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Predicting and Preventing Myocardial Infarction in the Young

In this issue of Diabetes Care , Divakaran et al. (1) report on patients from the Partners YOUNG-MI registry who suffered a first myocardial infarction (MI) at or before the age of 50 years. They describe diabetes prevalence and long-term cardiovascular outcomes stratified by diabetes status. Diabetes is a well-established risk factor for major adverse cardiovascular events (MACE) such as MI, stroke, or cardiovascular death. However, most existing data are in older patients. Thus, this article offers an opportunity to gain insight into an important and understudied population.

The mean age of this study cohort was 44 years, 19% were women, and 73% were white. Patients were enrolled between 2000 and 2016, and median follow-up was just over 11 years. Of the 2,097 patients in this cohort, 416 (20%) had diabetes, 39 (2%) of whom had type 1 diabetes. In 81 patients (20% of the patients with diabetes, 4% of the overall cohort), this was a new diabetes diagnosis. Although young, the risk factor burden in these patients was substantial. Half the cohort reported current smoking, 9 in 10 carried a diagnosis of hyperlipidemia, and 1 in 4 reported a family history of premature cardiovascular disease. Despite this significant risk factor burden, the median atherosclerotic cardiovascular disease (ASCVD) 10-year risk score was just under 10% in study patients with diabetes.

Despite the young age of this cohort, the cumulative incidence curves shown in Fig. 1 of the article show all-cause mortality >20% at 10 years in patients on insulin and >10% in patients with diabetes not on insulin. Cardiovascular mortality was ∼10% in patients with diabetes, over threefold higher than …