Younger MI Survivors May Face Premature Heart Disease Death

For patients age 50 years and younger, the risk of premature death after myocardial infarction (MI) has dropped significantly over the last 30 years, but their risk is still almost twice as high when compared to the general population, largely due to heart disease and other smoking-related diseases, according to a new study.

The researchers conducted a nationwide population-based cohort study using prospectively collected medical data from all hospitals in Denmark from 1980-2009. They examined 30-year cause-specific death rates among 21,693 MI patients <50 years vs 216,930 sex- and age-matched people from the general population. The investigators calculated mortality rate ratios (MRRs) based on Cox regression.
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Between 1980-1989 and 2000-2009, MI mortality declined from 12.5%-3.2% within 30 days, 5.1%-1.6% within 31-365 days, and 24.2%-8.9% within 1-10 years. Compared with the general population, the MRR adjusted for sex, age, and cardiovascular and noncardiovascular comorbidity decreased 4.5-fold within 30 days (from 468-97), 3-fold within 31-365 days (from 11.32-3.70), and 2.5-fold within 1-10 years (from 4.77-1.89). The remaining 1.89-fold increased mortality rate among 1-year survivors in 2000-2009 corresponded to 6 additional deaths each year per 1000 patients compared with the general population.

Long-term causes of death were primarily cardiovascular and chronic pulmonary diseases. The excess 10-year MRR among 1-year survivors was consistent within MI subtypes, did not differ substantially between comorbidity categories, but was higher for women than men (3-fold vs 1.7-fold).

“Patients with a heart attack in young age should be advised that an excess risk of fatal events persists, warranting compliance to their prescribed medicine and efforts to reduce modifiable lifestyle-related risk factors, particularly smoking,” said study lead author Morten Schmidt, MD, PhD, of the department of clinical epidemiology, Aarhus University Hospital, in Denmark.

The researchers will continue to work on gaining insights into prognostic factors for MI outcome, he said.

—Mike Bederka

Reference:

Schmidt M, Szépligeti S, Horváth-Puhó E, et al. Long-term survival among patients with myocardial infarction before age 50 compared with the general population: a Danish nationwide cohort study [published online Aug. 30, 2016]. Circ Cardiovasc Qual Outcomes. doi: 10.1161/CIRCOUTCOMES.115.002661.