Nearly Half of Acute MI Patients Under Age 50 May Have Metabolic Syndrome

In people under age 50 who have an acute MI, the incidence of metabolic syndrome is high and the likelihood of having a repeat event is greater than in older individuals, a Korean registry study shows.

“Frequent rehospitalization due to re-MI is a cause of disability in young adults and carries a socioeconomic burden,” write Inna Kim, MD (Chonnam National University Hospital, Gwangju, South Korea), and colleagues. “Therefore, aggressive pharmacological intervention and lifestyle modification are needed for these patients.”

Michael E. Farkouh, MD, MSc (University of Toronto, Canada), who was not involved in the study, said the results are not surprising and that they reflect the burden of premature CAD and competing risks.

“Younger patients are much more likely to survive an acute MI and go on to have another event, whereas older folks may die from the event so their likelihood of having a repeat event is much lower,” he noted in an interview with TCTMD.

Farkouh said another important problem that the study highlights is with regard to issues of prescribing and taking secondary prevention, which may need to be studied as a quality metric in this population.

“Their LDL cholesterol may not be at target, they may not be on a high-dose statin, they may not be taking their dual antiplatelet therapy, blood pressure may not be under control. All those issues are what causes problems in the long term,” he said. “Compliance and adherence is a big question in younger people, because once they’re treated they may believe that they’re ‘back to normal’ and they’re not. There also is a sense of denial in younger patients.”

Repeat Events Highest in Those With Metabolic Syndrome Below Age 40

For the study, published online April 11, 2018, ahead of print in the American Journal of Cardiology, Kim and colleagues examined data on 2,082 patients enrolled in the COREA-AMI registry. Of these, 18.4% were under age 50. Metabolic syndrome was present in 43.4% of younger patients and in 47.6% of those aged 50 or older. Compared with the older acute MI patients, those under age 50 were more often male and were more likely to have a family history of CAD, have higher triglyceride and LDL cholesterol levels, and be current smokers.

Patients age 50 and older who had metabolic syndrome had higher overall rates of MACCE, all-cause death, and cardiac death than did older patients without metabolic syndrome and younger patients with or without metabolic syndrome. However, repeat MI was most frequent in younger patients with metabolic syndrome. Additionally, being a young MI patient and having metabolic syndrome together were an independent predictor of having a repeat event within 6 years (HR 5.70; 95% CI 1.86-17.5). Individuals with the highest rate of repeat events were those between the ages of 25 and 40 years old with metabolic syndrome.

When the researchers looked at the individual components of metabolic syndrome (abdominal obesity, hypertriglyceridemia, low HDL cholesterol, hypertension, and impaired fasting glucose or diabetes diagnosis), none showed a significant impact on the incidence of repeat MI events. Rather, it was having metabolic syndrome as a whole that increased the likelihood of MACCE and repeat events in younger patients.

“As cardiologists we don’t see these patients until they have the MI. We need to work with primary care docs and people in the community to treat and prevent metabolic syndrome,” Farkouh observed. “A lot of these people are diabetic and they don’t even know they’re diabetic until they have an event.”

Kim and colleagues note that limited data exist regarding the prognostic role of metabolic syndrome in young patients with acute MI. Farkouh agreed, adding that more studies are needed. But by and large, he reiterated, much of the change needs to be made at the patient level.

“I have no doubt that there are some doctors that aren’t as aggressive as others, both in the acute setting and in secondary preventions,” Farkouh said. “But this is also an education issue and system issue.” More work may be needed to “flag” patients with metabolic syndrome for optimization of therapies, he added, and to ensure that they understand their heightened risk and the importance of complying with prescribed medications.

“These are the patients we sweat about,” he said. “We know that they’re at very high risk . . . but they may not know it.”