Surprising risk factors may predict heart attacks in young women

Date:
May 4, 2022
Source:
Yale University
Summary:
A new study has for the first time identified which risk factors
are more likely to trigger a heart attack or acute myocardial
infarction (AMI) for men and women 55 years and younger.



FULL STORY ==========================================================================
A new Yale-led study has for the first time identified which risk factors
are more likely to trigger a heart attack or acute myocardial infarction
(AMI) for men and women 55 years and younger.


========================================================================== Researchers discovered significant sex differences in risk factors
associated with AMI and in the strength of associations among young
adults, suggesting the need for a sex-specific preventive strategy. For example, hypertension, diabetes, depression, and poverty had stronger associations with AMI in women compared with men, they found.

The study was published May 3 inJAMA Network Open.

While heart attacks are often associated with older adults, this
population- based case-control study examined the relationship between
a wide range of AMI- related risk factors among younger adults. The
researchers used data from 2,264 AMI patients from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) study and 2,264 population-based controls matched for age,
sex, and race from the National Health and Nutrition Examination Survey (NHANES).

The key finding is that young men and women often have different risk
factors.

Seven risk factors -- including diabetes, depression, hypertension or high blood pressure, current smoking, family history of AMI, low household
income, and high cholesterol -- were associated with a greater risk of
AMI in women.

The highest association was diabetes, followed by current smoking,
depression, hypertension, low household income, and family history
of AMI. Among men, current smoking and family history of AMI were the
leading risk factors.

Rates of AMI in younger women have increased in recent years said Yuan
Lu, an assistant professor at Yale School of Medicine and the study's
lead author.



========================================================================== "Young women with AMI are an unusual or extreme phenotype on account of
their age," she said. "In the past, we found that young women, but not
older women, have a twice higher risk of dying after an AMI than similarly
aged men. In this new study, we now identified significant differences
in risk factor profiles and risk factor associations with AMI by sex."
Analysis of population attributable risk was used to measure the impact different risk factors at the population level. The study found that
seven risk factors, many potentially modifiable, collectively accounted
for majority of the total risk of AMI in young women (83.9%) and young
men (85.1%). Some of these factors -- including hypertension, diabetes, depression, and poverty - - have a larger impact on young woman than
they do among young men, Lu and her colleagues found.

"This study speaks to the importance of specifically studying young
women suffering heart attacks, a group that has largely been neglected
in many studies and yet is about as large as the number of young women diagnosed with breast cancer," said Dr. Harlan M. Krumholz, the Harold
H. Hines Jr. Professor of Medicine at Yale, director of the Center for
Outcomes Research and Evaluation (CORE), and senior author of the paper.

Raising awareness among physicians and young patients is a first
step, researchers said. National initiatives, such as the American
Heart Association's "Go Red for Women" campaign, should be expanded to
increase awareness about cardiovascular disease risk in young women, they
said. Health care providers also need to identify effective strategies
to improve optimal delivery of evidence-based guidelines on preventing
AMI. For example, risk prediction tool for individual patients could
help physicians identify which individuals are most at risk and develop treatment strategies.

Accounting for AMI subtypes may also be effective. The researchers found
that many traditional risk factors including hypertension, diabetes,
and high cholesterol, are more prevalent in type-1 AMI, whereas different
AMI subtypes - - including type-2 AMI (a subtype associated with higher mortality) -- are less common.



==========================================================================
"We are moving more towards a precision medicine approach, where we are
not treating each patient the same, but recognizing that there are many different subtypes of AMI," Lu said. "Individual-level interventions are
needed to maximize health benefits and prevent AMI." The study is among
the first and the largest in the United States to comprehensively evaluate
the associations between a wide range of predisposing risk factors and
incident AMI in young women and a comparable sample of young men. The
study design also included a comparable population-based control group
from the National Health and Nutrition Examination Survey, a program
to assess demographic, socioeconomic, dietary, and health-related
information.

A longitudinal study is traditionally used to assess AMI risk in younger populations. Because the incidence rate is low in young people, however,
it takes a long time for the disease to manifest. So researchers often
don't have enough AMI events to make inferences about risk factors and
their relative importance in young women and men, said Lu.

"Here we used a novel study design with a large cohort of patients
with AMI and then we identified age-sex-race matched population control
from a national population survey to compare this with, and we used a case-control design to evaluate the association of these risk factors with AMI," said Lu. "This is one of the first and largest studies to address
this issue comprehensively." In the United States, hospitalization rates
for heart attacks have been decreasing with time, according to research
in the journal JAMA Cardiology.

"However, if you analyze the proportion of these patients by age, you
will find that the proportion of younger people who are hospitalized for
heart attack is increasing," said Lu. "So it seems there's a general
trend for AMI to happen earlier in life, so that makes prevention of
heart attack in younger people, especially important." Younger women
represent about 5% of all heart attacks that occur in the U.S.

each year. "This small percentage effects a large number of people because
so many AMIs occur in the US each year," she said. "There about 40,000
AMI hospitalizations in young women each year, and heart disease is the
leading cause of death in this age group." Lu emphasized the importance
of education. "When we talk about heart attack in young women, people are
often not aware of it," she said. "If we can prevent women from having
heart attacks that will improve outcomes." Raising awareness about the incidence of heart attacks in younger women is a key part of the strategy,
she said. The next frontier of cardiovascular disease prevention in young
women could be better understanding the role of women- related factors.

Previous studies have shown that women-related factors may be associated
with risk of heart attack, but there is limited data on women under the
age of 55.

"We hope to explore women-related factors including menopausal history, pregnancy, menstrual cycle, and other factors that are specifically
related women and analyze whether that's contributing to the risk of
heart attack," she said.

The study team also included Shu-Xia Li, Yutian Liu, Rachel P. Dreyer,
Rohan Khera, Karthik Murugiah, Gail D'Onofrio, Erica S. Spatz, all from
Yale; Fatima Rodriguez from Sandford University; Karol E. Watson from
the University of California, Los Angeles; and Frederick A. Masoudi from Ascension Healthcare.

The VIRGO study was funded by the US National Institutes of Health.


========================================================================== Story Source: Materials provided by Yale_University. Original written
by Elisabeth Reitman.

Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Yuan Lu, Shu-Xia Li, Yuntian Liu, Fatima Rodriguez, Karol E. Watson,
Rachel P. Dreyer, Rohan Khera, Karthik Murugiah, Gail D'Onofrio,
Erica S.

Spatz, Khurram Nasir, Frederick A. Masoudi, Harlan M. Krumholz. Sex-
Specific Risk Factors Associated With First Acute Myocardial
Infarction in Young Adults. JAMA Network Open, 2022; 5 (5):
e229953 DOI: 10.1001/ jamanetworkopen.2022.9953 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/05/220504130820.htm

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