European Journal of Cardiovascular Medicine

Acute myocardial infarction (AMI), traditionally considered a disease affecting older populations, is increasingly prevalent among young adults. Recent epidemiological shifts reveal an alarming rise in cardiovascular events in younger populations, prompting renewed investigation into the specific risk factors and challenges involved in managing AMI in this age group [1]. This demographic trend has profound clinical and public health implications, demanding targeted research and intervention strategies to mitigate early cardiovascular morbidity and mortality [2].

AMI in young adults, typically defined as individuals younger than 45 years, exhibits unique clinical presentations and distinct etiological profiles compared to older adults. While older populations often present with traditional cardiovascular risk factors like hypertension, hypercholesterolemia, diabetes mellitus, and smoking, younger adults frequently present with atypical or non-traditional risk profiles, including genetic predispositions, obesity, drug abuse, psychosocial stress, and lifestyle-associated conditions [3,4]. The disparity in clinical manifestations and underlying mechanisms poses significant challenges for early diagnosis, effective management, and secondary prevention in young adults, thus necessitating a tailored diagnostic and therapeutic approach [5].

Several studies emphasize smoking and obesity as predominant modifiable risk factors among younger AMI patients. Smoking contributes significantly to the premature onset of coronary artery disease through mechanisms involving endothelial dysfunction, enhanced thrombogenesis, and accelerated atherosclerosis, all of which disproportionately affect younger smokers [6]. Concurrently, the rising global prevalence of obesity and metabolic syndrome among young populations further exacerbates cardiovascular risk, highlighting the urgency of lifestyle intervention programs and preventive strategies targeting weight management, physical activity, and dietary modification [7].

Moreover, psychosocial stress and recreational drug use are increasingly recognized as pertinent contributors to early-onset AMI. Cocaine, amphetamines, and other stimulants have been clearly implicated in acute cardiovascular events due to their vasoactive and pro-thrombotic effects, complicating the clinical picture and management decisions among young AMI patients [8]. Additionally, chronic psychological stress has emerged as a key modifiable determinant, influencing the incidence and recurrence of myocardial infarction via neurohormonal dysregulation and inflammatory pathways, reinforcing the need for holistic approaches encompassing mental health support and stress reduction interventions [9].

Addressing AMI in younger adults is also challenging due to gaps in awareness and recognition both by patients and healthcare providers. Young adults often underestimate their cardiovascular risk, frequently ignoring symptoms or attributing chest discomfort and other cardiac symptoms to non-cardiac causes, thereby delaying timely medical intervention and worsening prognosis [10]. Healthcare professionals may similarly overlook the possibility of myocardial infarction in younger patients presenting with atypical symptoms, leading to diagnostic delays and suboptimal treatment initiation.

Given these multifaceted challenges and evolving epidemiology, comprehensive research into risk factors, clinical management, and preventive strategies specific to AMI in young adults is critical. Enhanced understanding of this issue can facilitate early diagnosis, promote effective intervention strategies, and significantly reduce long-term morbidity and mortality in this vulnerable patient population.

Study Design

This research employed a prospective observational design conducted at a tertiary care cardiac center. The primary objective was to evaluate and characterize the risk factors and management challenges associated with acute myocardial infarction (AMI) in young adults, defined for this study as individuals aged 18 to 45 years. Ethical clearance was obtained from the Institutional Ethics Committee, and informed consent was secured from all participants before enrollment.

Study Population

Patients presenting with clinical features suggestive of AMI, confirmed by electrocardiographic changes and elevated cardiac biomarkers (troponins, CK-MB), were included. Subjects with documented prior myocardial infarction, known congenital heart disease, or established cardiomyopathies were excluded to maintain homogeneity and focus on newly occurring AMI events. A total of 150 eligible patients who met these criteria were consecutively enrolled from the emergency and cardiology departments during the one-year study period.

Data Collection

Comprehensive demographic details were collected at baseline, including age, gender, socioeconomic status, education level, and occupation. Clinical data encompassed presenting symptoms, time of symptom onset, duration from symptom onset to hospital admission, family history of coronary artery disease, and detailed medical histories focusing on known risk factors such as hypertension, diabetes mellitus, dyslipidemia, obesity (body mass index ≥30 kg/m²), smoking status, alcohol intake, and recreational drug use. Psychosocial factors, including stress levels and psychiatric history, were assessed through structured questionnaires and clinical interviews.

Clinical Evaluation

All participants underwent a detailed clinical examination, standard 12-lead electrocardiogram (ECG), transthoracic echocardiography (TTE), and coronary angiography when clinically indicated. Blood samples for biochemical analyses (lipid profile, fasting blood glucose, glycated hemoglobin (HbA1c), and cardiac biomarkers) were drawn at admission. Additional investigations, such as toxicology screening for illicit substances, were performed when history or clinical suspicion warranted further exploration.

Follow-Up and Outcomes

Patients were followed up during hospitalization to document immediate outcomes, including complications such as arrhythmias, cardiogenic shock, heart failure, and mortality. Management strategies—pharmacological interventions, primary percutaneous coronary intervention (PCI), thrombolysis, or surgical revascularization—were recorded in detail. Challenges encountered during management, including delays in diagnosis, atypical clinical presentations, non-compliance to treatment, and referral delays, were documented and analyzed systematically.

Statistical Analysis

The collected data were entered into Microsoft Excel and analyzed using SPSS software (version 25, IBM Corporation, Armonk, NY, USA). Descriptive statistics were presented as means ± standard deviation (SD) for continuous variables and frequencies with percentages for categorical variables. Chi-square or Fisher's exact test was utilized to assess associations between categorical variables. Continuous variables were compared using independent t-tests or Mann-Whitney U tests as appropriate. Multivariate logistic regression analysis was conducted to identify significant independent risk factors associated with AMI in young adults, with a significance level set at p < 0.05.

The present study enrolled 150 young adults (aged 18–45 years) presenting with acute myocardial infarction (AMI). The key findings, as presented across four tables, demonstrate the clinical characteristics, risk factor profiles, management strategies, and associated challenges encountered in this patient population.

Table 1 illustrates the demographic and clinical characteristics of study participants. The majority of patients (82%) were male, and the mean age was 37.4 ± 5.6 years. Chest pain was the predominant presenting symptom (87.3%), followed by shortness of breath (42%), and atypical presentations such as gastrointestinal symptoms (14.6%). Family history of coronary artery disease was reported in 36.7% of patients.

Table 2 presents the prevalence of identified risk factors among study subjects. Smoking was the most prevalent risk factor (64.7%), followed by dyslipidemia (42%), obesity (37.3%), hypertension (30%), and diabetes mellitus (19.3%). Psychosocial stress (26.7%) and illicit drug use (11.3%) were also significant contributors.

Table 3 details the clinical management strategies implemented. Primary percutaneous coronary intervention (PCI) was performed in 58% of cases, thrombolytic therapy in 28.7%, while conservative medical management was provided to 13.3% of patients. Complications were observed in 22% of patients, including arrhythmias (12%), heart failure (6%), cardiogenic shock (3.3%), and mortality (0.7%).

Table 4 outlines management challenges encountered during hospitalization. Delay in hospital presentation (>12 hours from symptom onset) was documented in 34% of patients, primarily due to misinterpretation or underestimation of symptoms. Diagnostic delays due to atypical presentations occurred in 20.7%, while non-adherence to prescribed medication post-discharge was reported in 18%. Difficulties associated with patient referral to advanced cardiac centers were identified in 16.7%.

Table 1: Demographic and Clinical Characteristics of Study Participants (n=150)

Table 2: Prevalence of Identified Risk Factors (n=150)

Table 3: Clinical Management and Immediate Complications (n=150)

Table 4: Challenges Encountered During Management (n=150)

This study highlights critical insights into the epidemiological patterns, risk factors, clinical management, and challenges associated with acute myocardial infarction (AMI) among young adults. Notably, the predominance of males (82%) among the participants mirrors broader epidemiological trends reported globally, underscoring gender disparities in cardiovascular risk [6]. Male gender, combined with modifiable lifestyle factors such as smoking and obesity, significantly increases the risk for premature coronary artery disease (CAD). Smoking emerged as the predominant risk factor, observed in approximately two-thirds (64.7%) of the participants. This aligns with established evidence demonstrating that tobacco use markedly accelerates the process of atherosclerosis by inducing endothelial damage, increasing platelet aggregation, and altering lipid metabolism [7].

Obesity, another prevalent risk factor (37.3%), represents a significant public health concern given its strong association with diabetes, hypertension, and dyslipidemia—conditions collectively termed metabolic syndrome. Young obese individuals exhibit an increased likelihood of early-onset CAD due to elevated inflammatory markers and insulin resistance, emphasizing the importance of targeted lifestyle interventions at an early age [8]. The considerable prevalence of dyslipidemia (42%) further accentuates the metabolic derangements prevalent among younger populations, necessitating proactive screening and lipid-lowering interventions to mitigate cardiovascular risks.

Hypertension and diabetes mellitus, traditionally associated with older demographics, were also notably present, highlighting a concerning trend towards premature manifestation of these chronic conditions. The documented prevalence of hypertension (30%) and diabetes mellitus (19.3%) among younger AMI patients suggests a need for early screening programs targeting high-risk individuals to facilitate timely intervention and reduce long-term cardiovascular morbidity [9]. The frequent identification of psychosocial stress (26.7%) as a contributing factor corroborates emerging research that emphasizes psychological health as integral to cardiovascular risk assessment and management strategies [10]. Chronic stress triggers neurohormonal and inflammatory pathways, predisposing individuals to acute coronary events.

A particularly alarming finding was the significant incidence (11.3%) of illicit drug use, known to precipitate acute cardiovascular events through vasospastic and thrombotic mechanisms. Substances such as cocaine and amphetamines acutely elevate sympathetic tone, inducing coronary vasospasm and enhancing thrombotic potential, thereby complicating clinical management [11]. These findings underscore the necessity for comprehensive substance-use screening among younger patients presenting with AMI.

Clinical management strategies demonstrated substantial reliance on primary percutaneous coronary intervention (PCI) (58%), aligning with current international guidelines that advocate timely PCI as the gold standard for managing ST-elevation myocardial infarction (STEMI). However, logistical challenges, including delayed hospital presentation beyond 12 hours (34%) and diagnostic delays due to atypical symptoms (20.7%), significantly affected treatment efficacy and outcomes. Delayed presentation is particularly detrimental, reducing the likelihood of successful reperfusion therapy and increasing mortality and morbidity risks [12]. Educational initiatives aimed at enhancing public awareness regarding AMI symptoms and urgency of seeking immediate medical care are critical in addressing this issue.

Post-discharge non-adherence to medication (18%) posed another significant management challenge. Adherence to prescribed pharmacological regimens, including antiplatelet agents, beta-blockers, and statins, is pivotal for secondary prevention and reducing recurrent cardiovascular events [13]. Interventions such as patient education, simplified medication regimens, and regular follow-ups may enhance compliance rates among younger patients.

Referral difficulties to specialized cardiac centers were documented in approximately one-sixth of patients (16.7%). Timely referral and access to advanced cardiac care facilities are essential components influencing prognosis, particularly for patients requiring complex interventions or specialized follow-up care [14]. Thus, improving the healthcare infrastructure and streamlining referral pathways is essential for addressing these systemic gaps in care delivery.

Collectively, these findings underscore the complexity and multifaceted nature of AMI in young adults, advocating for an integrated approach incorporating risk-factor modification, public health awareness, early clinical intervention, and targeted psychosocial support. Strategic initiatives designed specifically for younger populations can significantly reduce the burden of premature cardiovascular disease and improve long-term health outcomes [15].

Acute myocardial infarction in young adults presents distinct epidemiological patterns and clinical management challenges, predominantly driven by modifiable risk factors such as smoking, obesity, and psychosocial stress. Addressing delayed presentation, diagnostic difficulties, and medication adherence requires targeted public awareness initiatives, enhanced screening, and improved healthcare access. Holistic and proactive interventions specifically tailored to younger populations can effectively mitigate early cardiovascular risks, improve clinical outcomes, and significantly reduce long-term morbidity and mortality.

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