Acute myocardial infarction in the young— The University of Michigan experience ☆

Myocardial infarction in young patients

Despite the recent decline in mortality from coronary heart disease (CHD), this disease remains the leading killer of US adults of all ages. CHD in young adults is not as well characterized as CHD in older individuals because it occurs less frequently, but this disease can have devastating consequences for young patients and their families. As in older adults, the majority of coronary events in young adults are related to atherosclerosis, and one or more of the traditional CHD risk factors is typically present. Young patients, however, are more likely than older patients to be smokers, male, obese, and to have a positive family history. Risk factor reduction is thus of major importance in managing young CHD patients. Approximately 20% of CHD in young adults, however, is related to non-atherosclerotic factors, such as coronary abnormalities, connective tissue disorders, and autoimmune diseases. Cocaine and other illicit drug use have been increasingly associated with acute myocardial infarction and accelerated atherosclerosis. The differences in etiologies and risk profiles of younger and older CHD patients result in differences in disease progression, prognosis, and treatment. Limited data suggest that prognosis may be better in the young population, although long-term mortality studies have suggested otherwise. Screening for CHD in the young population may help to improve prognosis in young patients by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.

Coronary Heart Disease in Young Adults

Atherosclerosis starts in childhood, and is accelerated in some individuals. A cluster of clinical and biochemical factors constitute the risk profile for many of them, perhaps most important being metabolic insulin resistance syndrome. Insulin resistance and its components for children and adolescents, especially obesity and dyslipidemia, are generators of hypertension, glucose intolerance and complications of atherosclerosis in adulthood. Some individuals are genetically predisposed, particularly those with the family history of such disorders. For many subjects, there is 'tracking' of metabolic and lifestyle factors from early age to adulthood. Several new risk factors of atherosclerosis (e.g. level of lipoprotein (a), procoagulant state, hyperhomocysteinemia, low birth weight and adverse in-utero environment, and possibly inflammatory markers) are current and potentially future areas of research concerning children and young individuals. Definition of and research on new and hitherto not investigated factors and formulation of strategies to neutralize the known factors are of paramount importance for primary prevention of atherosclerosis. Simple and effective measures for prevention include increasing awareness of the diseases, maintenance of ideal body weight, regular physical exercise, avoidance of smoking and chewing of tobacco, eating a balanced diet, and early periodic monitoring of blood pressure and metabolic status. These measures, starting from childhood, should be applied to all and in particular to the susceptible offspring, predisposed individuals, and populations.

Risk factors for atherosclerosis in young individuals.

Objective -Acute myocardial infarction (AMI) in adult patients under the age of 45 is relatively unusual. Recent studies have shown a higher prevalence of AMI in young South Asian migrants. Data on South Asians in South Asia on cardiovascular disease (CVD) patients is lacking.The purpose of this study is to look at the classical risk factors of coronary artery disease (CAD) in young men and women and their older counterparts who presented to the emergency service of the Aga Khan university hospital (AKUH) and were diagnosed with AMI. Methods - 976 consecutive patients admitted to AKUH with AMI between January 2000-December 2002 were divided into two groups: 45 years (old). Demographic factors, clinical symptoms and presence of risk factors for CAD were recorded with the help of pre-tested data extraction forms. Results - Young patients represented 16.1% of all patients with AMI. 93.1% of the young patients were men.Young male patients were more likely to be smokers and have high cholesterol levels as compared to their young female counterparts. Young AMI patients when compared to old AMI patients, were more likely to have hypertension, positive family history of coronary artery disease, high cholesterol, high LDL and high triglycerides. Conclusion - In this study, the risk factor profile between young and old patients and between the two genders was found to be different. Thus adult management protocols for AMI should be different from the ones for older patients and gender difference should also be considered.

CAD risk factors and acute myocardial infarction in Pakistan.

A review was done on 631 patients with acute myocardial infarction who underwent coronary angiography within 30 days after onset of myocardial infarction at Yonsei University Severance Hospital from January, 1985, to August, 1993. The incidence of acute myocardial infarction in patients under 40 years of age was 10.3% (65/631). Acute myocardial infarction below the fourth decades was the predominant disease of men. Risk factor analysis revealed a history of cigarette smoking and hypercholesterolemia were more frequently found in the young patients, but a history of hypertension and diabetes were more frequently found in the elderly patients. Angiographically, the incidence of one vessel disease and normal or minimal lesion coronary anatomy were more frequent in the young patients and incidence of multi-vessel disease were more frequent in the elderly patients. Of the 65 patients under 40 with acute myocardial infarction, the patients with multi-vessel disease tended to have a history of diabetes mellitus in comparison with those with normal coronary anatomy or one vessel disease.

K. J. Chang

Papers

Acute myocardial infarction in the young adults.