MSGID: 1:317/3 6273534b   
   PID: hpt/lnx 1.9.0-cur 2019-01-08   
   TID: hpt/lnx 1.9.0-cur 2019-01-08   
    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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