Despite increased understanding of heart disease risk factors and the need for preventive lifestyle changes, patients suffering the most severe type of heart attack have become younger, more obese and more likely to have preventable risk factors such as smoking, high blood pressure, diabetes type two and chronic obstructive pulmonary disease, according to a study scheduled to be presented at the American College of Cardiology’s 65th Annual Scientific Session, Chicago, USA.
The new study analysed heart disease risk factors among more than 3,900 patients who were treated for ST-elevation myocardial infarction (STEMI) at the Cleveland Clinic (Cleveland, USA) between 1995 and 2014.
“On the whole, the medical community has done an outstanding job of improving treatments for heart disease, but this study shows that we have to do better on the prevention side,” says Samir Kapadia, professor of medicine and section head for interventional cardiology at Cleveland Clinic and the study’s primary investigator. “When people come for routine checkups, it is critical to stress the importance of reducing risk factors through weight reduction, eating a healthy diet and being physically active.”
The researchers divided the records of the Cleveland Clinic’s STEMI patients from 1995 to 2014 into four quartiles, each representing a span of five years. Analysing the baseline risk factors and health conditions of patients in each grouping, they found the average age of STEMI patients decreased from 64 to 60, and the prevalence of obesity increased from 31 to 40% between the first five-year span and the last five-year span.
The proportion of patients with diabetes increased from 24 to 31%, the proportion with high blood pressure grew from 55 to 77%, and the proportion with chronic obstructive pulmonary disease rose from 5 to 12% over the same period. All changes were statistically significant.
One of the most striking findings, according to study authors, was the change in smoking rates, which increased from 28 to 46%—a finding counter to national trends, which reflect an overall decline in smoking rates over the past 20 years. All of the other risk factor trends seen in the study were in line with national trends.
The study also revealed a significant increase in the proportion of patients who have three or more major risk factors, which grew from 65 to 85%. Kapadia said the findings carry strong messages for both the medical community and the general public.
“Prevention must be kept in the forefront of primary care,” Kapadia says. “Cardiac health is not just dependent on the cardiologist. The primary care physicians and the patient need to take ownership of this problem.”
One caveat to the study is that because helicopter transports brought a greater number of patients to the Cleveland Clinic from surrounding rural areas during the course of the study period, it is possible that the observed trends reflect changes in the hospital’s patient population. Study authors said this factor is likely to only have had a minor effect, if any.
The study was self-funded by the Cleveland Clinic.
