Myocardial Infarction- A Growing Menace in Younger People!

The increasing prevalence of Myocardial Infarction (MI) in people less than 45 years of age is significantly alarming. Dr. Samir Kubba. Senior Consultant, Clinical and Interventional Cardiology, Max Super Speciality Hospital, Patparganj, says that there is a relative scarcity of data on premature coronary heart disease (CHD) and MI in the young, but we are now seeing a growing number of patients having MI at a relatively young age. He recalls a successful angioplasty case that he performed in a 21 year old college student with a very large MI- he was a heavy smoker.

He says that this increasing trend of MI in the young is a disturbing phenomenon with devastating consequences causing a greater impact on patient’s psychology, ability to work and socio-economic burden.

Who are at a greater risk of MI?

• Higher Prevalence of Smoking
• Family History of premature CHD
• Male counterparts < 45 years of age
• Diabetes
• Hypertension
• Stress
  • Obesity: Particularly truncal obesity due to a sedentary lifestyle, unhealthy dietary patterns and lack of physical activity counters the protection offered by a young age.

However, we are now diagnosing more and more patients with hypertension, dyslipidemia, and diabetes for the first time after they present to us with MI at a young age. To escalate matters further, ignorance of CHD combined with a false sense of security prevents younger individuals from seeking early medical advice. Hence early recognition and risk factor modification in this population are of key importance.

Other factors that need attention:

A number of other potential but uncommon causes in young MI patients which deserve attention include:

• Cocaine abuse
• Kawasaki disease
• Aortoarterits, spontaneous coronary artery dissection
• Hyperhomocysteinemia
• Low levels of oestrogen and oral contraceptives usage in young women can also cause MI.

An important point to understand here is that young MI patients often lack warning symptoms like escalating chest pain, unlike their elderly counterparts. The first presentation of MI can be sudden death. The coronary angiography in the young tends to reveal less extensive disease in comparison to older counterparts.

We are seeing a growth in the multivessel disease more often, but with improvements in medical therapy and angioplasty, many of the young patients are being salvaged and are leading normal lives.

Post MI outcome

There is a high incidence of depression post-MI in young patients and it can be as high as 50%. It often requires multiple strategies including counseling, personalized prescription, and management of co-occurring mental health conditions. It affects the quality of life and hence identifying and managing depression early is important. Some patients may develop significant reduction in their left ventricular Function (pumping function of the heart) post MI and may have heart failure. However, on the brighter side, significant improvements in medical and device therapies for heart failure have dramatically improved outcomes in many of these patients.

As goes the age-old adage “Prevention is better than cure”, it is of utmost importance to educate the youth on the harmful effects of smoking, sedentary lifestyle, obesity, unhealthy dietary patterns, stress and substance abuse – all of which are “modifiable” risk factors. In addition, early screening and management of young patients who are at risk- especially those with a strong family history of premature CHD is the need of the hour to collectively fight this alarming problem.