Study Suggests MI Prevention Efforts Slipping, as Certain Risk Factors Creep Higher

Troubling new data suggest that efforts at preventing MI may be backfiring. Rather than showing a downward trend over the last two decades, they show that a handful of the most important—and most modifiable—risk factors have actually increased. 

“Very amazingly, what we found was that the patients presenting with myocardial infarction were getting younger,” said Samir Kapadia, MD (Cleveland Clinic, Cleveland, OH), in a press briefing ahead of the American College of Cardiology Annual Scientific Sessions in Chicago. In the study, scheduled to be presented at the meeting on April 4, 2016, Kapadia and colleagues found that not only has the average age of patients experiencing MI decreased from 64 years to 60, other risk factors including smoking have risen dramatically. 

To determine differences in risk factors among patients presenting with STEMI over time, the researchers examined data on 3,912 consecutive patients (42.5% anterior, 57.5% inferior) presenting to the Cleveland Clinic from 1995 through 2014. Of these, 34% had a prior diagnosis of CAD.

Unexpected and Contrary Results

Patients were divided into four groups according to date of presentation: 1995-1999, 2000-2004, 2005-2009, and 2010-2014. Risk factors were assessed for the entire cohort and for the CAD population.

Across those time periods, the proportion of STEMI patients who had hypertension, obesity, (BMI > 30), and diabetes steadily increased. Most alarming of all, the percentage of self-reported current smokers jumped by more than 60%

Furthermore, when trends were compared between the entire cohort and the subset with known CAD, the findings were the same.

Kapadia called the results “unexpected,” adding that clinicians most likely think they are doing a better job at disease prevention. They run contrary, he noted, to what his group initially believed they would find in the contemporary population compared to 20 years ago.

“The implication . . . is that we have to extend and put a lot of effort [into] educating patients,” Kapadia said. Simply telling people to diet and exercise is not enough, he adding. Instead, a “very structured program of preventive cardiology” is needed to show them how to carry out the lifestyle changes that are necessary to decrease their risk. Both cardiologists and primary care physicians need to be involved and focused on helping the patient make the changes, he added.

Work Needed in Risk Assessment, Data Comparison

In the telebriefing, ACC Vice President Mary Norine Walsh, MD (St. Vincent Heart Center, Indianapolis, IN), who moderated the call, described the finding as “very disheartening news” and asked Kapadia if a regional phenomenon could account for the findings considering that all patients were from one institution.

He responded that his group cannot be sure if the findings are generalizable to the entire country, but said they hope to confirm the results through the National Cardiovascular Data Registry and National Inpatient Sample databases.

To TCTMD, Walsh said that would be an appropriate next step, but she cautioned that whether or not the findings apply to the population as a whole “is a big open question.” Not only were the patients a select group geographically, she noted, the cohort included both those who were taken to the hospital by medical transport as well as those who elected to go.

“It’s very much a study that should prompt others to look at their own data, and in datasets that include multiple institutions, not just a single one,” Walsh observed. “The smoking data in particular need to be looked at further, because we know that smoking rates are lower as a whole than they were 20 years ago and they continue to decrease yearly. . . . [But] this particular group of patients doesn’t show that.” Similarly, she said, studies have shown that hypertension control is improving but “disturbingly in this patient population, the risk was quite high.”

For clinicians, Walsh said one of the main messages is that improvements are needed in risk assessment of patients with CAD who have and have not had an MI. “One of the big takeaways to me,” she concluded, “is to make sure that people who’ve had an MI are seen in cardiac rehab, because we know that people who attend live longer and do better from a standpoint of morbidity and staying out of the hospital.”

Source:

• Mentias A, Barakat AF, Raz MQ, et al. An alarming trend change in risk profile of patients with ST elevation myocardial infarction over the last two decades. Presented at: American College of Cardiology Scientific Session; April 4, 2016; Chicago, IL. 

Disclosures:

• Kapadia reports no relevant conflicts of interest. 
• Walsh reports consultant fees/honoraria from Amgen, Janssen Pharmaceuticals, Minnetronix, Novartis, Roche, Thoratec, and United Health Care. 

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