incidence, particularly if enforced over several years.

Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin

ObjectiveRosiglitazone was found associated with approximately a 43% increase in risk of acute myocardial infarction (AMI) in a two meta-analyses of clinical trials. Our objective is to estimate the magnitude of the association in real-world patients previously treated with metformin.Research Design and MethodsWe conducted a nested case control study in British Columbia using health care databases on 4.3 million people. Our cohort consisted of 158,578 patients with Type 2 diabetes who used metformin as first-line drug treatment. We matched 2,244 cases of myocardial infarction (AMI) with up to 4 controls. Conditional logistic regression models were used to estimate matched odds ratios for AMI associated with treatment with rosiglitazone, pioglitazone and sulfonylureas.ResultsIn our cohort of prior metformin users, adding rosiglitazone for up to 6 months was not associated with an increased risk of AMI compared to adding a sulfonylurea (odds ratio [OR] 1.38; 95% confidence interval [CI], 0.91–2.10), or compared to adding pioglitazone (OR for rosi versus pio 1.41; 95% CI, 0.74–2.66). There were also no significant differences between rosiglitazone, pioglitazone and sulfonylureas for longer durations of treatment. Though not significantly different from sulfonylureas, there was a transient increase in AMI risk associated with the first 6 months of treatment with a glitazone compared to not using the treatment (OR 1.53; 95% CI, 1.13–2.07)ConclusionsIn our British Columbia cohort of patients who received metformin as first-line pharmacotherapy for Type 2 diabetes mellitus, further treatment with rosiglitazone did not increase the risk of AMI compared to patients who were treated with pioglitazone or a sulfonylurea. Though not statistically significantly different compared from each other, an increased risk of AMI observed after starting rosiglitazone or sulfonylureas is a matter of concern that requires more research.

Haptoglobin and risk of myocardial infarction, stroke, and congestive heart failure in 342,125 men and women in the Apolipoprotein MOrtality RISk study (AMORIS)

Background. Few studies have analysed the importance of haptoglobin (Hp) as a risk factor for acute myocardial infarction (AMI), stroke, and heart failure (HF) in large healthy populations.Aims. We examined Hp as risk factor for AMI, stroke, and HF in the Apolipoprotein MOrtality RISk (AMORIS) Study and compared its predictive strength with that of total serum cholesterol (TC).Methods. Prospective study (11.8 years) of AMI, stroke, and HF through linkage with Swedish hospital discharge and mortality registers with measurements of Hp in 342,125 subjects.Results. Hp is a significant risk factor of AMI, stroke, and HF. Relationships were stronger for men than women with regard to stroke and HF, but not AMI. Hp was almost as predictive as TC for AMI and about equally predictive of stroke with a stronger relationship to ischaemic than haemorrhagic stroke. A 4.2-fold increase in risk of AMI was observed comparing subjects in the joint lower quartiles of TC and Hp to those in the upper. For stroke, the risk increase was 2-fold, and 1.5-fold for HF.Interpretation. The inflammation marker Hp carried as much additional predictive information value on AMI and stroke as TC. Hp was also a risk factor of HF.

Post menopausal hormone replacement therapy and risk of acute myocardial infarction--a case control study of women in the East Midlands, UK.

To examine the relationship between hormone replacement therapy (HRT) and acute myocardial infarction (AMI) adjusting for coronary risk factors and social and behavioural confounders that might indicate a healthy user effect and could account for the discrepancy between randomized and observational studies of HRT use. A case-control study of 864 women aged between 35-65 suffering an AMI with two age matched community controls from the same geographical area. Information was collected by interview and from general practitioner records. Conditional logistic regression was used to calculate odds ratios (OR) adjusted for diabetes, hypertension, smoking, alcohol, social class, family history and a health conscious behaviour score. HRT use was recorded for 34% of non-fatal AMI cases and 39% of controls with the adjusted OR for ever-use of HRT versus never-use being 0.74 (95% CI 0.55-0.99). The pattern of risk of AMI was similar for oestrogen only and combined HRT. During the first 12 months of HRT use there was a small increase in risk of AMI with the adjusted OR being 1.14 (0.72-1.80). HRT use for 13-60 months was associated with a small reduction in AMI risk (adjusted OR 0.85, 0.55-1.29). Only HRT used for >60 months was associated with a substantial risk reduction (adjusted OR 0.42, 0.24-0.73). Data for deceased cases and controls showed a similar pattern. HRT use whether as oestrogen only or combined hormones was only associated with a significant reduction in risk when used for greater than 60 months. These findings could reflect a dual effect of HRT on AMI risk by prothrombotic and anti-atherogenic mechanisms. Neither oestrogen only or combined HRT can be recommended for prevention of coronary artery disease.

Occupational exposure to extremely low frequency magnetic fields and mortality from cardiovascular disease.

The authors evaluated the relation between occupational exposure to extremely low frequency (ELF) magnetic fields and mortality from cardiovascular diseases. The study was based on 27,790 subjects from the Swedish Twin Registry. Exposure to ELF magnetic fields was assessed by linking occupation reported in 1967 or 1973 to a job exposure matrix. Four levels of exposure were related to cause-specific mortality through 1996, and primary and contributing causes of death were considered. The authors estimated relative risks by Cox regression, with adjustment for several cardiovascular disease risk indicators. The authors calculated the synergy index to evaluate potential interaction between exposure to ELF magnetic fields (>0.2 microT) and genetic susceptibility to acute myocardial infarction (AMI). Arrhythmia-related death, ischemic heart disease other than AMI, and atherosclerosis showed no association with ELF magnetic fields. The authors found a low-level increase in AMI risk in the highest exposure group (relative risk=1.3, 95% confidence interval: 0.9, 1.9) and suggestions of an exposure-response relation (p=0.02). A synergy index of 2.7 (95% confidence interval: 1.1, 6.6) in monozygotic twins indicated that the risk of AMI was strengthened among ELF magnetic field-exposed subjects with genetic susceptibility to the disease. The results for AMI corroborate previous findings from the United States. The unusual opportunity to include genetic susceptibility in the present analyses showed that evaluations of effect modification in vulnerable subjects are warranted in ELF magnetic field research.