title: High-risk myocardial infarction in the young: the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial.
abstract: 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.
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02445, USA.
authors: Rachel E
authors: RE
authors: Anderson
authors: Marc A
authors: MA
authors: Pfeffer
authors: Jens Jakob
authors: JJ
authors: Thune
authors: John J V
authors: JJ
authors: McMurray
authors: Robert M
authors: RM
authors: Califf
authors: Eric
authors: E
authors: Velazquez
authors: Harvey D
authors: HD
authors: White
authors: Jean L
authors: JL
authors: Rouleau
authors: Hicham
authors: H
authors: Skali
authors: Aldo
authors: A
authors: Maggioni
authors: Scott D
authors: SD
authors: Solomon
mesh_terms: 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
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine