Pattern of Standard Modifiable Risk Factors and Outcomes in Very Young Patients with Myocardial Infarction

Background The incidence of myocardial infarction (MI) is rising among young individuals. This study aimed to identify the profile of standard modifiable risk factors (SMuRFs) and their impact on long-term survival in very young MI patients (≤35 years). Methods The VYTAL-MI study (Very Young Tracking and Analysis of Long-term Myocardial Infarction Outcomes) is a retrospective cohort analysis of MI patients aged ≤35 years, admitted to Beijing Anzhen Hospital and Peking Union Medical College Hospital between December 1st, 2011, and December 1st, 2021. SMuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were documented. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, recurrent MI, ischemia-driven revascularization, and ischemic stroke. Cox proportional hazard models were used to assess associations between SMuRFs and outcomes. Results Among 690 patients (median age 33 years [interquartile range, IQR: 30-34]; 95% male), only 8% had no SMuRFs. Smoking was most common (76%), followed by hypercholesterolemia (43%), hypertension (40%), and diabetes (12%). The most frequent combination was smoking and hypercholesterolemia (16.4%). Over a median follow-up of 6.3 years (IQR: 4.0-8.6), MACCE occurred in 165 patients (23.9%). Patients with ?3 SMuRFs had significantly higher cumulative hazards (P=0.003). Hypertension (hazard ratio, HR: 1.50; 95% confidence interval, CI: 1.09-2.06; P=0.014) and diabetes (HR: 1.67; 95% CI: 1.10-2.54; P=0.016) were independently associated with increased risk, while hypercholesterolemia (HR: 1.24; 95% CI: 0.91-1.68; P=0.177) and smoking (HR: 1.06; 95% CI: 0.72-1.55; P=0.776) showed no significant association. Conclusions Very young MI patients exhibited a high burden of SMuRFs, particularly smoking. Hypertension and diabetes increased long-term event risk. Targeted SMuRF management is essential to improve survival in this population. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR2400085600.