First myocardial infarction: risk factors, symptoms, and medical therapy

Abstract

Background and aims: Despite the implementation of clinical risk algorithms based on traditional risk factors, the global burden of atherosclerotic cardiovascular disease has continued to rise over the past decades. There are few real-world data on prevalence of both symptoms and risk factors prior to myocardial infarction (MI). This study aimed to investigate the prevalence of documented coronary artery disease risk factors, documented symptoms, physician visits, and preventive therapy uptake prior to first MI.

Methods: In this retrospective cohort study, US patients ≥18 years with a first MI [International Classification of Diseases, 10th Revision (ICD-10) definition] between 1 January 2017 and 30 September 2022 were included from the Clarivate Real-World Data Product that links electronic health records, medical claims, and pharmacy claims from 98% of government and commercial health insurance plans in the US. Prevalence of previously ICD-10 documented cardiac symptoms and standard modifiable risk factors (SMuRFs), physician visits, and use of preventive medical therapy were assessed prior to MI.

Results: The study identified 4 657 412 patients with a first MI (2017-2022), with a median age of 70 years; 42.3% were women. Prior to MI, 50.5% of patients had no documented symptoms, 18.0% had no SMuRFs, 22.2% did not have documented physician visits, and 63.4% were not prescribed any preventive therapy. Individuals ≤60 years and men were less likely to have documented symptoms and SMuRFs, had lower frequency of primary care physician visits, used less preventive therapy, and had more frequent occurrence of ST-elevation MI than individuals >60 years and women, respectively.

Conclusions: In a large real-world dataset, half of the patients with first MI did not have documented antecedent symptoms, and approximately 1 in 5 had no previously identified SMuRFs. The majority of those who visited a physician prior to the MI with identified SMuRFs and symptoms were not using any preventive medical therapy. These findings highlight an urgent unmet need for improved tools to identify patients at risk of MI who may benefit from preventive therapy.

Keywords: Acute coronary syndromes; Myocardial infarction; Prevention; Real-world data; Standard modifiable risk factors.

Structured Graphical Abstract

Identification and treatment of patients prior to first myocardial infarction. EHR, electronic health records; MI, myocardial infarction; SMuRFs, standard modifiable risk factors; STEMI, ST-elevation myocardial infarction; US, United States.

Figure 1

Association between documented risk factors, documented symptoms, physician visits, and use of cardiovascular drugs. Venn diagram of documented risk factors, symptoms, physician visits, and use of cardiovascular drugs prior to myocardial infarction