Risk Factor For Myocardial Infarction Research Articles

Which one to do first?: a case report of simultaneous acute ischemic stroke and myocardial infarction

Background: Although there are common risk factors for acute ischemic stroke and myocardial infarction, simultaneous onset of both diseases is uncommon. Here, we present a case of acute cerebral infarction with concurrent fatal myocardial infarction. Case Report: A 54-year-old man presented with left hemiparesis, gaze preponderance to the right side, and visual and tactile extinction. Computed tomography angiography showed occlusion of the right middle cerebral artery. ST-elevation myocardial infarction was suspected on electrocardiography. After the injection of intravenous tissue plasminogen activator, thrombectomy was attempted first, and the coronary angiogram was planned after recanalization of the cerebral artery. However, thrombectomy was discontinued because of cardiac arrest. Despite extracorporeal membrane oxygenation and emergency percutaneous coronary intervention, the patient died of multiorgan failure.Conclusion: Double primary acute ischemic stroke and myocardial infarction are rare but may be fatal due to the narrow therapeutic time window for both diseases. Careful consideration of the urgency of cardiac status is essential.

English

BACKGROUND Given newly debates on the association of birth-month with various diseases, we investigated the association of patients' birth-month with a burdensome lethal disease, ST-elevation myocardial infarction (STEMI). METHODS The data comes from an ongoing cohort-registry conducted on patients with STEMI registered to a mega cardiovascular hospital, in Western Iran (2016 - 2019). Baseline and follow-up data were collected using the European observational registry program (EORP) case report form, through interviewing eligible patients and reviewing their medical records. The quality of data as well as ethics considerations has been approved by EORP and Kermanshah University Medical Sciences (KUMS) Ethics Committees. RESULTS Among 2341 patients (81.5 % male) analysed, the peak of event [myocardial infarction (MI)] was 10 am followed by 8 pm. Their mean age (± SD) was 60.34 ± 12.40 years, minimum 19 years and maximum 96 years. March was significantly more frequent birth-month (16.4 %) (p < 0.001). Nevertheless, in terms of MI incidence, no significant variation was found between 12 months of a year, as well as the four seasons. The most common risk factors were smoking, hypertension, hypercholesterolemia and diabetes. About 3.8 % (n = 90) died in hospital (23 women). More than 6 % of patients expired during the first year of follow up. Although birth- month of 18.89 % (n = 17) of those expired was March, the difference was not significant (p = 0.025). CONCLUSIONS Among 12 months, March was highly significant common birth-month among patients with STEMI; however, this birth-month was not significantly associated with MI frequency of MI risk factors and/or a worse outcome. KEY WORDS Birth Month, Acute Myocardial Infarction, Heart Attack, Risk Factors, Outcomes

MIAT, a potent CVD-promoting lncRNA.

The initial identification of long non-coding RNA myocardial infarction associated transcript (MIAT) as a genetic risk factor of myocardial infarction has made this lncRNA (designated as lncR-MIAT here) a focus of intensive studies worldwide. Emerging evidence supports that lncR-MIAT is susceptible in its expression to multiple deleterious factors like angiotensin II, isoproterenol, hypoxia, and infection and is anomaly overexpressed in serum, plasma, blood cells and myocardial tissues under a variety of cardiovascular conditions including myocardial infarction, cardiac hypertrophy, diabetic cardiomyopathy, dilated cardiomyopathy, sepsis cardiomyopathy, atrial fibrillation and microvascular dysfunction. Experimental results consistently demonstrated that upregulation of lncR-MIAT plays active roles in the pathological processes of the cardiovascular system and knockdown of this lncRNA effectively ameliorates the adverse conditions. The available data revealed that lncR-MIAT acts through multiple mechanisms such as competitive endogenous RNA, natural antisense RNA and RNA/protein interactions. Moreover, the functional domains of lncR-MIAT accounting for certain specific cellular functions of the full-length transcript have been identified and characterized. These insights will not only tremendously advance our understanding of lncRNA biology and pathophysiology, but also offer good opportunities for more innovative and precise design of agents that have the potential to be developed into new drugs for better therapy of cardiovascular diseases (CVDs) in the future. Herein, we provide an overview of lncR-MIAT, focusing on its roles in cardiovascular diseases, underline the unique cellular/molecular mechanisms for its actions, and speculate the perspectives about the translational studies on the potential diagnostic and therapeutic applications of lncR-MIAT.

Impact of serum uric acid on subclinical myocardial injury in general population

Background and aimsHyperuricemia is widely thought as a risk factor for myocardial infarction (MI) and all-cause mortality; however, the relation of serum uric acid (sUA) and subclinical myocardial injury (SCeMI) remains unclear. We hypothesize that sUA is associated with subclinical myocardial injury. Methods and resultsA total of 5880 adult individuals (57.9 ± 13.0 years, 54.23% women) without known cardiovascular disease from National Health and Nutrition Examination Survey (NHANES) III were included. Determined by Cardiac Infarction Injury Score (CIIS) from 12-lead electrocardiogram, SCeMI was defined by CIIS ≥10 units. The relationship between sUA and SCeMI was analyzed by using logistic regression models and the smooth curve fitting. Subgroup analyses were conducted. After adjusting for potential confounding variables, the smooth curve fitting revealed a non-linear relationship between sUA level and SCeMI. When sUA was above the inflection point 266.5 μmol/L, each 100 unit increase in sUA increase the risk of SCeMI by 15%. In women group, when sUA>340.3 μmol/L, each 100 unit increase in sUA increase the risk of SCeMI by 71%, but no significant correlation was observed in men group. ConclusionsOur findings confirm that sUA is an independent risk factor for subclinical myocardial injury after adjusting for potential confounding variables, and existence of such an association in women only, which require more random control trials to confirm the strategy of cardiovascular disease prevention based on sUA reduction in female.

Mitochondrial deacetylase Sirt3 in vascular dysfunction and hypertension.

Purpose of reviewHypertension is a multifactorial disorder involving perturbations of the vasculature, the kidney, and the central nervous system. Hypertension represents a major risk factor for stroke, myocardial infarction, and heart failure. Despite treatment with multiple drugs, 37% of hypertensive patients remain hypertensive, likely due to the mechanisms contributing to blood pressure elevation that are not affected by current treatments. This review focuses on recently described novel role of mitochondrial deacetylase Sirt3 in vascular dysfunction and hypertension.Recent findingsIn the past several years, we have shown that the mitochondria are dysfunctional in hypertension; however, the role of mitochondria in the pathogenesis of hypertension remains elusive. We recently showed that patients with essential hypertension have decreased levels of the mitochondrial deacetylase Sirt3 leading to hyperacetylation of mitochondrial proteins. There is likely a causative role. Indeed, genetic deletion of Sirt3 in mice promotes vascular dysfunction and hypertension. Sirt3 depletion promotes endothelial dysfunction, increases smooth muscle cell hypertrophy, instigates vascular inflammation, and induces age-dependent hypertension.SummarySirt3 is critical for vascular cell homeostasis, however, multiple risk factors impair Sirt3 leading to mitochondrial dysfunction and vascular dysregulation which contribute to hypertension and end-organ injury. Targeting Sirt3 may represent novel therapeutic approach to improve treatment of vascular dysfunction and reduce hypertension.

A predictive model of perioperative myocardial infarction following elective spine surgery

Myocardial infarction (MI), and its predictive factors, has been an understudied complication following spine operations. The objective was to assess the risk factors for perioperative MI in elective spine surgery patients as a retrospective case control study. Elective spine surgery patients with a perioperative MI were isolated in the NSQIP. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests. Univariate/multivariate analyses assessed predictive factors of MI. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence. The study included 196,523 elective spine surgery patients (57.1 yrs, 48%F, 30.4 kg/m2), and 436 patients with acute MI (Spine-MI). Incidence of MI did not change from 2010 to 2016 (0.2%–0.3%, p = 0.298). Spine-MI patients underwent more fusions than patients without MI (73.6% vs 58.4%, p < 0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more SPO (5.0% vs 1.8%, p < 0.001) and 3CO (0.9% vs 0.2%, p < 0.001), but less decompression-only procedures (26.4% vs 41.6%, p < 0.001). Spine-MI underwent more revisions (5.3% vs 2.9%, p = 0.003), had greater invasiveness scores (3.41 vs 2.73, p < 0.001) and longer operative times (211.6 vs 147.3 min, p < 0.001). Mortality rate for Spine-MI patients was 4.6% versus 0.05% (p < 0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes, cardiac arrest and PVD, past blood transfusion, dialysis-dependence, low preoperative platelet count, superficial SSI and days from operation to discharge. A model with good predictive capacity for MI after spine surgery now exists and can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period.

A Study of Dermatoglyphic Patterns of Fingers in Patients with Myocardial Infarction

Background: The myocardial infarction (MI), the most common manifestation of coronary artery disease remains as a major cause of mortality in both developed and developing countries. The people without known major risk factors can be screened for MI with a simple and cost-effective tool which will be helpful in developing countries to reduce the mortality. Dermatoglyphic patterns in clinical conditions have been studied so far and their relationship is established in the literature. Dermatoglyphics has been considered as a diagnostic tool in many diseases with genetic bases. Hence this study is conducted to analyse the correlation between dermatoglyphic features and MI, so that dermatoglyphics may be used as screening tool for MI. Materials and Methods: We conducted a cross-sectional study of 150 MI patients diagnosed with ECG or coronary angiography who were admitted in the Institute of cardiology, Madras Medical College, Chennai after obtaining clearance from Institutional ethics committee. 150 healthy consented volunteers were included as controls. The finger prints from both groups were taken by ink method and type of fingerprint patterns and total finger ridge count (TFRC) and absolute finger ridge count (AFRC) were studied. The correlation of the findings between cases and controls were analysed with t-test and Chi-square test using SPSS 13.0. Results: The frequency of loop, arch and whorls is 54.9%, 8.3% and 36.8% respectively in MI as compared to 59.4%, 13.2% and 27.4% respectively in controls. The frequency of whorls is increased in thumb, middle finger and little finger of both hands of the MI patients when compared with controls with statistically significant difference (p&lt;0.005). The mean value of TFRC and AFRC is increased in cases than controls and statistically significant difference was observed for AFRC. Conclusion: Thus, our study has indicated the specific fingerprint patterns in MI and we hope this knowledge can be used for screening the people without known risk factors for MI. KEY WORDS: Fingerprint, Dermatoglyphics, Myocardial infarction, early diagnosis.

Abstract 11198: Role of Different Lipid Parameters and Lipoproteins on Coronary Microvascular Dysfunction in the Young

Aim: Young with coronary microvascular dysfunction (CMD) have increased cardiovascular morbidity. Particularly, Asian patients with CMD are considerably younger than their Western peers. Blood lipids are traditionally considered risk factors for myocardial infarction (MI) of the elderly. However, little is known about CMD in the young. The purpose of our study was to test the associations between lipids and lipoprotein particles and CMD in the young. Methods: A cross-sectional study was conducted from 2014 to 2020, 1868 young participants were included. CMD was defined as angina but no obstructive coronary disease. All participants had baseline laboratory testing. Lipid parameters, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), small dense low density lipoprotein cholesterol (sd LDL-C), high-density lipoprotein (HDL), non-HDL, TC/HDL ratio, TG/HDL ratio and LDL/HDL ratio were measured. Both low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) subfractions were measured using the Quantimetrix Lipoprint System. Logistic regression analysis was performed to determine associated factors for CMD. Results: Very low-, intermediate-, small dense-, and low- density lipoprotein particles were positively associated with CMD. HDL particles were inversely associated with CMD apart from small HDL. Cholesterol in large HDL was inversely associated with CMD (odds ratio [OR] = 0.75), whereas cholesterol in small HDL was not (OR = 1.08). TG within all lipoproteins, including most HDL particles, were positively associated with CMD. In multiple logistic regression analyses, non-HDL [OR = 1.56 (1.16-1.87)], sd LDL-C [OR = 1.80 (1.21-2.27)], TC [OR = 1.41 (1.25-1.93)], TC/HDL [OR = 1.26 (1.15-1.68)] were significantly associated with CMD. Conclusions: Lipids and lipoproteins showed similar associations with CMD. Within HDL particles, cholesterol concentrations were inversely associated, whereas triglyceride concentrations were positively associated with CMD. Non-HDL, sd LDL-C, TC, and TC/HDL were significantly associated with CMD than others. This result should be considered in future clinical lipid-lowering trials and a routine screening for CMD in the young.

Abstract 8904: Predictors of Type 1 and Type 2 Myocardial Infarction

Background: Our understanding of the risk factors for myocardial infarction (MI) is limited to type 1 events caused by atherosclerotic plaque rupture and thrombosis. It is unclear whether similar risk factors are related to future type 2 MI events. Hypothesis: Cardiovascular disease risk factors are important in predicting type 2 MI Method: We conducted a secondary analysis of a multi-centre randomised trial population of 48,282 consecutive patients attending hospital with suspected acute coronary syndrome. Cox regression was used to identify predictors of future type 1 and type 2 MI during a one-year follow-up period. Results: During one-year of follow up 1,331 patients had a subsequent MI, with 924 and 407 adjudicated as type 1 and type 2 myocardial infarction, respectively. Risk factors for type 1 and type 2 MI were similar, with age, hyperlipidaemia, diabetes, increasing creatinine concentration, and known coronary disease important predictors for both (P&lt;0.05 for all). Whilst male sex is an established risk factor for type 1 MI, sex did not predict type 2 myocardial infarction (adjusted HR 0.82, 95% CI 0.66 to 1.01). The strongest predictor of type 2 MI was a prior history of type 2 events (aHR 6.18, 95% CI 4.70 to 8.12, Figure). Conclusions: Cardiovascular risk factors associated with type 1 MI are also important predictors of type 2 MI, suggesting common mechanisms including coronary disease are important. Treatment of these risk factors may reduce future susceptibility to both type 1 and type 2 MI.

Abstract 9952: Periodontal Inflammation, Periodontal Bacterial Load and Virulence Genes Expression Are Risk Factors for Myocardial Infarction

Background: A causal relationship between periodontitis and Myocardial Infarction (MI) is stipulated but remains incompletely characterised. Methods: Prospectively recruited 160 acute MI patients underwent periodontal exam to quantify periodontal inflamed surface area (PISA), probing pocket depths (PPD) and clinical attachment loss (CAL). Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans and Prevotella intermedia loads were assessed in subgingival plaque, venous blood, aspirated intra-coronary thrombi and deployment balloons using quantitative polymerase chain reaction. Expression of periodontal bacterial virulence genes (n=13) was quantified with reverse transcription PCR. Myocardial injury was estimated by 12-hour troponin (TnI) and severity of coronary artery disease (CAD) burden by SYNTAX-I scores. CAD-symptom free controls (n=50) of similar age/gender distribution were used for comparison. Results: Compared to controls, MI patients had worse periodontitis and higher bacterial loads (all p &lt;0.05). In MI cohort, after adjusting established risk factors, hierarchical linear regression showed that PISA (5%), mean PPD (3%), mean CAL (2%), P. gingivalis load (4%) and upregulated expression of bioF-3 , fimA , prtH , prtP , ltxA , cdtB virulence genes (4-9%) were associated with an increase in Tnl release, all p &lt;0.05. Similarly, mean PPD (5%), mean CAL (4%), P. gingivalis load (5%) and upregulated expression of bioF-3 , fimA , prtP and ltxA virulence genes (4-9%) were associated with higher SYNTAX-I score, all p &lt;0.05. Every 200 mm 2 PISA, 1mm mean PPD, 1mm mean CAL and 10 9 P. gingivalis copies/ng DNA was responsible for 19,000, 32,000, 38,000 and 10,000 ng/L increase in TnI release, respectively. The SYNTAX-I score increased by 3, 4 and 1 unit with every 1mm mean PPD, 1mm mean CAL and 10 9 P. gingivalis copies/ng DNA, respectively. Periodontal bacterial DNA was detected in coronary thrombi and subgingival plaque sampled from the same patients, with a strong correlation for P. gingivalis and T. forsythia bacterial loads (Spearman's rho=0.6 for both, p &lt;0.05). Conclusions: These findings enable further recognition of periodontitis as a risk factor for MI; a new candidate for primary and secondary prevention.

Abstract 13238: Clinical Utility Of Hs-Tni In Healthy Thai Subjects With Intermediate Cardiovascular Risk

Introduction: In European countries, hs-cTnI is approved for risk stratification in general population. Whether this indication can be applied to Thai population is unknown. We test the utility of hs-cTnI as a risk stratification tool for incident cardiovascular disease among Thai subjects with intermediate cardiovascular (CV) risk and without previous cardiovascular disease. Hypothesis: Hs-cTnI can be used as a risk stratification tool in Thai subject who has intermediate cardiovascular risk. Methods: Data were retrieved from 1,757 subjects who had intermediate CV risk (7.5%-19.9%) and had no known CV disease from the electricity generating authority of Thailand (EGAT) study during the year 2007-2009. High-sensitive Troponin I was tested using the Abbot ARCHITECT i2000 SR system. Hs-cTnI was categorized into low, intermediate and high risk using gendered-specific cut-offs points. Major adverse cardiac event (MACE), defined as a composite of CV death, non-fatal myocardial infarction and non-fatal stroke, was collected and confirmed by medical record until 2017-2019. Survival analysis and net reclassification index (NRI) analysis were performed. Results: A total of 1,757 subjects had complete data for analysis. Mean age was 57-year-old, 77% were male. After 10 years, 88 CV event (5%) occurred. Median hs-cTnI was 3 (2.2, 4.1) mg/dL. The event rate was significantly highest in high-risk group of hs-cTnI (14%), followed by intermediate (6.4%) and low risk group (4.3%). Multivariate analysis adjusted for conventional risk factor from Thai CV risk score showed that hs-cTnI is an independent risk factor for MACE (HR 1.02, 95% CI 1.01 to 1.03). For the high-risk group, compared to low risk group, hazard ratio was 3.24, 95% CI 1.73 to 6.07 (p value for trend &lt; 0.001). The addition of hsTnI information to prognostic model yielded an NRI of 0.11 (p-value 0.006). Conclusions: In this intermediate CV risk population, elevation of hs-cTnI is not uncommon. Hs-cTnI is an independent risk factor for cardiovascular death, myocardial infarction and stroke. Hs-cTnI significantly improves the reclassification as shown by NRI. Hs-cTnI can be used as a risk stratification tool in Thai subject who has intermediate cardiovascular risk.

Causal effect of Lipoprotein-associated phospholipase A2 activity on coronary artery disease and myocardial Infarction: A Two-Sample Mendelian Randomization study

BackgroundLipoprotein-associated phospholipase A2 (Lp-PLA2) activity has been reported to be associated with coronary artery disease (CAD) and myocardial infarction (MI). However, whether Lp-PLA2 is a causal risk factor for CAD and MI remains unclear. Herein, we performed a two-sample mendelian randomization (MR) study to assess the causal effect of Lp-PLA2 activity on CAD and MI. MethodsWe selected 7 single-nucleotide polymorphisms (SNPs) associated with Lp-PLA2 activity as instrumental variables based on the data from Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium with 13,664 European individuals. Summary data about CAD and MI were obtained from Coronary Artery Disease Genome-wide Replication and Meta-analysis plus the Coronary Artery Disease Genetics (CARDIOGRAMPLUSC4D) consortium with 60,801 CAD cases and 43,676 MI cases (mostly European). The inverse-variance weighted method was applied to assess the causal associations of Lp-PLA2 activity with CAD and MI in the main analysis. ResultsThe main inverse-variance weighted (IVW) MR analysis showed that 1-SD increment in genetically determined LP-PLA2 activity was associated with increased risks of CAD (odds ratio, 5.93; 95% CI, 2.91–12.07; p value = 9.43 × 10-7) and MI (odds ratio, 4.71; 95% CI, 2.49–8.90; p value = 1.86 × 10-6). MR-Egger regression showed no evidence of pleiotropic bias. The causal associations were consistent in sensitivity analyses with multiple MR methods, in which showed Lp-PLA2 activity was causally associated with an increased risk of CAD and MI. ConclusionsIn this two-sample MR study, high Lp-PLA2 activity was a causal risk factor for CAD and MI, indicating that Lp-PLA2 activity may be a promising intervention target in reducing the risk of CAD and MI.

Comparison of Risk Factors &amp; Angiographic Profiles between Young Patients with ST Segment Elevation Myocardial Infarction and Non-ST Segment Elevation Myocardial Infarction

Background: Coronary artery disease is the leading cause of death in the world. Advancing age is a well-recognized risk factor for acute myocardial infarction (AMI). Myocardial infarction is less common in young adults. Prevalence of acute coronary syndrome in young individuals is increasing progressively. These patients have different risk profile, presentation and prognosis. Early recognition and risk factor modification in this population sub-set is of key importance. Objectives: The purpose of the present study was to determine the differences in risk factors and coronary angiographic profile of young patients with ST-segment elevated myocardial infarction (STEMI) vs. those with non-ST-segment elevated myocardial infarction (NSTEMI). Methods: In this cross sectional analytical study total 135 patients (70 STEMI and 65 NSTEMI) aged ≤45 years were enrolled to see the differences of risk factors and angiographic profile. Results: The mean age of the study population was 39.39±5.12 years and the study showed male predominance (90.40 % was male and 9.60 % was female). Smoking/tobacco consumption was significantly higher in STEMI patients, whereas diabetes mellitus and hypertension were more prevalent in NSTEMI patients. The frequency of single vessel disease and involvement of left anterior descending artery was significantly higher in young STEMI patients. In case of young NSTEMI patients frequency of triple vessel disease, noncritical coronary artery disease and involvement of left circumflex coronary was significantly higher. The frequency of double vessel disease and involvement of left main coronary artery was also nonsignificantly higher in young NSTEMI patients. There was no significant difference regarding involvement of right coronary artery. Conclusion: There are significant differences between young STEMI and young NSTEMI patients in respect to risk factors and angiographic profile. Key words: Young patient, STEMI, NSTEMI, Risk factors, Coronary angiographic profile. Bangladesh Heart Journal 2021; 36(2): 124-132

Impact of myocardial scars on left ventricular deformation in type 2 diabetes mellitus after myocardial infarction by contrast-enhanced cardiac magnetic resonance

BackgroundType 2 diabetes mellitus (T2DM) is a major risk factor for coronary artery disease and myocardial infarction (MI). The interaction of diabetic cardiomyopathy and MI scars on myocardial deformation in T2DM patients is unclear. Therefore, we aimed to evaluate myocardial deformation using cardiac magnetic resonance (CMR) in T2DM patients with previous MI and investigated the influence of myocardial scar on left ventricular (LV) deformation.MethodsOverall, 202 T2DM patients, including 46 with MI (T2DM(MI+)) and 156 without MI (T2DM(MI−)), and 59 normal controls who underwent CMR scans were included. Myocardial scars were assessed by late gadolinium enhancement. LV function and deformation, including LV global function index, LV global peak strain (PS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR), were compared among these groups. Correlation and multivariate linear regression analyses were used to investigate the relationship between myocardial scars and LV deformation.ResultsDecreases were observed in LV function and LV global PS, PSSR, and PDSR in the T2DM(MI+) group compared with those of the other groups. Reduced LV deformation (p < 0.017) was observed in the T2DM(MI+) group with anterior wall infarction. The increased total LV infarct extent and infarct mass of LV were related to decreased LV global PS (radial, circumferential, and longitudinal directions; p < 0.01) and LV global PSSR (radial and circumferential directions, p < 0.02). Multivariate analysis demonstrated that NYHA functional class and total LV infarct extent were independently associated with LV global radial PS (β = − 0.400 and β = − 0.446, respectively, all p < 0.01; model R2 = 0.37) and circumferential PS (β = 0.339 and β = 0.530, respectively, all p < 0.01; model R2 = 0.41), LV anterior wall infarction was independently associated with LV global longitudinal PS (β = 0.398, p = 0.006).ConclusionsThe myocardial scarring size in T2DM patients after MI is negatively correlated with LV global PS and PSSR, particularly in the circumferential direction. Additionally, different MI regions have different effects on the reduction of LV deformation, and relevant clinical evaluations should be strengthened.

Risk factors in young patients with myocardial infarction: what is different from the general population?

Abstract Introduction Patients that suffer from myocardial infarction (MI) at a younger age are of special medical and socioeconomic interest. Data on risk factors for MI in this patient group are however scarce. Methods In this case–control study, clinical characteristics of consecutive patients admitted to hospital with MI at age of ≤45 years were compared to a randomly selected cohort from the general population in the same geographic region in Germany. After 3:1 matching on age and gender and multivariable analyses, independent risk factors for the occurrence of MI at a younger age were analyzed. Results 522 patients with MI ≤45 years were compared to 1191 matched controls from the general population. The proportion of active smokers was more than 3-fold higher in younger MI-patients compared to the general population (82.4% vs. 24.1%, p&amp;lt;0.01), while the proportion of persons consuming alcohol at least 2 times a week was higher in the general population (19.9% vs. 36.6%, p&amp;lt;0.01). Younger patients with MI were more often obese (median body mass index 28.4 vs. 25.5 kg/m2, p&amp;lt;0.01), had a higher proportion of hypertension (25.1% vs. 0.5%, p&amp;lt;0.01) or diabetes mellitus (11.7% vs. 1.7%, p&amp;lt;0.01) and had more often a family history of the father (22.4% vs. 7.1%, p&amp;lt;0.01) or the mother (7.5% vs. 1.3%, p&amp;lt;0.01) for premature coronary artery disease. In multivariable analysis, hypertension or diabetes, active smoking, family history and body mass index ≥30 kg/m2 were strong predictors for the occurrence of MI at a younger age, while alcohol consumption was a protective factor (Figure). Conclusions This case-control study demonstrates a very strong association of active smoking, metabolic syndrome and family history with the occurrence of MI at a younger age. The contrary is found regarding alcohol consumption. These data suggest that the risk of young-onset MI goes beyond family history and underline the importance of primary prevention efforts to reduce smoking and metabolic syndrome in children, adolescents and young adults in order to reduce the burden of cardiovascular diseases. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Bremen Heart FoundationLeibniz Institute for Prevention Research and Epidemiology

Latent class cluster analysis of knowledge on acute myocardial infarction symptoms and risk factors in community residents

Abstract Background Knowledge of Acute Myocardial Infarction (AMI) symptoms and risk factors (RF) have been studied worldwide in various populations. However, the studied specific symptom and RF of different surveys varies, the number of surveyed symptom and RF varies, and the criteria for judging good/high knowledge and bad/low knowledge are different (group classification criteria include the number, the percentages or the scores), which makes the results difficult to compare. Purpose The aim was to identify clusters of knowledge on symptoms and modifiable RFs using Latent Cluster Analysis, and to further compare characteristics and the awareness of the need for prompt treatment among different clusters. Methods A structured questionnaire was used to interview 4122 community residents over 35 years old on their knowledge about AMI symptoms and RFs. Latent GOLD Statistical Package was used to identify and classify the respondent subtypes (latent classes) of the knowledge on AMI symptoms or modifiable RFs. An individual's class membership probabilities are computed from the estimated model parameters and the observed scores. The multivariable logistic regression was performed in order to identify factors that predicted High knowledge membership. Results Two and three distinct clusters were identified in terms of knowledge of symptoms and RFs. 62.7% (Symptom High Knowledge Cluster) and 39.5% (RF High Knowledge Cluster) of the respondents were able to identify most symptoms and modifiable RFs. A number of common differences were observed with respect to higher probability of having high knowledge on symptom and RF, which was mostly better among those with higher education and average monthly income, insured, having annual physical examination, have disease history of AMI RFs, AMI history in immediate family member or acquaintance and have been exposed to AMI related public education. There was also significant difference in awareness of the prompt treatment in case of AMI occurs among different symptom or RF clusters. Conclusions A moderate or relatively low knowledge regarding AMI symptoms and modifiable RFs was observed in our study. Identification of Symptom or RF knowledge clusters can be a way to detect specific targeted groups that are most likely to possess lower knowledge of AMI with readily identifiable characteristics, which may facilitate health education and further reduce the pre-hospital delay and improve patient outcomes. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Key Project of Scientific and Technological Support Plan of Tianjin in 2020 Cluster category chartProfile plot

Effect of endothelial nitric oxide synthase gene polymorphism on cardiovascular death and nonfatal myocardial infarction in Japanese general population

Abstract Introduction Single nucleotide polymorphisms (SNP) of endothelial nitric oxide synthase (NOS3) have been reported to be associated with diabetes mellitus and myocardial infarction. However, few reports have prospectively investigated the effects of NOS3 SNP on cardiovascular death and nonfatal myocardial infarction. Purpose The purpose of this study was to investigate the impact of NOS3 SNP on cardiovascular death and the development of nonfatal myocardial infarction. Methods This prospective cohort study included 2,752 subjects (aged ≥40) who participated in a community based health checkup. We genotyped two SNPs within NOS3 (rs1808593, rs1799983). All subjects were prospectively followed during the median follow-up period of 15.4 years with the end point of cardiovascular death and nonfatal myocardial infarction. Results The homozygous G-allele (GG), heterozygous (GT), and homozygous T-allele (TT) carriers of rs1808593 were identified in 60 (2%), 706 (26%), and 1,986 (72%) subjects, respectively. Kaplan-Meier analysis demonstrated that homozygous G-allele carriers of rs1808593 had the greater risk than those without. Multivariate Cox proportional hazard regression analysis revealed that the homozygous G allele of rs1808593 was associated with cardiovascular death and the development of nonfatal myocardial infarction after adjusting for confounding risk factors. Conclusions NOS3 gene polymorphism could be a genetic risk factor for cardiovascular death and nonfatal myocardial infarction in the Japanese general population. Funding Acknowledgement Type of funding sources: None. Figure 1

A novel natural-derived pentameric peptide protects from angiotensin-evoked high blood pressure

Abstract Background Arterial hypertension is the most important risk factor for cardiovascular diseases, myocardial infarction, heart failure, renal failure and peripheral vascular disease. In the last decade, milk-derived bioactive peptides have attracted attention for their beneficial cardiovascular properties. Methods Here we combined in-vitro chemical assay such as LC-MS/MS analysis of buffalo ice cream, ex-vivo vascular studies evaluating endothelial and smooth muscle responses using pressure myograph, and translational assay testing in-vivo the vascular actions of PG1 administration in murine models. Results We demonstrate that a novel buffalo ice-cream-derived pentapeptide “QKEPM”, namely PG1, is a stable peptide that can be obtained at higher concentration after gastro-intestinal digestions (GID) of buffalo ice-cream (BIC). It owns potent vascular effect in counteract the effects of angiotensin II-evoked vasoconstriction and high blood pressure levels. Its effects are mediated by the inhibitory effect on AT1 receptor leading to a downregulation of p-ERK½/Rac1-GTP and consequent inactivation of NADPH oxidase activity. Conclusions These results strongly candidate PG1, as a novel bioactive peptide for the prevention and management of hypertension, thus expanding the armamentarium of preventive strategies aimed at reducing the incidence and progression of hypertension and its related cardiovascular complications. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): University

Improving primary prevention of hypertension using a social networking site

Abstract Purpose To determine the most effective methods of informing people about the primary prevention of hypertension using a social networking site. Materials and methods It was a randomized, prospective, two-stage study conducted on a social networking site (i.e., the Instagram platform). At Stage 1 online school was announced, and 945 applicants were registered for the training. The online training programme had the following modes: risk factors for cardiovascular diseases, diet, cholesterol, physical activity, obesity, smoking, hypertension and myocardial infarction. At Stage 2 a total of 125 participants were randomly selected and assigned into one of the four training groups where medical training materials were represented by texts of up to 4,000 characters (n=31), short video clips of up to 5 minutes (n=31), by text publications followed by video clips (n=33) and by video clips followed by text publications (n=30) in the 1st, 2nd, 3rd and 4th accounts, respectively. Before and after training participants in all the four groups completed the Heart Disease Knowledge Questionnaire (HDKQ). The study was approved by the Ethics Committee. Results The total number of people who listened to and read the materials of the online school was 2,108 people; the overall engagement was 1,598 people. The average percentage viewed was 22%. The online school audience was mostly female (84%), with a mean age of 45.9±12.3 years.The mean duration of hypertension was 6.1±7.6 years. Before training the number of correct responses for 29 HDKQ statements was 18.4±5.1 (CI, 17.5; 19.4), with no significant differences between the groups. After training the number of correct responses increased to 21.9±3.9 (CI, 21; 22.7) (P(ANOVA) &amp;lt;0.0001).The post-hoc analysis showed that after training the respondents from Group 3 gave the lowest number of correct responses compared to Groups 1 and 2, i.e. Δ=4.9 (CI, −7.8; 2.0) and Δ=3.7 (CI, −6.5; −0.8), respectively. Participants from Group 4 had more correct responses than the respondents in Group 3, i.e. Δ=5.2 (CI, 2.2; 8.1). The regression analysis showed that the post-training number of correct responses in Group 4 increased on average by 3.9 compared to Group 3 (β=3.94, P=0.04 (CI, 0.21; 7.66). In the study there was a significant association between the duration of hypertension and the number of correct responses both before and after training (β=0.20, P=0.007 (CI, 0.06; 0.34) and β=0.16, P=0.005 (CI, 0.05; 0.27), respectively). Conclusions In all the 4 groups there was a tendency to increase in the number of correct responses after training, but among the training modes the most effective method of informing people about the primary prevention of hypertension using a social networking site corresponded to the following sequence: a video clip of up to 5 minutes followed by a text publication of up to 4,000 characters. The results of this study can be used in planning online training programmes for the primary prevention of hypertension. Funding Acknowledgement Type of funding sources: None.

Predictors of Quality of Life in Patients With Myocardial Infarction Combined With Dyslipidemia.

Background: Dyslipidemia is an important risk factor for myocardial infarction (MI). This study aimed to examine the health-related quality of life (HRQoL) and its predictors of patients with MI combined with dyslipidemia in China.Methods: Information on patients' sociological characteristics, lifestyle, clinical characteristics, and quality of life were collected by electronic medical records and questionnaires. Tobit regression model was used to investigate the predictors of quality of life.Results: There were 756 patients responded. The average EQ-5D score of all the patients was 0.95 (SD: 0.11). For all patients, factors such as age, high-fat and high-cholesterol diet, sports, family history of dyslipidemia, history of peripheral artery disease significantly affected HRQoL.Conclusions: Post-discharge care of the elderly group should be paid more attention to and suggestions on the healthy lifestyle (fat control) of the patients should be encouraged to improve the quality of life of these population.