Pattern of Standard Modifiable Risk Factors and Outcomes in Very Young Patients with Myocardial Infarction

BackgroundThe incidence of myocardial infarction (MI) is rising among young individuals. This study aimed to identify the profile of standard modifiable risk factors (SMuRFs) and their impact on long-term survival in very young MI patients ([≤]35 years). MethodsThe VYTAL-MI study (Very Young Tracking and Analysis of Long-term Myocardial Infarction Outcomes) is a retrospective cohort analysis of MI patients aged [≤]35 years, admitted to Beijing Anzhen Hospital and Peking Union Medical College Hospital between December 11920, 2011, and December 11920, 2021. SMuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were documented. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, recurrent MI, ischemia-driven revascularization, and ischemic stroke. Cox proportional hazard models were used to assess associations between SMuRFs and outcomes. ResultsAmong 690 patients (median age 33 years [interquartile range, IQR: 30-34]; 95% male), only 8% had no SMuRFs. Smoking was most common (76%), followed by hypercholesterolemia (43%), hypertension (40%), and diabetes (12%). The most frequent combination was smoking and hypercholesterolemia (16.4%). Over a median follow-up of 6.3 years (IQR: 4.0-8.6), MACCE occurred in 165 patients (23.9%). Patients with [≥]3 SMuRFs had significantly higher cumulative hazards (P=0.003). Hypertension (hazard ratio, HR: 1.50; 95% confidence interval, CI: 1.09-2.06; P=0.014) and diabetes (HR: 1.67; 95% CI: 1.10-2.54; P=0.016) were independently associated with increased risk, while hypercholesterolemia (HR: 1.24; 95% CI: 0.91-1.68; P=0.177) and smoking (HR: 1.06; 95% CI: 0.72-1.55; P=0.776) showed no significant association. ConclusionsVery young MI patients exhibited a high burden of SMuRFs, particularly smoking. Hypertension and diabetes increased long-term event risk. Targeted SMuRF management is essential to improve survival in this population. What is knownO_LITargeting standard modifiable cardiovascular risk factors, including hypertension, diabetes, hypercholesterolemia, and smoking, is crucial for improving outcomes in myocardial infarction. C_LIO_LILimited data exist on the pattern of standard modifiable risk factors in very young myocardial infarction patients aged [≤]35 years, and how these factors influence long-term outcomes. C_LI What the study addsO_LIVery young myocardial infarction patients exhibited a substantial burden of standard modifiable risk factors, with smoking being notably prevalent. C_LIO_LIIncreased standard modifiable risk factors exposure was associated with an elevated risk of major adverse cardiovascular and cerebrovascular events C_LIO_LIHypertension and diabetes were linked to a higher risk of major adverse cardiovascular and cerebrovascular events, while smoking and hypercholesterolemia did not show a significant independent effect. C_LI Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR2400085600.