Research Evidence-Based: Acute Myocardial Infarction
Introduction
Globally, acute myocardial infarction (MI) is the leading cause of death in women. The prevalence of acute MI is higher in men than women, 10% and 6% consecutively. However, the risk factors associated with acute MI are stronger in women compared to men. Recent studies have drawn attention to the significance of high blood pressure as a predictor of acute MI. High blood pressure is among the leading causes of acute MI. Besides, high blood pressure is associated with myocardial infarction as a risk factor. Studies indicate that women with a history of high blood pressure are more likely to transact acute MI. Other risk factors for getting acute MI include older age, diabetes, and vascular comorbidities. This annotated bibliography report seeks to answer the PICOT question: “Are women aged between 30-40 years of age who have high blood pressure at increased risk of having Acute MI compared with women without high blood pressure?”
Chandrasekhar, J., Gill, A., & Mehran, R. (2018). Acute myocardial infarction in young women: current perspectives. International Journal of Women’s Health, 10, 267-284. doi:https://doi.org/10.2147/IJWH.S107371
In Chandrasekhar, Gill, and Mehran’s study, the authors used the qualitative study design to study the current perspectives of acute myocardial infarction (MI) in young women. The article examined the role of gender, female sex, and non-traditional risk factors for acute MI and CAD in young women. The authors argued that acute MI is the leading cause of death in women globally. The study indicates that the incidence of acute MI in younger women (<55 years) is increasing in the context of high blood pressure, diabetes mellitus, metabolic syndrome, and non-traditional risk factors like stress, anxiety, and depression. In this study, the authors utilized several observational data to confirm that women with high blood pressure were more vulnerable to acute MI in comparison to those without hypertension.
The study results indicated that high blood pressure, in conjunction with diabetes, smoking, chronic kidney disease, and metabolic syndrome, increases acute MI risk in younger women. Young women, including 30-40 years of age, have a more extended in-hospital stay and mortality rate than young men. As per the study, there has been a rise in the prevalence of acute MI for younger women with hypertension and increasing waist circumference linked to intake of fast food and sugar-sweetened beverages, reduced physical activity, and shorter sleep duration. Further, the study indicated that the incidence of acute MI in young women is growing in conjunction with growing lifestyle risk factors and greater prevalence of high blood pressure, diabetes, metabolic syndrome, and obesity. The authors associated this prevalence with the likelihood of women not receiving evidence-based treatments compared to their male counterparts.
There are both strengths and weaknesses in (Chandrasekhar, Gill, & Mehran, 2018) study. There are various strengths of the study. First, the authors capture the changing trends within the target group over time. The study’s clinical outcomes are based on pooled data for the years 1995 to 2010 from Multi-Ethnic Study of Atherosclerosis, Framingham Heart Study, Coronary Artery Risk Development in Young Adults, and Atherosclerosis Risk in Communities. Second, the study concentrated on clinical studies of young women with acute MI. The target group was racially diverse, i.e., Black and White Women with hypertension and acute MI prevalence were observed. The main limitation of this study is that the authors focused on a broad scope. The study focused on both young women and men to study the effect of high blood pressure on acute MI. Also, the study focused on a broad age group by focusing on young women, limiting the authors’ conclusion to the question at hand. This indicates that more research is required to understand the problem statement.
Gabizon, I., & Lonn, E. M. (2015). Young women with acute myocardial infarction and the post-hospital syndrome. Circulation, 132(3), 149-151. doi:10.1161/CIRCULATIONAHA.115.017433
The study by (Gabizon & Lonn, 2015) used a quantitative study design to analyze young women with acute myocardial infarction and the post-hospital syndrome. Gabizon and Lonn’s study focused on younger women aged below 65-years with acute MI. The authors argued that younger women IHD, a condition caused by high blood pressure, are a distinct high-risk phenotype for AMI. The authors suggest that significant sex variances exist among younger AMI patients. In the study, 230,684 AMI hospitalizations with 30-50-year-old patients were studied. The authors used a comparative study to analyze the prevalence of AMI resulting from IHD in women and men. Also, the study was based on an analysis of a big inpatient admin database from California from 2007 to 2009. The prevalence of acute MI in women resulting from IHD and high blood pressure was higher than that of men as well as women without pre-existing hypertension conditions.
The findings of the study indicate that among younger people with acute MI, women were more likely to have a history of high blood pressure, acute coronary syndrome (ACS), diabetes mellitus, congestive heart failure, and stroke. In addition, the study results indicated that younger women are more likely to present with noncardiac comorbidities such as renal failure, chronic obstructive pulmonary condition, major psychotic disorders, or cancer. Particularly, young women with high blood pressure are vulnerable to acute MI. On the question of readmissions after AMI hospitalizations, the study findings indicated that the all-cause 30-day clinical readmission rate was 15.5% in women and 9.7% in men. Also, the study found that the risk of readmission was greatest on the 2nd and 4th days after being discharged. These findings were critical observations. The study results answers the question, with younger women having hypertension being identified with greater risks of acute MI compared to those without.
The strength of this study is that the authors hypothesize the multiple factors amounting to the post-hospital syndrome in younger AMI survivors. The study by (Gabizon & Lonn, 2015) has various weaknesses. First, the study is limited to a specific geographic zone. This leaves it unclear to determine whether the study results may get generalized to other regions of the U.S. or to other nations. Second, the study’s administrative database misses important data, for example, smoking history information, uses of medication during the index AMI, income level, social support data, and psychological factors. Besides, further studies are needed to explore the patterns of early readmission after AMI in different healthcare delivery models and racial make-ups. Thus, additional research is required in this field.
Luo, D., Cheng, Y., Zhang, H., Ba, M., Chen, P., Li, H., & Chen, H. (2020). Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis. BMJ, 70(1), 370. doi:https://doi.org/10.1136/bmj.m3222
Luo et al., (2020) article used a quantitative study design to evaluate and quantify the future risk of cardiovascular events in young adults with high blood pressure. The authors argued that high blood pressure is a leading risk factor for cardiovascular events like acute MI. Also, the authors posited that cardiovascular diseases cause over 18 million deaths annually, approximating one-third (1/3) of all worldwide deaths. The authors conducted the study using systematic reviews and a metal-analysis approach. Searches on Embase, Medline, and Web of Science were conducted from inception to March 6th, 2020. The researchers pooled relative risks utilizing a random effects model, achieving a 95% confidence interval level. Studies investigating the adverse effects of high blood pressure on adults aged 18-45 were used. The primary study outcome comprised of cardiovascular diseases such as stroke, coronary heart failure, and all-cause mortality were used as secondary outcomes.
The analysis of this study included seventeen (17) observational cohorts, all consisting of 4.5 million young adults. Study results showed that young women with normal blood pressure were vulnerable to acute MI compared to young women with optimal blood pressure. Generally, young adults with high blood pressure were seen to have increased risks of converting acute MI and other cardiovascular events compared to those with optimal blood pressure. The confidence interval for those requiring treatment to prevent cardiovascular events was 95% for participants with high blood pressure. The study concluded that young adults with high blood pressure have an increased risk of converting cardiovascular diseases such as acute MI, especially in their later life stages. The authors argued that there is limited evidence for lowering blood pressure, and thus a cautious investigation is required for active interventions. The study results answered the study objective.
This study’s strengths include the long follow-up period and the large sample size, averaging up to 14.7 years and the sample size approximating 4.5 million participants at risk. Unlike majority of past studies, this study examined the associations of increased blood pressure with several study outcomes. Another strength is consistency of results. The results are supported by various scenarios hence increasing the robustness of findings. On the other side, the study had various weaknesses. First, the review was not preregistered but rather done under a predefined protocol and Cochrane handbook guidance. Second, there was observed heterogeneity in the design of the considered studies. Third, using results from male-based studies was out of context and biased of the results. Also, female analysis was based on four studies, and the estimates for women were highly uncertain.
Mehta, L. S., Beckie, T. M., DeVon, H. A., Grines, C. L., Krumholz, H. M., Johnson, M. N., & Wenger, N. K. (2016). Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation, 133(9), 916-947. doi:https://doi.org/10.1161/CIR.0000000000000351
In (Mehta, et al., 2016) study, the authors used a qualitative research design to study women of 30 to 55 years of age with acute MI. The authors argued that the study was the first scientific statement from the American Heart Association on acute MI in women. Besides, the authors argued that gender-specific variances exist in the pathophysiological mechanisms, presentation, and clinical outcomes of people with acute MI. The study posits that although there has been progress in compacting acute MI mortality in young women, medical studies have neglected women’s health needs. The study’s hypothesis was largely derived from observation, with the authors conducting meta-analysis of observational studies. Also, the authors used placebo-controlled secondary prevention trials in this study. Controlled trials examined the effect of high blood pressure on women transacting acute MI.
Acute myocardial infarction remains a leading mortality and mortality threat affecting millions of women. The study results showed that CHD affects approximately 6.6 million American women annually. Of these, 2.7 million have a history of MI. Most women having acute MI have underlying hypertension conditions. Regardless of age, women with acute MI have heart failure associated with high blood pressure. As per the study results, hypertension is a significant risk factor for acute MI in women, with a population risk prevalence of 36%. This suggests that the risks associated with MI can be lowered by 36% if high blood pressure is eliminated as a risk factor. Further, the study indicates that high blood pressure is significantly linked to acute MI in women compared to men. In younger women (less than 40-years of age), high blood pressure is the commonest cause of acute MI, with women suffering from hypertension being more vulnerable to acute MI compared to those without the disorder. These results clearly answer the study question.
The study by Mehta et al. (2016) has various strengths. First, the study reinforces the urgent need for advanced cardiovascular knowledge among young women, including an emphasis on women’s access to care for as a preventive measure. Second, the study establishes a clear comparison of the risks of high blood pressure in transacting acute MI for women of diverse races. The limitations of Mehta et al. (2016) study include a limited score. The study focuses on American women at large. This indicates that there exists limited data on the frequency of AMI among young women in relation to pre-existing conditions like high blood pressure. Second, the study was qualitative and thus difficult for the researchers to verify the results. Interpreting the study results might have been highly subjective.
Literature Evaluation
Chandrasekhar, Gill, and Mehran’s (2018) article explores the current perspectives of acute myocardial infarction in young women. In this study, various studies designed to explore female-specific risk factors and outcomes of AMI are included. Different studies explore the role of female gender, sex, and non-traditional risk factors for CAD and AMI. Studies show that the prevalence of AMI is high in young women having pre-existing conditions of high blood pressure compared to those with normal blood pressure. As described by the American Heart Association (AHA), incidence of AMI remains an equal opportunity killer for both women and men. Also, studies show that the rate of women’s hospitalization is increasing while that of men is decreasing.
The study by (Gabizon & Lonn, 2015) dispels the myth that heart attacks are male disorders. Younger women (less than 55 years) are not immune to acute MI. Studies show that women with heart conditions have an increased burden of cardiovascular risk factors as well as other comorbidities. Gabizon and Lonn’s (2015) study cites Dryer et al. study, which examines circulation in younger women. As per Dryer et al. study, younger women with acute MI are considered a distinct high-risk phenotype. Other studies posit that Black women are at higher risk of converting acute myocardial infarction than White women. Besides, studies report that early readmissions post-ACS are noncardiac in nature and very common – and are unrelated to index hospitalization.
The article by (Luo, et al., 2020) quantifies and evaluates the future risk of cardiovascular events in young adults with hypertension. The authors argue that further research should be conducted to determine whether cumulative exposure to high blood pressure for young adults (18-45 years of age) contributes to increased risks of cardiovascular diseases such as acute MI. The prevalence of high blood pressure is progressively increasing among young adults. Existing studies indicate that higher measured blood pressure for young adults, especially women, is linked with advanced risks of all cardiovascular events. This study found that the risk increasing association with cardiovascular diseases is consistent for females older than 30-years across different regions.
In (Mehta, et al., 2016) article, the aim of the study is to analyze acute myocardial infarction (AMI) in women. In the U.S., CHD’s prevalence is approximately 6.6 million in women – remaining the main mortality and morbidity threat in women. Of these women, at least 2.7 million have a history of MI, heart failure, stroke, and pre-existing conditions of high blood pressure. Marked CVD mortality reductions in young women have happened as a result of an increase in awareness and greater focus on women and their cardiovascular risk. Despite this awareness, CVD conditions such as acute MI continue to trouble women globally. Multiple studies indicate that women with acute MI are less likely to be treated with guideline-directed medical therapies, get timely reperfusion, and less likely to undergo cardiac catheterization.
Conclusion
This annotated bibliography reviewed the PICOT question, “are women aged between 30-40 years of age who have high blood pressure at increased risk of having Acute MI compared with women without high blood pressure?” The four articles (Chandrasekhar, Gill, & Mehran, 2018), (Gabizon & Lonn, 2015), (Luo, et al., 2020), and (Mehta, et al., 2016) are up to date and relevant to the PICOT question. The review suggests that the prevalence of acute MI is higher in young women compared to men. Similarly, young women having high blood pressure are at an increased risk of having acute MI compared to women without high blood pressure. The proper management of high blood pressure is vital in addressing acute MI. Thus, the four articles used were relevant and helped in answering the PICOT question. However, further studies on the topic should be conducted.