High-risk myocardial infarction in the young: the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial.
BACKGROUND
Advanced age is a well-established prognostic risk factor after acute myocardial infarction (AMI), yet approximately 10% of MIs occur in patients <45 years. We examined characteristics, cardiovascular outcomes, and the influence of risk factors on outcomes in young survivors of AMI.


METHODS
Fourteen thousand seven hundred three patients enrolled in the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial were divided into 3 age groups: 18 to < 45 (n = 803), 45 to < 65 (n = 6185), > or = 65 years (n = 7715). Multivariate Cox regression was used to compare cardiovascular event rates and assess the impact of risk factors on outcomes.


RESULTS
The youngest patients had less diabetes, hypertension, and history of MI and were more likely to be male (18 to < 45 years, 88%; > or = 65 years, 59.1%), nonwhite (18 to < 45 years, 9.6%; > or = 65 years, 5%), current smokers (18 to < 45 years, 73.7%; > or = 65 years, 15.9%), obese (18 to < 45 years, 37.9%; > or = 65 years, 25.1%), and dyslipidemic at randomization (18 to < 45 years, 43.1%; > or = 65 years, 32.7%). Adjusted relative risks of smoking (18 to < 45 years, hazard ratio [HR] 1.6 [95% confidence interval {CI} 1.1-2.5]; > or = 45 years, HR 0.9 [95% CI 0.9-1.1]; P =.014) and hypertension (18 to < 45 years, HR 1.8 [95% CI 1.3-2.6]; > or = 45 years, HR 1.2 [95% CI 1.1-1.3]; P = .044) were higher in the young, with significant interactions observed between age and these risk factors.


CONCLUSIONS
After AMI, risk factors and outcomes of the young differ substantively from their older counterparts. The influence of hypertension and smoking is more profound in the young, underscoring the need for aggressive risk factor modification post-AMI.
Anderson
Rachel E
RE
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02445, USA.
Pfeffer
Marc A
MA
Thune
Jens Jakob
JJ
McMurray
John J V
JJ
Califf
Robert M
RM
Velazquez
Eric
E
White
Harvey D
HD
Rouleau
Jean L
JL
Skali
Hicham
H
Maggioni
Aldo
A
Solomon
Scott D
SD
D000328:Adult; D000367:Age Factors; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D017741:Survivors; D013777:Tetrazoles; D014633:Valine / Q000031:analogs & derivatives; D000068756:Valsartan
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine