Very young patients with myocardial infarction and obesity: A high-risk constellation in clinical practice

Kilian Clemens (Bremen)1, H. Kerniss (Bremen)1, L. A. Mata Marín (Bremen)1, C. Litfin (Bremen)1, A. Seidel-Sarpong (Bremen)1, S. Rühle (Bremen)1, J. Schmucker (Bremen)1, R. Osteresch (Bremen)1, A. Fach (Bremen)1, R. Hambrecht (Bremen)1, H. Wienbergen (Bremen)1

1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland



The surge in obesity, particularly among young individuals, is a growing concern, impacting national healthcare systems. Even though this patient collective is constantly increasing, it is rarely investigated. This study evaluates the prevalence of obesity in patients with MI ≤ 45 years old and investigates risk factor profile and clinical findings of these patients.


All consecutive patients ≤ 45 years old with MI who were admitted to an overregional heart center between 2015 and 2022 were included into the analysis. Patients were classified into four BMI groups: normal weight (BMI < 25 kg/m²), overweight (BMI 25-29.9 kg/m²), class 1 obesity (BMI 30-34.9 kg/m²), and severe obesity (BMI ≥ 35 kg/m²). Groups were compared regarding risk factor profile and clinical findings.


Among 400 patients with MI, only 83 (20.8%) had a normal weight, while 159 (39.8%) were overweight, 87 (21.8%) had class 1 obesity, and 71 (17.8%) had a BMI of ≥ 35 kg/m².

The mean age was 40.6 ± 3.9 years in obese patients and 40.3 ± 5.0 years in non-obese patients (p = 0.61); BMI tended to be higher in women than in men (30.4 ± 5.2 kg/m² vs. 29.4 ± 8.1 kg/m², p = 0.09).

Obesity was associated with numerous other risk factors: Obese young patients exhibited significantly higher levels of HbA1c (6.2 ± 1.4% vs 5.7 ± 1.2%, p = 0.005), a higher incidence of type 2 diabetes mellitus (30.3% vs 8.6%, p < 0.001), higher levels of Non-HDL-C (167 ± 51 mg/dl vs 155 ± 51 mg/dl, p = 0.03), and triglycerides (196 ± 143 mg/dl vs 151 ± 125 mg/dl, p < 0.01). The prevalence of arterial hypertension increased with increasing weight categories (23% vs 34% vs 48% vs 62%, p<0.01). Obese young patients were significantly less often physically active (7.6% vs 19.4%, p = 0.001). The rate of family history of premature coronary heart disease was elevated in obese patients (44.7% vs 28.7%, p = 0.014).

With increasing weight categories the CK max. levels -as a clinical sign of infarction size- increased (1763 vs 1832 vs 1999 vs 2294 U/l) and very obese patients (BMI ≥ 35 kg/m²) had the highest rate of CK max. levels > 1500 I/U (52.1% vs 38.3%, p = 0.03). Overweight was associated with more often advanced coronary heart disease (multivessel disease 41.5% vs. 29.9%, p = 0.049).


In this study on consecutive patients with MI ≤ 45 years only 21% had normal body weight, while 40% of the patients had obesity. Obese patients represented a high-risk cohort with elevated cardiovascular risk factor profile and findings of larger infarction size and advanced coronary heart disease. Preventive efforts to reduce the risk burden of these young patients with MI have to be intensified.

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