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Meta-Analysis
. 2024 Nov 25;120(14):1683-1692.
doi: 10.1093/cvr/cvae188.

Burden of risk factors in women and men with unrecognized myocardial infarction: a systematic review and meta-analysis †

Julie A E van Oortmerssen  1 , Noluthando Ntlapo  1 , Martijn J Tilly  1 , Wichor M Bramer  2 , Hester M den Ruijter  3 , Eric Boersma  4 , Maryam Kavousi  1 , Jeanine E Roeters van Lennep  5
Affiliations
Meta-Analysis

Burden of risk factors in women and men with unrecognized myocardial infarction: a systematic review and meta-analysis †

Julie A E van Oortmerssen et al. Cardiovasc Res. .

Abstract

Unrecognized myocardial infarction (MI) is an MI that remains undetected in the acute phase and is associated with an unfavourable prognosis. With this systematic review and meta-analysis, we evaluated the burden of cardiovascular risk factors in individuals with unrecognized MI. We searched general population-based cohort studies diagnosing unrecognized MI by electrocardiogram or myocardial imaging up to 24 November 2023. Pooled mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were determined, and random-effects meta-analyses were performed. Fourteen cohort studies were included involving 200 450 individuals (mean age 62.8 ± 9.9 years, 56.0% women), among which 4322 (2.2%) experienced unrecognized MI (mean age 66.3 ± 8.2 years, 47.8% women) and 4653 (2.1%) recognized MI (mean age 68.5 ± 7.3 years, 33.8% women). Compared to individuals without MI, those with unrecognized MI had higher body mass index (MD 0.27, 95% CI 0.16-0.39) and systolic blood pressure (MD 4.48, 95% CI 2.81-6.15) levels, and higher prevalence of hypertension (RR 1.27, 95% CI 1.06-1.51) and diabetes mellitus (RR 1.67, 95% CI 1.36-2.06). Furthermore, individuals with unrecognized MI had lower prevalence of hypertension (RR 0.92, 95% CI 0.88-0.97) and diabetes mellitus (RR 0.80, 95% CI 0.70-0.92). Individuals with unrecognized MI are characterized by a substantial burden of metabolic risk factors. Our findings suggest insufficient recognition and management of cardiovascular risk factors among individuals with unrecognized MI.

Keywords: Asymptomatic disease; General population; Heart disease risk factors; Silent myocardial infarction; Unrecognized myocardial infarction.

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Conflict of interest statement

Conflict of interest: J.R.v.L. received a research grant from Novartis paid to the institution. This funding source had no involvement in the study design, data collection, analysis, interpretation, writing, and submission. The other authors have no conflict of interest to declare.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flowchart of the inclusion and exclusion of studies. MI, myocardial infarction; n, number.
Figure 2
Figure 2
Forest plots of mean values/prevalence of body mass index (A), systolic blood pressure (B), diastolic blood pressure (C), hypertension (D), diabetes mellitus (E), total cholesterol (F), dyslipidaemia (G), and ever smoking (H) in individuals with unrecognized MI vs. individuals without MI. CI, confidence interval; MI, myocardial infarction; n, number; SD, standard deviation; MD, mean difference; RR, risk ratio.
Figure 3
Figure 3
Forest plots of mean values/prevalence of body mass index (A), systolic blood pressure (B), diastolic blood pressure (C), hypertension (D), diabetes mellitus (E), total cholesterol (F), dyslipidaemia (G), and ever smoking (H) in individuals with recognized MI vs. individuals without MI. CI, confidence interval; MI, myocardial infarction; n, number; SD, standard deviation; MD, mean difference; RR, risk ratio.
Figure 4
Figure 4
Forest plots of mean values/prevalence of body mass index (A), systolic blood pressure (B), diastolic blood pressure (C), hypertension (D), diabetes mellitus (E), total cholesterol (F), dyslipidaemia (G), and ever smoking (H) in individuals with unrecognized MI vs. individuals with recognized MI. CI, confidence interval; MI, myocardial infarction; n, number; SD, standard deviation; MD, mean difference; RR, risk ratio.
Figure 5
Figure 5
Forest plots of mean values/prevalence of body mass index (A), hypertension (B), diabetes mellitus (C), and current smoking (D) in individuals with unrecognized MI vs. individuals without MI, stratified for sex. CI, confidence interval; MI, myocardial infarction; n, number; SD, standard deviation; MD, mean difference; RR, risk ratio.
See this image and copyright information in PMC

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