THE CARDIOVASCULAR RISK FACTORS PROFILE PREDISPOSING TO HEART ATTACKS IN YOUNG WOMEN

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1 Hanna Szwed MD. PhD 2 nd Department of Coronary Artery Disease. Institute of Cardiology. Warsaw, Poland THE CARDIOVASCULAR RISK FACTORS PROFILE PREDISPOSING TO HEART ATTACKS IN YOUNG WOMEN Authors: Maciej Beckowski 1 Lech Polonski 2 Marek Gierlotka 2 Tomasz Zdrojewski 3 Wojciech Drygas 1 Jaroslaw Karwowski 1 Ilona Kowalik 1 Hanna Szwed 1 1. Institute of Cardiology. Warsaw, Poland 2. Silesian Center for Heart Diseases. Zabrze, Poland 3. National Institute of Public Health. National Institute of Hygien. Warsaw, Poland This study received no specific funding. Conflict of interest: none declared.

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3 The aim: to determine the effect of various risk factors on the incidence of MI in the population of young women (<45 yrs) and to assess the differences related to age Material The study used data from three national registries: PL-ACS, NATPOL, WOBASZ A total of 7386 patients were examined PL-ACS n=1941 women < 45 years old with MI PL-ACS n= 4275 women years old with MI WOBASZ + NATPOL n = 1170 women < 45 years old without CAD in history Study group 1941 women aged < 45 years with ACS hospitalized in Polish hospitals pursuing Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2007 to Control group women aged years with ACS hospitalized in Polish hospitals pursuing Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2007 to Control group 2 Young women without CAD in history - data collected from: Multicenter Study of State National Population Health (WOBASZ), n=14769 National Survey of Risk Factors for Cardiovascular Diseases (NATPOL), n=2400

4 PL-ACS 45 y.o N=1941 Baseline characteristic PL-ACS 63-65y.o. N=4275 PL-ACS <45 vs. PL-ACS WOBASZ/NATPOL * N=1170 PL-ACS 45 vs NATPOL/WOBASZ Age 42 (21-45) 63 [63 65] <0.0001* 42 (21-45) Body mass 73.6 ± ± 14.8 < ± 13.2 < Hight 165 ± ± 6 < ± 6 < BMI 26.7 ± ± 5.5 < ± 4.8 < Previous stroke 23 (1.2%) 121 (2.8%) < (0.20%) < Peripheral artery disease 27 (1.4%) 153 (3.6%) < (0.9%) Chronic kidney disease 43 (2.2%) 116 (2.7%) (0.9%) Pulmonary disease 17 (0.9%) 146 (3.4%) < (5.5%) < Family history of CAD 339 (17.5%) 492 (11.5%) < (40.1%) < Hypertension 966 (49.8%) 3340 (78.1%) < (16.8%) < Hypercholesterolemia 700 (36.1%) 1894 (44.3%) < (12.9%) < Diabetes mellitus 203 (10.6%) 1255 (29.9%) < (1.8%) < Obestity 433 (22.3%) 1201 (28.1%) < (15.6%) < Smoking 1270 (65.5%) 1969 (45.1%) < (42.7%)* < Smoking currently 944 (48.7%) 949 (22.2%) < (39.0%) < Number of risk factors 1.7 ± ± 1.1 < ± 1.0. <0.0001

5 The prevalence of risk factors, depending on the age and history of myocardial infarction NATPOL +WOBASZ PL-ACS 45y.o. PL-ACS 63-65y.o. The relationship between the average number of risk factors and the number of heart attacks according to age of patients % of young women with MI numbers of risk factors * p< % * * * * * * * * * * * * 70 65, , ,9 0,8 0,57 1,8 1,5 6,96 1,6 24,94 1,75 2 1,5 1 0,5 0 Hypertension Hyperchol. Diabetes mellitus Obesity Currently Smoking Smoking years old

6 Independent predictors of ACS in young women (<45 yrs old) Odds Ratios with 95% Profile-Likelihood Confifdence Limits ROC Curves for All Model Building Steps Hypertension 4.22 [ ] Hyperchol [ ] Diabetes mellitus 6.66 [ ] Currently smoking 1.63 [ ]

7 Conclusions: 1. The risk factor profile in young women is similar to the older population, with a significant difference in occurrence of tobacco smoking in young woman. 2. The risk of MI in this population increases with the number of coexisting factors 3. The most common risk factor in young women with MI is arterial hypertension. 4. Diabetes mellitus, hypertension, hypercholesterolemia and smoking increase the risk of ACS, but the strongest risk factor is diabetes. 5. Diabetes increases MI risk by six-fold, hypertension by four times, hypercholesterolemia by three times, current smoking by 1.6 times. 6. Obesity do not increase the risk of heart attack in this population At present, there are not enough scientific, global reports which concern the problem of coronary heart disease in young populations, particularly in women.

8 Additional analysis Women with MI <45 y.o. were divided in 2 groups with first ACS in life with one or more ACS in history Women MI < 45 y.o. without MI in the past n=1706 (87.9%) Women MI < 45 y.o. with MI in the past N=235 (12.1%) p Age [yrs] Weight [kg] NS BMI [kg/m2] NS Prior stroke 14 (0.8%) 91 (3.8%) < Peripheral artery disease 18 (1.1%) 9 (3.8%) Chronic kidney disease 29 (1.7%) 14 (6.0%) < Pulmonary disease 15 (0.9%) 2 (0.9%) NS Family history of CAD 228 (16.9%) 51 (21.7%) Hypertension 798 (46.8%) 168 (71.5%) < Hypercholest. 574 (33.6%) 126 (53.6%) < Diabetes mellitus 169 (10.1%) 34 (14.7%) Smoking currently 857 (50.3%) 87 (37.0%)

9 Additional analysis By multivariate analysis, we demonstrated as an independent predictors of another ACS in young women: stroke history (OR: 2.97 [ ], p=0.0160) hypertension (OR: 2.91[ ], p<0.0001) kidney disease (OR: 2.28 [ ], p=0.0238) hypercholesterolemia (OR: 1.75 [ ], p<0.0001) Conclusions II 1. For classic factors only hypertension and diabetes increase the risk of another MI in young women 2. Chronic kidney diasease and stroke in history increase risk of another MI almost three fold in young women