Inflammatory Diseases Double Mortality Risk in Young Heart Attack Patients

Brittany Weber, MD

New research suggests patients with systemic inflammatory conditions, such as psoriasis, lupus, or rheumatoid arthritis, face a greater risk of mortality following myocardial infarction than their counterparts without an inflammatory condition.

Using data from the YOUNG-MI registry, a team from Brigham and Women’s Hospital and Harvard Medical School found patients experiencing a heart attack before the age of 50 were nearly twice as likely to die from the event if they had a diagnosis of an inflammatory condition prior to the event.

"This suggests that the worse long-term survival in young heart attack patients with inflammatory diseases could be related to inflammation versus higher prevalence of other cardiovascular risk factors,” said Brittany Weber, MD, a cardio-rheumatology specialist at Brigham and Women's Hospital and Harvard Medical School, in a statement.

With cardiovascular disease among the greatest threats to mortality among patients and little data examining prevalence and impact of systemic inflammatory disease in young adults who experience myocardial infarction, Weber and a team of colleagues designed the current studying an attempt to fill the apparent knowledge gap. Created with the goal of developing a greater understanding of myocardial infarction in patients 50 years of age or younger, the YOUNG-MI registry provided data related to 2097 individuals for the current analysis, including 53 with a diagnosis of a systemic inflammatory disease. As part of the design of YOUNG-MI, the registry also contained data related to cardiovascular risk factors and baseline demographics of participants.

The most common inflammatory condition among the inflammatory disease cohort was psoriatic disease (64%) followed by systematic lupus erythematosus (23%) and rheumatoid arthritis (9%). Compared to their counterparts without systemic inflammatory disease, patients with systemic inflammatory disease were more likely to be female and be diagnosed with hypertension but there were no significant differences in the prevalence of other cardiovascular risk factors.

Over a median follow-up of 11.2 years, 11 (20.8%) of the patients with a systemic inflammatory disease died compared to 243 (11.9%) of patients without an inflammatory disease diagnosis before experiencing their first myocardial infarction (P=.083). Overall, the unadjusted risk for death after index myocardial infarction was nearly twice as high among patients with a systemic inflammatory disease (HR, 1.95; 95% CI, 1.07-3.57; P=.030). Further analysis indicated this increased risk remained significant after adjusted for eGFR and hospital length of stay (HR, 1.86; 95% CI, 1.02-3.42; P=.044).

In analyses using a subsample of 138 patients matched based on age, sex, and risk factors, results indicated patients with a diagnosis of a systemic inflammatory disease prior to index myocardial infarction were at a 2.5-fold greater risk of mortality compared to their matched counterparts without a diagnosis of a systemic inflammatory disease (HR, 2.68; 95% CI, 1.18-6.07; P=.018).

Based on previous research and the results of the current study, Weber calls for a greater emphasis on risk mitigation among patients with inflammatory diseases considered at high risk for cardiovascular disease.

"Lifestyle behaviours are incredibly important, including healthy eating, physical activity and not smoking, plus controlling cholesterol, blood pressure and diabetes,” added Weber.

This study, “Association of inflammatory disease and long-term outcomes among young adults with myocardial infarction: the Mass General Brigham YOUNG-MI Registry,” was published in the European Journal of Preventive Cardiology.