Comparison of Clinical Characteristics and Risk Factor Profile Between Very Young and Older Patients Presenting with First Acute Myocardial Infarction

Background: Cardiovascular diseases are the leading global cause of mortality, accounting for 31% of deaths and AMI is responsible for 85% of fatalities. Very young patients (≤ 30 years) with first acute MI often exhibit distinct clinical presentations compared to older patients (≥ 50 years). Our objective was to compare and analyze the clinical characteristics and risk factor profiles between very young and older patients presenting with first acute MI.

Methods: This cross-sectional analytical study was conducted on 160 patients with first acute MI in the Department of Cardiology, Dhaka Medical College & Hospital, Sir Salimullah Medical College & Mitford Hospital, National Institute of Cardiovascular Diseases (NICVD) and Bangladesh Specialized Hospital (BSH), Dhaka, Bangladesh from July 2022 to December 2023. Among the study subjects, 80 patients were included in the very young (≤ 30 years) group (Group I) and another 80 patients were included in the older (≥ 50 years) group (Group II)The patients/attendants involved were briefed about the study and provided consent forms. A detailed history, thorough physical examination, and risk factor assessment of each patient were carried out. Data were collected in a preformed case-record form and analyzed by SPSS 26.0.

Results: Among the baseline characteristics there was no statistically significant difference between the two age groups. Symptoms such as chest pain and sweating were significantly more prevalent in the very young group (p <0.001) compared to older group of patients. Certain risk factors like smoking, obesity, dyslipidemia, family history of CAD, and substance abuse were significantly more prevalent in very young patients (p<0.001). Complications like cardiogenic shock were significantly more common in very young patients (p=0.008) and regarding biochemical parameters, significant differences were found in FBS, serum sodium, serum troponin-I, CRP, lipid profile, serum vitamin-D, and serum homocysteine levels between the two age groups (p<0.05). Notably, serum vitamin D levels were significantly lower and serum homocysteine levels were significantly higher in very young patients (p<0.001 in both parameters). Multivariate analysis in very young patients showed smoking, dyslipidemia, obesity family history of CAD, substance abuse and CRP level were significant independent predictors of first acute MI occurrence. On the other hand, multivariate analysis in older patients showed DM, hypertension and serum vitamin-D level were significant independent predictors of first acute MI occurrence.

Conclusions: Our study revealed significant differences between very young and older patients with first acute MI. Very young patients exhibited more typical clinical features, higher complication rates, and a greater prevalence of certain risk factors such as smoking, obesity, dyslipidemia, family history of CAD, and substance abuse. However, the older group of people had more atypical symptoms with predominant conventional risk factors. Serum vitamin D was significantly lower and serum homocysteine was considerably higher in very young patients. These findings underscore the importance of targeted risk factor management and intervention in very young individuals to mitigate their risk of first AMI.