Heart attack patients without modifiable risk factors are more common and better, study finds

Heart attack patients without modifiable risk factors are more common and better, study finds

A new study by researchers at Intermountain Healthcare in Salt Lake City finds that patients without standardized modifiable cardiac risk factors who have heart attacks are common and more likely to do better than heart attack patients with known risk factors, but researchers say it remains difficult to identify people at risk for an event before it occurs.

Intermountain researchers have examined the puzzling trend of high rates of heart attacks among people who do not have well-known modifiable risks for cardiovascular disease, including smoking, high blood pressure, high cholesterol and diabetes.

In the case of heart attacks that arise from blocked arteries (heart attacks with ST elevation), it is one in four patients. In heart attacks, where oxygen is still getting to the heart but not enough (non-ST elevation heart attacks, which are more common), it is one in five patients.

In the new study, Intermountain researchers looked at heart attack patients without ST elevation and found that patients without known modifiable risk factors fared better than those with them.

These findings are important because they contribute to a body of research that they hope will lead to ways to determine who and why these patients are at risk of heart attack, and to develop better treatments to prevent it.

The results of the study were presented on Sunday, November 6, 2022 at the American Heart Association's 2022 Scientific Sessions in Chicago.

This study showed us how many patients we see with this type of heart attack who were not obvious heart attack candidates coming into our hospitals and what their outcomes were. It’s not a small number and we need to identify who is at risk.”

Jeffrey L. Anderson, MD, lead author of the study and a cardiologist and heart researcher with the Intermountain Healthcare Heart and Vascular Program

"The best time to treat a heart attack is before you have one, and we need to figure out how to help these types of patients before they do," he added.

In the retrospective study, Intermountain heart researchers identified 8,196 Intermountain patients who had non-ST-elevation myocardial infarction (NSTEMI), the most common type of heart attack in which the artery is not completely blocked but the heart cannot get enough oxygen.

Of these, 1,458 patients had no standardized modifiable risk factors. Researchers then looked at the patients' outcomes and their likelihood of suffering a major cardiac event 60 days later.

They found that these patients were slightly less likely to undergo revascularization than heart attack patients with known modifiable risk factors. They were also less likely to have a subsequent major cardiac event or die within that 60-day window.

These results helped the Intermountain researchers, according to Dr. Anderson to quantify this patient population and document their outcomes. A better outcome makes sense in that they appear to bear a lower burden of factors that cause advanced disease.

"But it leaves us with the question and the challenge of how exactly we can identify these patients who are going to have a heart attack and don't have standard modifiable risk factors," said Dr. Anderson. “The question is, can we identify them in advance and take preventative measures?”

“We also need to determine the non-standard risk factors that are present in these patients.” Intermountain researchers are currently studying such options, including coronary calcium scans and blood tests for C-reactive protein, which is a marker of inflammation, and lipoprotein (a), a lipid molecule that is not regularly tested for.

Source:

Intermountain Healthcare

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