Risk Of Hospitalization For Myocardial Infarction Research Articles

Short-term effects of ambient temperature variability on myocardial infarction hospitalizations in Sweden: A nationwide case-crossover study

Abstract Background Climate change threatens human health and general welfare via multiple dimensions. However, the short-term effect of temperature variability, a crucial aspect of climate change, on myocardial infarction (MI) remains largely unexplored. Purpose We aimed to assess the short-term effects of temperature variability on MI hospitalizations within the nationwide SWEDEHEART registry. Methods This population-based nationwide study involved 228,897 MI patients from the SWEDEHEART registry in Sweden from 2005 to 2019. High-resolution (1 km × 1 km) daily mean ambient temperature was estimated using a spatiotemporal machine learning methodology and assigned to patients’ home addresses. Temperature variability was calculated as the difference between the same-day (as the MI event) ambient temperature and the average temperature recorded over the preceding seven days. Specifically, an upward temperature shift represents a rise in the current day’s temperature relative to the seven-day average, while a downward temperature shift indicates a corresponding decrease. A time-stratified case-crossover design incorporating a conditional logistic regression model with distributed lag non-linear model was applied to estimate the association between ambient temperature variability and total MI, ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Moreover, we assessed potential effect modification by sex and medication intake. The results were expressed as odds ratio (OR, with their 95% confidence intervals [CIs]) per 1°C increase in temperature variability. Results Our study found that a 1°C increase in upward temperature shift was significantly associated with increased risks for total MI, STEMI, and NSTEMI (OR [95% CI]: 1.010 [1.006-1.015], 1.014 [1.006-1.022], and 1.009 [1.004-1.014], respectively). Furthermore, a 1°C greater in downward temperature shift was significantly associated with decreased risks for total MI and NSTEMI (OR [95% CI]: 0.995 [0.991-0.999], and 0.993 [0.988-0.998], respectively). Moreover, we found that males and patients who were on any heart medication, particularly digitalis, were at a higher risk of MI associated with exposure to higher upward temperature shifts compared to females and their counterparts not taking these medications. Conclusions This nationwide case-crossover study provides novel evidence that short-term exposure to increasing upward temperature shift is associated with an increased risk of MI hospitalization. Our finding highlights the cardiovascular health threats posed by upward temperature shifts, which are anticipated to increase in frequency and intensity due to climate change.

Short-Term Effects of Lower Air Temperature and Cold Spells on Myocardial Infarction Hospitalizations in Sweden

BackgroundLower air temperature and cold spells have been associated with an increased risk of various diseases. However, the short-term effect of lower air temperature and cold spells on myocardial infarction (MI) remains incompletely understood. ObjectivesThe purpose of this study was to investigate the short-term effects of lower air temperature and cold spells on the risk of hospitalization for MI in Sweden. MethodsThis population-based nationwide study included 120,380 MI cases admitted to hospitals in Sweden during the cold season (October to March) from 2005 to 2019. Daily mean air temperature (1 km2 resolution) was estimated using machine learning, and percentiles of daily temperatures experienced by individuals in the same municipality were used as individual exposure indicators to account for potential geographic adaptation. Cold spells were defined as periods of at least 2 consecutive days with a daily mean temperature below the 10th percentile of the temperature distribution for each municipality. A time-stratified case-crossover design incorporating conditional logistic regression models with distributed lag nonlinear models using lag 0 to 1 (immediate) and 2 to 6 days (delayed) was used to evaluate the short-term effects of lower air temperature and cold spells on total MI, non–ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). ResultsA decrease of 1-U in percentile temperature at a lag of 2 to 6 days was significantly associated with increased risks of total MI, NSTEMI, and STEMI, with ORs of 1.099 (95% CI: 1.057-1.142), 1.110 (95% CI: 1.060-1.164), and 1.076 (95% CI: 1.004-1.153), respectively. Additionally, cold spells at a lag of 2 to 6 days were significantly associated with increased risks for total MI, NSTEMI, and STEMI, with ORs of 1.077 (95% CI: 1.037-1.120), 1.069 (95% CI: 1.020-1.119), and 1.095 (95% CI: 1.023-1.172), respectively. Conversely, lower air temperature and cold spells at a lag of 0 to 1 days were associated with decreased risks for MI. ConclusionsThis nationwide case-crossover study reveals that short-term exposures to lower air temperature and cold spells are associated with an increased risk of hospitalization for MI at lag 2 to 6 days.

Effect of air pollution on hospitalization for acute exacerbation of chronic obstructive pulmonary disease, stroke, and myocardial infarction.

This study aims to analyze the acute effects of PM2.5, PM10, SO2, NO2, and O3 on hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), stroke, and myocardial infarction (MI) from 2014 to 2017 in Shenyang, China. Hospitalization records for AECOPD (17,655), stroke (276,736) and MI (26,235) and air pollutions concentration data (PM2.5, PM10, SO2, NO2, and O3) were collected. A generalized additive model (GAM) was utilized to determine the impact of air pollutants on the relative risk (RR) of hospitalization for AECOPD, stroke, and MI. Stratified analysis for AECOPD was based on gender and age. It was based on gender, age, hypertension, and diabetes for stroke, and for MI it was based on gender, age, and coronary atherosclerosis. The lag effect for AECOPD in terms of gender analysis occurred at lag3-lag5. The hospitalization risk for stroke with hypertension due to SO2 and NO2 was greater than that of stroke without hypertension. The risk of hospitalization for stroke with hypertension as a comorbidity due to O3 was lower than without hypertension. The risk of hospitalization for MI combined with coronary atherosclerosis due to PM2.5, PM10, or NO2 was higher than that of hospitalizations for MI without coronary atherosclerosis. Air pollution increased the rate of hospitalization for AECOPD. SO2 and O3 appeared protective for stroke patients with coronary atherosclerosis. PM2.5, PM10, and NO2 had no influence on total hospitalization for myocardial infarction.

Cardiovascular Outcomes and Mortality in Patients Using Clopidogrel With Proton Pump Inhibitors After Percutaneous Coronary Intervention or Acute Coronary Syndrome

Recent studies have raised concerns about the reduced efficacy of clopidogrel when used concurrently with proton pump inhibitors (PPIs), but those studies may have overestimated the risk. We studied the potential for increased risk of adverse cardiovascular events among users of clopidogrel with versus without concurrent use of PPIs in 3 large cohorts of patients > or =65 years of age, treated between 2001 and 2005. All patients had undergone percutaneous coronary intervention or had been hospitalized for acute coronary syndrome in Pennsylvania, New Jersey, or British Columbia, and subsequently had initiated treatment with clopidogrel. We recorded myocardial infarction hospitalization, death, and revascularization among PPI users and nonusers. We assessed our primary end point of myocardial infarction hospitalization or death using cohort-specific and pooled regression analyses. We entered 18 565 clopidogrel users into our analysis. On a pooled basis, 2.6% of those who also initiated a PPI versus 2.1% of PPI nonusers had a myocardial infarction hospitalization; 1.5% versus 0.9% died; and 3.4% versus 3.1% underwent revascularization. The propensity score-adjusted rate ratio for the primary end point of myocardial infarction or death was 1.22 (95% confidence interval, 0.99 to 1.51); for death, 1.20 (95% confidence interval, 0.84 to 1.70); and for revascularization, 0.97 (95% confidence interval, 0.79 to 1.21). Matched analyses generally yielded similar results. Although point estimates indicated a slightly increased risk of myocardial infarction hospitalization or death in older patients initiating both clopidogrel and a PPI, we did not observe conclusive evidence of a clopidogrel-PPI interaction of major clinical relevance. Our data suggest that if this effect exists, it is unlikely to exceed a 20% risk increase.

Abstract 5607: Risk of Re-hospitalization for Patients Using Clopidogrel With a Proton Pump Inhibitor

Background: Recent pharmacodynamic and retrospective clinical analyses have suggested that proton pump inhibitors (PPIs) may modify the antiplatelet effects of clopidogrel. Methods: We conducted a retrospective cohort study of persons enrolled in a large multi-state health insurance plan with commercial and Medicare clients to evaluate adverse clinical outcomes for patients using clopidogrel plus PPI compared to clopidogrel alone. Using propensity scoring methodology, patients discharged from the hospital for myocardial infarction (MI) or coronary stent placement and treated with clopidogrel plus PPI were matched 1:1 with patients with similar cardiovascular risk factors treated with clopidogrel alone. Re-hospitalizations for MI or coronary stent placement were evaluated over a period of up to 360 days. A subanalysis was conducted to study the impact of pantoprazole, the most prescribed PPI. Results: Rates of re-hospitalization for MI or coronary stent placement were higher for clopidogrel plus PPI versus clopidogrel alone (Table ). Patients receiving clopidogrel plus PPI had 92% higher risk of re-hospitalization for MI and 53% higher risk of re-hospitalization for MI or coronary stent placement than patients receiving clopidogrel alone. Increased risk of re-hospitalization for MI or coronary stent placement was also observed for the subgroup of clopidogrel plus PPI patients receiving pantoprazole. Conclusion: Patients receiving clopidogrel plus PPI had significantly higher risk of re-hospitalization for MI or coronary stent placement than patients receiving clopidogrel alone. Prospective clinical trials and laboratory analyses of biochemical interactions are warranted to further evaluate the potential impact of PPIs on the efficacy of clopidogrel. Rates and Risk of Hospitalization for MI or Coronary Stent Placement

Abstract 4183: Gender Difference in the Relationship Between Socioeconomic Deprivation and Fatal Compared to Non-fatal Myocardial Infarction

Introduction: Although socioeconomic deprivation (SED) has been identified as an important risk factor for myocardial infarction (MI), it is not clear whether it predicts outcome after adjustment for traditional risk factors. The relative importance of SED as a predictor of fatal versus non-fatal outcomes and in men versus women is also uncertain. Hypothesis: We hypothesized that SED is an independent predictor of both first hospitalization for MI and MI death (and equally so in men and women). Methods: We examined outcomes in 15,378 men and women initially surveyed between 1972–76 in Renfrew and Paisley, Scotland, and followed until 3/31/2004. Hazards ratios (HR) for a first admission with a MI (as principal diagnosis) and death from MI were calculated using Cox Regression. All analyses were adjusted for age, body mass index, systolic and diastolic blood pressure, cholesterol, smoking, ECG ischemia, and a history of diabetes, angina or stroke. Deprivation was defined using the seven category Carstairs deprivation index. Deprivation categories (depcat) 6 and 7 (the most deprived depcats) were combined to increase power due to small numbers of individuals in group 7. Log rank tests were used to compare the overall trend across depcats. Results: During >=28 years follow-up, 1873 men and women had a first MI hospitalization and 2370 a MI death. Compared to the most affluent (depcat 1), the risk of MI death in men and women combined in depcat 6/7 was 37% higher (hazard ratio (HR) 1.37 (P=0.001)), trend P<0.0001. The HR for men alone in depcat 6/7 versus depcat 1 was 1.35 (P=0.018) and similarly 1.38 for women alone (P=0.027). For men and women in depcat 6/7 (compared to depcat 1), the HR for a first MI hospitalization was 1.34 (P= 0.007), P<0.0001. The HR was 1.1 for men (P=0.5) and 1.74 for women (P=0.002). Conclusion: SED is associated with an increased risk of MI death which is of similar magnitude in men and women, even after accounting for “traditional” risk factors. By contrast, SED is associated with a smaller risk of 1st hospitalization for MI in men than women. This explanation for this gender difference is uncertain but may represent a differential effect of SED on survival to hospital admission in men and women.

Antipsychotics and risk of first‐time hospitalization for myocardial infarction: a population‐based case–control study

Use of antipsychotics has been linked with an adverse cardiovascular risk factor profile and an increased risk of dysrhythmia and sudden cardiac death. However, detailed data on the association between use of antipsychotics and development of atherosclerotic disease are limited. To examine risk of hospitalization for myocardial infarction (MI) amongst users of antipsychotics compared with non-users. A population-based case-control study using data from hospital discharge registries in the counties of North Jutland, Viborg and Aarhus, Denmark, and the Danish Civil Registration System. We identified 21,377 cases of first-time hospitalization for MI and 106,885 sex- and age-matched non-MI population controls in the period 1992-2004. All prescriptions for antipsychotics filled prior to the date of admission for MI were retrieved from population-based prescription databases. We used conditional logistic regression to adjust for a wide range of covariates. Current users of atypical [adjusted relative risk: 0.98, 95% confidence interval (CI): 0.88-1.09] and typical antipsychotics (adjusted relative risk: 0.99, 95% CI: 0.96-1.03) had no increased overall risk of being admitted to hospital for MI when compared with non-users of antipsychotics. These findings were consistent in all examined subgroups. Further, we found no association between the cumulative dose of antipsychotics and the risk of hospitalization for MI. These findings do not support the hypothesis that use of antipsychotics and in particular atypical antipsychotics is associated with increased risk of MI.

The Effect of Particulate Air Pollution on Emergency Admissions for Myocardial Infarction: A Multicity Case-Crossover Analysis

Recently, attention has focused on whether particulate air pollution is a specific trigger of myocardial infarction (MI). The results of several studies of single locations assessing the effects of ambient particular matter on the risk of MI have been disparate. We used a multicity case-crossover study to examine risk of emergency hospitalization associated with fine particulate matter (PM) with aerodynamic diameter < 10 μm (PM10) for > 300,000 MIs during 1985–1999 among elderly residents of 21 U.S. cities. We used time-stratified controls matched on day of the week or on temperature to detect possible residual confounding by weather. Overall, we found a 0.65% [95% confidence interval (CI), 0.3–1.0%] increased risk of hospitalization for MI per 10 μg/m3 increase in ambient PM10 concentration. Matching on apparent temperature yielded a 0.64% increase in risk (95% CI, 0.1–1.2%). We found that the effect size for PM10 doubled for subjects with a previous admission for chronic obstructive pulmonary disease or a secondary diagnosis of pneumonia, although these differences did not achieve statistical significance. There was a weaker indication of a larger effect on males but no evidence of effect modification by age or the other diagnoses. We also found that the shape of the exposure–response relationship between MI hospitalizations and PM10 is almost linear, but with a steeper slope at levels of PM10 < 50 μg/m3. We conclude that increased concentrations of ambient PM10 are associated with increased risk of MI among the elderly.