title: Temporal trends in clinical characteristics of patients without known cardiovascular disease with a first episode of myocardial infarction.
abstract: BACKGROUND
  Recent initiatives have focused on primary prevention to delay time to first myocardial infarction (MI). The aim of this study was to evaluate the change in risk factor profile over time in patients without known cardiovascular disease presenting with first MI.
  
  
  METHODS
  In the American Heart Association's Get With The Guidelines-Coronary Artery Disease national registry, 100,884 patients without known cardiovascular disease presenting with acute MI from 408 hospitals were evaluated between 2002 and 2008. The time trends of the proportion of patients with cardiovascular risk factors (nonmodifiable: age >45 years for men or >55 years for women, male sex, modifiable: diabetes mellitus, hypertension, hyperlipidemia, tobacco use) were analyzed. Analyses were stratified by non-ST-segment elevation MI (NSTEMI) versus ST-segment elevation MI (STEMI).
  
  
  RESULTS
  The proportion of patients with ≥3 of 6 traditional risk factors slightly decreased over time in the NSTEMI (69.5%-66.8%, P < .0001) and STEMI (68.9%-66.4%, P < .0001) cohorts. The proportion of patients with ≥2 of 4 modifiable risk factors increased from 52% to 59% and then declined to 52.1% (P < .0001) in the NSTEMI cohort but declined slightly in the STEMI cohort (50.9%-47.3%, P < .0001). After adjusting for age and gender, the time trend of proportion with diabetes mellitus, hypertension, and tobacco use declined in both cohorts. However, the proportion of patients with hyperlipidemia remained similar.
  
  
  CONCLUSIONS
  Although risk factor profiles in patients presenting with first MI have shown improvements over time, the changes are modest.
authors.affiliation: New York University School of Medicine, New York, NY. Electronic address: binita.shah@nyumc.org.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
authors.affiliation: New York University School of Medicine, New York, NY.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: New York University School of Medicine, New York, NY.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Gianos
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: University of California, Los Angeles Medical Center, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: University of New Mexico, Albuquerque, NM.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D011322:Primary Prevention / Q000592:standards*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology