Acute Ischemic Heart Disease
Acute myocardial infarction in young adults: Prognostic role of angiotensin-converting enzyme, angiotensin II type I receptor, apolipoprotein E, endothelial constitutive nitric oxide synthase, and glycoprotein IIIa genetic polymorphisms at medium-term follow-up

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Abstract

Background A number of reports have investigated the association between various gene polymorphisms and the phenotypic expression of myocardial infarction. No investigations have evaluated the prognostic role of genetic factors in young people with premature coronary disease. The aim of this study was to investigate the influence of genetic factors compared with that of conventional risk factors on follow-up events in a population of Italian young adults with myocardial infarction. Methods and Results: The study population consisted of 106 young patients (mean age 40 ± 4 years, range 23 to 45 years) with diagnosis of acute myocardial infarction. Clinical and genetic data from the group of patients with events during follow-up were compared with those from patients without events. The following genetic polymorphisms were tested: angiotensin I converting enzyme, angiotensin II type I receptor, apolipoprotein E (ApoE), endothelial constitutive nitric oxide synthase, and platelet glycoprotein IIIa. Coronary angiography was performed in 94 patients. Coronary angiography showed coronary artery disease in 93% of patients. During follow-up (46 ± 12 months, range 25 to 72) the overall combined end points (cardiac death, myocardial infarction, and revascularization procedures) accounted for 21 events. Family history of coronary artery disease, smoking, stenosis of the left anterior descending artery at coronary angiography, and ApoE polymorphism (presence of ϵ4 allele) were significantly more prevalent (univariate analysis) in the group of patients with events. Logistic multivariate analysis showed that ApoE polymorphism (P =.004, odds ratio [OR] 6.8, 95% confidence interval [CI] 2 to 22), family history (P =.005, OR 8.3, 95% CI 2 to 35), smoking after acute myocardial infarction (P =.008, OR 10.9, 95% CI 2 to 62), and left anterior descending coronary artery disease (P =.02. OR 6.6, 95% CI 1.3 to 33) were independent predictors of adverse events. Conclusions: Myocardial infarction at a young age is commonly characterized by evidence of multiple cardiovascular risk factors and by a favorable prognosis in short- and medium-term follow-up. Evidence of significant disease at coronary angiography suggests the presence of a premature atherosclerotic process. ApoE polymorphism (presence of ϵ4 allele) appears to be a strong independent predictor of adverse events, suggesting a remarkable influence in the accelerated coronary disease. (Am Heart J 2000;139:979-84.)

Section snippets

Study population

The study population was recruited from patients ≤45 years of age, consecutively admitted between 1992 and 1995 to the coronary care units of 3 different hospitals (S. Giovanni Battista and Maria Vittoria, Turin, SS. Annunziata, Savigliano), who satisfied the World Health Organization criteria for the diagnosis of myocardial infarction.17

Risk factor data were obtained from each patient and included age, sex, body mass index, smoking habits, history of hypercholesterolemia (total cholesterol

Results

The study population consisted of 106 young patients (mean age 40 ± 4 years, range 23 to 45) with AMI. The fraction of female patients was low (5%), in agreement with the prevalence of coronary disease in young women. Smoking (72%), hypercholesterolemia (52%), and family history of CAD (35%) were the more prevalent risk factors. History of CAD was rare (6%). More than half (52%) of the patients had anterior AMI. Coronary angiography was performed in 94 patients. Significant lesion (stenosis

Discussion

Epidemiologic and clinical data from the studies performed on young adults with premature AMI have shown that the occurrence of myocardial infarction in young Italian people is uncommon (2% in GISSI study), prognosis in short-term outcome is good (mortality rate <2% in GISSI study), and conventional risk factors are usually present despite the observation that the cardiovascular risk profile is peculiar when compared with older patients.6, 7 Young patients, in fact, have significantly higher

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    Reprint requests: Serena Bergerone, MD, Cardiologia Universitaria, Dipartimento di Medicina Interna, Ospedale Molinette, C.so Dogliotti 14 – 10126, Torino, Italia.

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