Increased Mortality After MI in Young Adults With Systemic Inflammatory Disease

March 31, 2021

Myocardial infarctions (MI) in young adults are twice as likely to be fatal in those with inflammatory conditions like psoriasis, lupus, or rheumatoid arthritis, according to results from a study published in the European Journal of Preventive Cardiology.
“This suggests that the worse long-term survival in young heart attack patients with inflammatory diseases could be related to inflammation versus higher prevalence of other cardiovascular risk factors,” said Brittany Weber, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts.

The study used data from the YOUNG-MI registry, which enrolled patients who had a MI at aged 50 years or younger between 2000 and 2016 and were treated at Massachusetts General Hospital and Brigham and Women’s Hospital. The researchers identified patients with systemic inflammatory diseases and compared them with those without these conditions.

Among 2097 patients with MI, 53 (2.5%) had an inflammatory disease. Psoriasis was the most common at 64%, followed by lupus at 23%, rheumatoid arthritis at 9%, and other conditions at 4%. As expected, patients with inflammatory conditions were more likely to be female. They were also more likely to have hypertension but had similar rates of high cholesterol and diabetes compared with those without inflammatory diseases.

During a median follow-up of 11.2 years, patients with inflammatory conditions were nearly twice as likely to die compared with those without inflammatory conditions.

The researchers then compared death rates in the 53 patients with inflammatory diseases to a subsample of 138 patients without these conditions. The 2 groups were matched for age, sex, and cardiovascular risk factors including diabetes, obesity, smoking, high blood pressure, and high cholesterol. Patients with inflammatory diseases were 2.68 times more likely to die during the 11.2-year follow-up compared with the matched group without inflammatory conditions.

The study found that patients with inflammatory conditions were less likely to be prescribed aspirin and statins at discharge than those without inflammatory diseases.

“We were surprised at this finding,” said Dr. Weber. “One reason could be concerns about drug-drug interactions since these patients often take medications that suppress the immune system. Given that systemic inflammatory diseases are rare, numbers in this study were small, and it is important to confirm this result in other similar cohorts.”


SOURCE: European Society of Cardiology