Risk factors profile of young and older patients with myocardial infarction

Abstract

Myocardial infarction (MI) among young adults (< 45 years) represents a considerable proportion of the total heart attack incidents. The underlying pathophysiologic characteristics, atherosclerotic plaque features and risk factors profile differ between young and older patients with MI. This review article discusses the main differences between the younger and elderly MI patients as well as the different pathogenic mechanisms underlying the development of MI in the younger. Young patients with MI often have eccentric atherosclerotic plaques with inflammatory features but fewer lesions, and are more likely to be smokers, obese, and have poor lifestyle, such as inactivity and alcohol intake. Compared to older MI patients, younger are more likely to be men, have familial-combined hyperlipidemia and increased levels of lipoprotein-a. In addition, MI in younger patients may be related to use of cannabis, cocaine use and androgenic anabolic steroids. Genomic differences especially in the pathways of coagulation and lipid metabolism have also been identified between young and older patients with MI. Better understanding of the risk factors and the anatomic and pathophysiologic processes in young adults can improve MI prevention and treatment strategies in this patient group. Awareness could help identify young subjects at increased risk and guide primary prevention strategies. Additional studies focusing on gene pathways related to lipid metabolism, inflammation and coagulation are needed.

Why Do Marijuana and Synthetic Cannabimimetics Induce Acute Myocardial Infarction in Healthy Young People?

“…In the past five years, cannabis use has been listed among the risk factors of MI (also associated with an increased risk of cardiovascular mortality) in younger patients [ 52 , 53 ] and at least twelve reviews have appeared drawing attention to adverse cardiac effects of cannabinoids ( Table 1 ). They are based on numerous case reports, epidemiologic or retrospective cohort studies encompassing millions of cannabis users, patients or hospitalizations.…”

Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics

“…In addition to the electrical remodeling stimulated by the mechanisms described, ROS have also been demonstrated to contribute to atria structural remodeling. Researchers from Slovakia showed that hydroxyl radicals can alter the myofibrillar protein structure and function, promoting myocardial injury and further contributing to the formation of a fertile substrate for the development of arrhythmias [ 5 , 41 ].…”

“…In this article, an update is presented on the emerging data connecting oxidative stress and inflammation to unfavorable atrial structural and electrical remodeling [ 4 ]. Moreover, it is epidemiologically proven that AF is correlated to several factors that either individually or in combination promote the initial development of the arrhythmia and the episodes that characterize the disease [ 5 , 6 ]. Undoubtedly, aging constitutes the primary factor responsible for the pathogenesis of the arrhythmia [ 5 ].…”

“…Moreover, it is epidemiologically proven that AF is correlated to several factors that either individually or in combination promote the initial development of the arrhythmia and the episodes that characterize the disease [ 5 , 6 ]. Undoubtedly, aging constitutes the primary factor responsible for the pathogenesis of the arrhythmia [ 5 ]. Additionally, arterial hypertension, obesity, diabetes mellitus and genetic factors have also been confirmed by the Framingham studies to be significant predisposing factors of the disease, while multiple dietary components seem to play a protective role reducing the occurrence of AF [ 7 , 8 , 9 ].…”

Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

“…Myocardial autopsies of COVID-19 patients who suffered heart attacks highlighted the probability of viral myocarditis. SARS-CoV-2 myocarditis has been reported as a significant acute ventricular dysfunction coupled with widespread myocardial edema, while cases of fulminant evolution, complicated with pericarditis, pericardial effusion, and consequent cardiac tamponade have been met [ 10 , 11 ]. In this context, reports of cardiac arrhythmias have been made.…”