Heart Attack Patients Getting Younger and More Obese

Heart diseases, particularly heart attack, are one of the leading causes of mortality around the world. Owing to extensive research on cardiovascular diseases, significant advances have been made to understand the nature of heart diseases, their risk factors and their prevention. Even then, one of the recent studies has discovered that younger and more obese patients are succumbing to heart attack. Many of the risk factors in these patients have been found to be preventable.  

This study was undertaken to understand the population dynamics of heart attack. It was carried out at Cleveland Clinic between 1995 and 2014 by Samir Kapadia, M.D. and his fellow investigators. The results of the study were recently presented at the American College of Cardiology's 65th Annual Scientific Session.

During the course of the study, medical records of more than 3,900 patients who were treated for ST-elevation myocardial infarction (STEMI) were analyzed. STEMI heart attack is the worst form of heart attack and results from the complete blockage of blood vessels supplying the heart by plaque.

The researchers divided the records of Cleveland Clinic's STEMI patients from 1995 to 2014 into four categories, each spanning 5 years.

Shift in the Dynamics of Risk Factors for Heart Attack

When the baseline risk factors and the health of the patients in each of the four categories were analyzed, some astonishing figures came to light. It was found that the average age at which patients develop STEMI has decreased from the age of 64 to 60. The prevalence of obesity was found to increase from 31 to 40 percent between the first five-year span and the last five-year span.

The number of patients with co-existing diabetes increased from 24 to 31 percent. The proportion of population with high blood pressure grew from 55 to 77 percent. The proportion of patients with chronic obstructive pulmonary disease rose from 5 to 12 percent.

One of the most remarkable findings was the change in smoking rate which increased from 28 to 46 percent, which demonstrated an overall decrease in the rate of smoking over the last 20 years and was the only shift that contradicted the national trends; all the other figures of the study matched the national trends. The study showed that the number of patients with multiple risk factors has also increased from 65 to 85 percent.

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The Future Implications

The study has helped find the trends of cardiovascular diseases, especially heart attack. It is expected that with better understanding of their condition and risk factors, high risk patients will be able to adopt an active approach for the prevention of heart attack. This way, the patients will be able to take ownership of their own condition which means adopting a heart-healthy lifestyle. Among the preventable risk factors for heart attack are exercise, smoking and a heart-healthy diet.

According to Dr. Kapadia, prevention constitutes the core of primary care. The primary care physicians and the patient both need to own this problem in order to tackle it heads-on.

Statins Prevent Heart Attacks in Low-Risk Patients

Statins have long been used to lower the levels of cholesterol in the body. They have been in use for the secondary prevention of cardiovascular diseases to lower the mortality in patients with pre-existing heart diseases. A new study has found that statins can prevent heart attack and stroke in patients at moderate risk of heart diseases.

The findings of this study called HOPE-3 trial were presented at the 65th Scientific Session of the American College of Cardiology (ACC) in Chicago. This trial included 12,705 men and women above the age of 55 years from six continents. All of the subjects had at least one risk factor for cardiovascular diseases like family history of heart diseases, smoking, uncontrolled diabetes etc. and had never been diagnosed with heart diseases before.

During the course of the study, the patients were randomized into four categories- those receiving both a cholesterol lowering and a BP-lowering medication, those receiving a cholesterol drug plus placebo, those receiving a BP drug plus placebo, and those receiving 2 placebos. The trail was conducted prospectively for 5.6 years.

Statins: The Miracle Drugs for Heart Attack Prevention

The results of the study were quite astonishing. Among patients who took both statins and blood pressure reducing drugs, the chances of heart attack and stroke were about 3.5% of the patients as compared to 5% of the study participants who were given the placebo. The overall risk reduction came out to be 30%, including 40% for those with elevated blood pressure and 20% for those who did not have elevated blood pressure.

In patients taking statins only, 3.7% of the patients developed heart attack and stroke as compared with 4.8% of placed on the placebo. In the statin group, 4.4% reached another terminal point, a comination of deaths along with heart failure, resuscitated cardiac arrest and revascularization as opposed to the  5.7% taking placebo.

In patients taking statins the low-density lipoprotein (LDL) cholesterol level dropped by 39.6 mg/dL (nearly 25%) after one year. It was found that statins lower the risk of heart attack irrespective of the ethnicity.

 Regardless of the level of LDL cholesterol of the patient before starting statin therapy, statins lowered the circulating levels of cholesterol. This is thought to be the key mechanism by which statins prevent heart attacks and not just be controlling the blood pressure.

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The response of the patients to blood pressure medications was quite diverse. Patients with systolic levels more than 143 mm Hg showed reduced cardiovascular events. Patients in the other subgroups did not show a significant response. Patients with lowest blood pressures were also found to be at a some degree of harm.

Statins Declared Safe for Use

The study proved that statins are quite safe for the prevention of heart attack in low and moderate-risk patients. This study has shown that a wide range of patients will benefit from statins. Also, no additional baseline blood tests will be required to identify the patients who will gain from statins therapy since they have been proven advantageous in all patients irrespective of their starting LDL levels.

According to Valentin Fuster, MD, of Mount Sinai Hospital, this study has filled a gaping hole in the knowledge. It has, certainly, proved to be a turning point for heart attack prevention programs.