Dugani Sagar B, Fabbri Matteo, Chamberlain Alanna M, Bielinski Suzette J, Weston Susan A, Manemann Sheila M, Jiang Ruoxiang, Roger Véronique L
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Mayo Clin Proc Innov Qual Outcomes. 2021 Apr 16;5(2):413-422. doi: 10.1016/j.mayocpiqo.2021.01.011. eCollection 2021 Apr.
To evaluate the trends in incident premature myocardial infarction (MI) and prevalence of cardiac risk factors in a population-based cohort.
We studied a population-based cohort of incident premature MIs among residents (MI in men aged 18-55 years and women aged 18-65 years) in Olmsted County, Minnesota, during a 26-year period from January 1, 1987 through December 31, 2012. Recurrent MI and death after incident premature MI were enumerated through September 30, 2018.
Of 3276 MI cases, 850 were premature events (37.9% [322/850] women). Age-adjusted premature MI incidence rates (2012 vs 1987) declined by 39% in men (rate ratio, 0.61; 95% CI, 0.46 to 0.81]) and 61% in women (rate ratio, 0.39; 95% CI, 0.27 to 0.57). Among men with premature MI, the prevalence of hypertension, diabetes, and hyperlipidemia increased over time, whereas in women, only the prevalence of hyperlipidemia increased. During a mean follow-up of 13.3 years, there was no temporal decline in recurrent MI in men and women. Women showed 66% decreased risk for mortality (hazard ratio, 0.34; 95% CI, 0.17 to 0.68) over time, whereas men showed no change.
The incidence of premature MI declined over a 26-year period for both men and women. The risk factor profile of persons presenting with MI worsened over time, especially in men. Death following incident MI declined only in women. These results underscore the importance of primary prevention in young adults and of sex-specific approaches.
评估基于人群队列中首次发生的早发性心肌梗死（MI）的趋势以及心脏危险因素的患病率。
我们研究了明尼苏达州奥尔姆斯特德县居民（年龄在18 - 55岁的男性和18 - 65岁的女性中的MI）中首次发生的早发性心肌梗死的基于人群队列，时间跨度为1987年1月1日至2012年12月31日的26年期间。通过2018年9月30日对首次发生早发性心肌梗死后的复发性心肌梗死和死亡情况进行计数。
在3276例心肌梗死病例中，850例为早发性事件（女性占37.9%[322/850]）。年龄调整后的早发性心肌梗死发病率（2012年与1987年相比）男性下降了39%（率比，0.61；95%CI，0.46至0.81），女性下降了61%（率比，0.39；95%CI，0.27至0.57）。在早发性心肌梗死的男性中，高血压、糖尿病和高脂血症的患病率随时间增加，而在女性中，只有高脂血症的患病率增加。在平均13.3年的随访期间，男性和女性的复发性心肌梗死没有随时间下降。随着时间推移，女性的死亡风险降低了66%（风险比，0.34；95%CI，0.17至0.68），而男性没有变化。
在26年期间，男性和女性的早发性心肌梗死发病率均下降。发生心肌梗死的人群的危险因素状况随时间恶化，尤其是在男性中。首次发生心肌梗死后的死亡仅在女性中下降。这些结果强调了年轻人一级预防以及针对性别的方法的重要性。
