Recent trends in acute myocardial infarction among the young

Abstract

Purpose of review: In recent decades, the incidence of myocardial infarction (MI) has declined among the general population. However, MI rates in the young have not decreased as much as has been observed among older individuals. This review will focus on recent trends of MI in young patients, factors that may account for these trends, and implications for future prevention.

Recent findings: MI rates in young patients, particularly in women, have not decreased in the same fashion as they have for their older counterparts, with some studies reporting an increase. The reasons for these findings include underestimation of cardiovascular risk, and accordingly treatment, in the young, as well as an increasing prevalence of risk factors such as obesity and diabetes.

Summary: Better recognition and treatment of cardiovascular risk factors among young adults may improve outcomes. There is a need for improved methods to assess and treat cardiovascular risk in young individuals.

Conflict of interest statement

Conflicts of Interest: Dr. Blankstein receives research support from Astellas Inc and Amgen Inc. The remaining authors have nothing to disclose.

Figures

Figure 1.

Trend in the proportion of very young myocardial infarction patients in the Young-MI Registry (2006–2016) – there is a significant average increase of 1.7% per year in proportion of young (40 years of age) individuals presenting with a type 1 myocardial infarction from 2007 to 2016.

Figure 2.

Leading causes of myocardial infarction among young individuals – substance use, tobacco use, type 2 diabetes, obesity, elevated lipids, and positive family history are major risk factors for myocardial infarction among young adults.

Figure 3.

Annual incidence rates for all-cause death and cardiovascular death – observed annual death and cardiovascular death rates are shown by drug of abuse in 100 person-years.

Figure 4.

All-cause mortality in young adults following type 1 myocardial infarction stratified by diagnosis of diabetes – Kaplan–Meier curves of all-cause mortality in patients without diabetes, diabetes not receiving insulin, and diabetes receiving insulin. Unadjusted hazard ratio 1.61, 95% confidence interval 1.13–2.32, P ¼ 0.009; adjusted hazard ratio 1.48, 95% confidence interval 0.88–2.45, P ¼ 0.133. ^ Unadjusted hazard ratio 2.08, 95% confidence interval 1.35–3.20, P ¼ 0.001; adjusted hazard ratio 1.40, 95% confidence interval 0.85–2.30, P ¼ 0.182. # Unadjusted hazard ratio 3.34, 95% confidence interval 2.42–4.59, P