ESC 2021: The Risk of Young-onset Heart Attack May Go Beyond Family History

Younger adults with myocardial infarction (MI) are more likely to be smokers, obese, and have hypertension compared to their peers, according to findings from a new study being presented at the European Society of Cardiology (ESC) Congress 2021, being held virtually between August 27-30, 2021.

The study suggests that although family history is associated with cardiovascular events at a young age, it is not the only contributing factor.

“The findings underline the importance of preventing smoking and overweight in children and adolescents in order to reduce the likelihood of heart disease later in life,” said study author Professor Harm Wienbergen, Bremen Institute for Heart and Circulation Research, Germany, in an ESC press release.

“Understanding the reasons for heart attacks in young adults is important from a societal perspective due to their employment and family responsibilities,” Wienbergen continued. “However, there are limited data on the predictors of heart events in this group.”

Researchers compared the clinical characteristics of consecutive patients aged ≤45 years admitted to hospital with MI with a randomly selected group of individuals from the general population in the same geographic region in Germany. Cases and controls were matched according to age and gender.

A total of 522 patients were enrolled from the Bremen STEMI registry and 1191 matched controls were identified from the German National Cohort.

Researchers found that the proportion of active smokers was more than 3-fold higher in younger patients with MI compared to the general population (82.4% vs 24.1%, p<.01). In contrast, the proportion of persons consuming alcohol at least 2 times per week was higher in the control group (36.6%) than in the MI-patient group (19.9%, p<.01).

The MI-patient group, compared to the control group, was more likely to have hypertension (25.1% vs 0.5%, p<.01), diabetes mellitus (11.7% vs 1.7%, p<.01), and a parental history of premature MI (27.6% vs 8.1%, p<.01). Also, patients with MI were more often obese, with a median body mass index (BMI) of 28.4 kg/m² compared to 25.5 kg/m² for controls (p<.01).

In a multivariable analysis, researchers observed that hypertension or diabetes, active smoking, family history, and a BMI ≥ 30 kg/m² were strong predictors for the occurrence of MI at a younger age, while alcohol consumption was a protective factor. The analysis was adjusted for age, sex, birth in Germany, years of school education, hypertension, diabetes mellitus, active smoking, BMI, and alcohol intake.

“Our study suggests that family history is not the only predisposing factor for early heart attacks. The findings add impetus to the argument that young people should be educated about why it is important to avoid smoking and have a healthy body weight,” stated Wienbergen in the press release.