At young age, classic risk factors related to recurrent cardiovascular events

3-5-2017 • Van de Berg MJ, et al, J Am Cardiol 2017  

Risk factors for recurrent cardiovascular events before age 65 or within 2.5 years of a recent first cardiovascular event

Van de Berg MJ, Westerink J, Van der Graaf Y, et al.
Am J Cardiol 2017, In Press


Around half of patients with cardiovascular events are younger than 65 years [1]. The pathophysiology and risk factors are different for younger patients compared to older patients [2-4].
To improve the prevention of recurrent vascular events, this study aimed to confirm the relation between risk factors and severe atherosclerosis in patients with clinically manifest arterial disease below age of 65, to in this way motivate doctors and patients to improve and comply to secondary prevention recommendations. In addition, risk factors were specifically investigated for a recurrent event within 2.5 years after the first cardiovascular event. For this, the prospective Dutch SMART (Second Manifestations of ARTerial disease) cohort was used. Data was used from 5115 patients (1996-2015).

Main results

  • Current smoking (HR 1.43, 95% CI 1.11-1.84), diabetes (HR 1.83, 95% CI 1.32-1.54), high diastolic blood pressure (≥90 mmHg compared with 70-90 mmHg HR 1.54, 95% CI 1.15-2.07) and low HDL-c (≤ versus >1.0 HR 1.34, 95% CI 1.03-1.76) were related to increased risk of recurrent MACE in patients ≤65yrs. Analyses irrespective of age and sensitivity analyses showed comparable results.
  • Current smoking (HR 1.65, 95% CI 1.23-2.22), physical inactivity (tertile 1 vs 3, HR 1.48, 95% CI 1.05-2.09), BMI (per kg/m2, HR 1.04, 95% CI 1.00-1.08), waist circumference (per 5 cm HR 1.11, 95% CI 1.05-1.18), diastolic blood pressure (>90 vs 70-90 mmHg HR 1.61, 95% CI 1.17-2.21), LDL-c (per 1 mmol/l HR 1.18, 95% CI 1.02-1.37) and non-HDL-c (per 1 mmol/L HR 1.15, 95% CI 1.03-1.28) were related to increased risk of recurrent MACE within 2.5 years of follow-up. HRs were comparable for risk of recurrent MACE with complete follow-up, except for diabetes and BMI.


In patients with a recurrent vascular event at a relatively young age and/or within a short time span, classical risk factors such as smoking, blood pressure and lipid levels are related to an increased risk of cardiovascular events.
Find this article online at Am J Cardiol


1. Sniderman AD, Thanassoulis G, Williams K, Pencina M. Risk of Premature Cardiovascular Disease vs the Number of Premature Cardiovascular Events. JAMA Cardiol 2016;1:492-494.
2. Kitulwatte ID, Pollanen MS. A Comparative Study of Coronary Atherosclerosis in Young and Old. Am J Forensic Med Pathol 2015;36:323-326.
3. Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial infarction in young adults: angiographic
characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol 1995;26:654-661.
4. Gransbo K, Almgren P, Nilsson PM, Hedblad B, Engstrom G, Melander O. Risk factor exposure in
individuals free from cardiovascular disease differs according to age at first myocardial infarction. Eur
Heart J 2016;37:1977-1981.

atherosclerosisCVRMrisk factorSMART

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