Risk of MI in young women

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Women aged 45 years and under with diabetes have a six-fold risk of heart attack, according to research presented at the recent ESC Congress. The study in more than 7,000 women also found that young women who had a heart attack (myocardial infarction, MI) were more likely to be smokers than older women with MI.

"Cardiovascular diseases (CVDs) affect mainly the elderly, but for many years an increase in incidence has been observed in young people as well, regardless of gender," said Professor Hanna Szwed, last author and head of the 2nd department of coronary artery disease, Institute of Cardiology in Warsaw, Poland. "The World Health Organisation estimates that CVDs cause more than 52% of all deaths in women and the number continues to rise. Up to 1% of all heart attacks are in young women."

This study in 7,386 women assessed the effect of risk factors on MI incidence in young women and assessed differences related to age. The epidemiological profile of 1,941 young women (aged ≤45 years) with MI was retrospectively compared with two control groups: 4 275 women aged 63-64 years with MI and 1 170 healthy women (no MI history) aged ≤45 years.

The study used data from three national registries. Data on women with MI came from the Polish Registry of Acute Coronary Syndromes (PL-ACS). Information on healthy women was from the Multicentre Study of State National Population Health (WOBASZ) and the National Survey of Risk Factors for Cardiovascular Diseases (NATPOL).

The average age among young MI patients in the study was 42 years (range 21-45 years). Multivariate analysis showed that four out of five classic risk factors were independent predictors of MI in young women. The strongest was diabetes which increased MI risk by six-fold. Arterial hypertension increased risk by four times while hypercholesterolemia tripled risk and current smoking increased risk by 1.6 times. There was no statistical significance for obesity expressed by body mass index (BMI).

Szwed said: "The lack of a correlation with obesity could be because of the overwhelming influence of diabetes in this population. We also found that the risk of MI in young women increased with the number of coexisting factors."

The researchers found that young healthy women had an average of 1.1 risk factors while young MI patients had 1.7 and older women with MI had 2.0. Compared to young healthy women, young women with MI more often had arterial hypertension, hypercholesterolemia and diabetes and were current or past smokers (Figure 2).6

In the population of older women with MI, the prevalence of nearly all individual risk factors was even greater than in young women with MI. Smoking was the only risk factor with a greater prevalence in the younger group (48.7% vs.22.2% p

Szwed concluded: "At present there are not enough global scientific reports focused on the problem of coronary heart disease in young populations, particularly in women. More research is needed into this growing problem to deepen our knowledge, improve prevention efforts and reduce mortality."

Abstract
Background: The coronary artery disease (CAD) mainly affects elderly people, but also more and more young people get sick. It is estimated that every 20th person with CAD is under the age of 45, and only 20% of them are women. The literature concerning this matter is rather limited.
The aim of this study was to determine the profile of risk factors predisposing to ACS in young women under the age of 45 years.
Methods: The study group includes 1941 women aged ≤45 years with ACS, hospitalized in Polish hospitals pursuing register PL – ACS from 2007 to 2014. The control group are young women, without CAD in history – data collected in NATPOL and WOBASZ registry (n=1170).
Results: In young women with ACS in comparison to control group significantly (p<0,0001) more common occurrence of hypertension (48.8% vs. 16.7%); hypercholesterolemia (36.1% vs.12.5%); obesity (22.3% vs. 15.3%); diabetes mellitus (10.6% vs.1.4%); smoking [currently] (48.7% vs. 40.0%). About 16.5% (n=320) of the women were not burdened with any of the above factors, while 12% had a family history of CAD. Woman with ACS had a higher number of risk factors in comparison to control group (1,7±1,2 vs. 1,1±1,0 p<0,0001). The independent predictors of risk ACS were: hypertension (OR – 4,22 [3,429–5,387][95% CI]); hypercholesterolemia (OR – 3,346 [2,605–4,299] [95% CI]); diabetes mellitus (OR – 6,657 [3,478–1,274][95% CI]); smoking (OR – 1,631 [1,340–1,987] [95% CI]) – for all p<0,001. There was no significance of obesity expressed by BMI (OR – 0,996 [0,975–1,017] [95% CI]).
Conclusions: Diabetes mellitus, hypertension, hypercholesterolemia and smoking increase the risk of ACS in young women, where the strongest factor is diabetes mellitus. Obesity and positive family history of CAD did not increase the risk of heart attack within tested population.

European Society of Cardiology material ESC Congress abstract

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