New York University School of Medicine, New York, NY.
New York University School of Medicine, New York, NY.
Am Heart J. 2014 Apr;167(4):480-488.e1. doi: 10.1016/j.ahj.2013.12.019. Epub 2014 Jan 4.
Recent initiatives have focused on primary prevention to delay time to first myocardial infarction (MI). The aim of this study was to evaluate the change in risk factor profile over time in patients without known cardiovascular disease presenting with first MI.
In the American Heart Association's Get With The Guidelines-Coronary Artery Disease national registry, 100,884 patients without known cardiovascular disease presenting with acute MI from 408 hospitals were evaluated between 2002 and 2008. The time trends of the proportion of patients with cardiovascular risk factors (nonmodifiable: age >45 years for men or >55 years for women, male sex, modifiable: diabetes mellitus, hypertension, hyperlipidemia, tobacco use) were analyzed. Analyses were stratified by non-ST-segment elevation MI (NSTEMI) versus ST-segment elevation MI (STEMI).
The proportion of patients with ≥3 of 6 traditional risk factors slightly decreased over time in the NSTEMI (69.5%-66.8%, P < .0001) and STEMI (68.9%-66.4%, P < .0001) cohorts. The proportion of patients with ≥2 of 4 modifiable risk factors increased from 52% to 59% and then declined to 52.1% (P < .0001) in the NSTEMI cohort but declined slightly in the STEMI cohort (50.9%-47.3%, P < .0001). After adjusting for age and gender, the time trend of proportion with diabetes mellitus, hypertension, and tobacco use declined in both cohorts. However, the proportion of patients with hyperlipidemia remained similar.
Although risk factor profiles in patients presenting with first MI have shown improvements over time, the changes are modest.
最近的一些举措侧重于初级预防，以延迟首次心肌梗死（MI）的时间。本研究旨在评估在无已知心血管疾病的患者中，首次 MI 发作时随时间推移，风险因素谱的变化情况。
在美国心脏协会的 Get With The Guidelines-Coronary Artery Disease 国家注册中心，在 2002 年至 2008 年间，从 408 家医院评估了 100884 名无已知心血管疾病但首次出现急性 MI 的患者。分析了心血管风险因素（不可变因素：男性年龄>45 岁或女性年龄>55 岁，男性性别；可改变因素：糖尿病、高血压、血脂异常、吸烟）的患者比例随时间的变化趋势。分析按非 ST 段抬高型心肌梗死（NSTEMI）与 ST 段抬高型心肌梗死（STEMI）进行分层。
在 NSTEMI（69.5%-66.8%，P<0.0001）和 STEMI（68.9%-66.4%，P<0.0001）两组中，有≥6 个传统风险因素中的≥3 个的患者比例随时间略有下降。有≥4 个可改变风险因素中的≥2 个的患者比例从 52%增加到 59%，然后下降到 NSTEMI 组的 52.1%（P<0.0001），但在 STEMI 组略有下降（50.9%-47.3%，P<0.0001）。在调整年龄和性别后，两个队列中糖尿病、高血压和吸烟的比例随时间呈下降趋势。然而，血脂异常患者的比例保持相似。
尽管首次 MI 患者的风险因素谱随时间推移有所改善，但变化幅度不大。
