Non-traditional risk factors for myocardial infarction in adults under forty: A systematic review of emerging trends

Table 2 Exposure details and outcomes

Study ID	Non-traditional risk factors assessed	Measurement methods	Outcome measures	Effect estimates (OR/HR/RR with 95%CI)	Covariates adjusted for
1	HIV, SLE, OSA, RA	ICD-9 codes (NIS)	AMI risk	HIV: OR = 4.06 (3.48-4.71); SLE: OR = 2.12 (1.89-2.39); OSA: OR = 1.16 (1.12-1.20); RA: OR = 0.83 (0.76-0.89)	Age, sex, race, BMI, DM, HTN, HLD, CKD, smoking
2	Marital/partner status, depression, social support, stress	Structured interview, PHQ-9, Social Support Inventory, Perceived Stress Scale	1-year all-cause readmission	HR = 1.31 (1.15-1.49) unpartnered vs partnered; adjusted HRs for demo/SES/clinical/psychosocial	Age, sex, race, SES, clinical, psychosocial
3	Depression, social support, stress, SES	PHQ-9, Social Support Inventory, PSS, SES data	1-year all-cause readmission	HR = 1.28 (1.15-1.42) unpartnered vs partnered; adjusted HRs	Age, sex, race, MI severity, comorbidities, psychosocial
4	Telomere length (biological aging)	qPCR for telomere length	Telomere length in MI vs controls	Mean T/S ratio MI 0.115 vs controls 0.792 (P < 0.0001); shorter in MI	Age, gender, BMI
5	Socioeconomic status, depression	Insurance premium, ICD-10 codes	AMI incidence	HR low SES vs high 1.16 (1.14-1.19); HR depression vs none 126 (1.21-1.31)	Age, sex, comorbidities
6	OSA	Polygraphy (AHI ≥15)	MACCE, unstable angina	HR = 1.55 (0.94-2.57) MACCE; HR = 3.87 (1.20-12.46) MACCE after 1 years	Age, sex, BMI, HTN, diabetes, prior MI/PCI
7	Depression, psychosocial stress	PHQ-9, PSS, interview	Prevalence of depressive symptoms at AMI	Women: 39% PHQ-9 ≥ 10, men: 22%; adjusted OR for women 1.64 (1.36-1.98)	Age, sex, SES, comorbidities
8	Mediterranean diet adherence	Food Frequency Questionnaire, MDS	Non-fatal AMI	MDS ≥ 6: OR = 0.55 (0.40-0.75); per point: OR = 0.91 (0.85-0.98)	Age, sex, BMI, HTN, diabetes
9	Type A behavior, psychosocial work, education	Jenkins Activity Survey, work environment survey	MI risk, variance explained	Work monotony/poor discretion 5% variance; type A 2%; education NS	Age, sex, education
10	Sleep duration	Self-report, AHA CVH score	Ideal CVH, BP, glucose, cholesterol	≤ 6 hours sleep: OR = 1.38 (1.15-1.67) for non-ideal CVH	Age, sex, BMI, comorbidities
11	Unexplained (likely non-traditional) risk	Autopsy, lesion quantification	Subclinical atherosclerosis	OR high-growth group per year age: 1.125 (1.063-1.190)	Age, cholesterol, BMI, HbA1c, CRP
12	Depression, low income, family history	PHQ-9, interview, lab, SES	First AMI, PAFs	Women: Depression OR = 3.09 (2.37-4.04); low income OR = 1.79 (1.28-2.50)	Age, sex, SES, comorbidities
				Men: Depression OR = 1.77 (1.15-2.73)
13	Hypothyroidism, CTD, RHD, takayasu, SCAD, OCP use	Medical record, interview, labs	Prevalence, in-hospital outcomes	Non-traditional RFs rare; no adjusted effect estimates; in-hospital mortality 1.77%-2%	Age, sex

OR: Odds ratio; HR: Hazard ratio; RR: Relative risk; CI: Confidence interval; HIV: Human immunodeficiency virus; SLE: Systemic lupus erythematosus; OSA: Obstructive sleep apnea; RA: Rheumatoid arthritis; BMI: Body mass index; DM: Diabetes mellitus; HTN: Hypertension; PHQ-9: Patient Health Questionnaire-9; SES: Socioeconomic status; MACCE: Major adverse cardiovascular/cerebrovascular event; MDS: Mediterranean Diet Score; CVH: Cardiovascular health; CTD: Connective tissue disorder; RHD: Rheumatic heart disease; SCAD: Spontaneous coronary artery dissection; OCP: Oral contraceptive pill; PAF: Population attributable fraction; PSS: Perceived Stress Scale; HLD: Hyperlipidemia; CKD: Chronic kidney disease; MI: Myocardial infarction; qPCR: Quantitative polymerase chain reaction; ICD-10: International classification of diseases, 10^th revision; AMI: Acute myocardial infarction; PCI: Percutaneous coronary intervention; SES: Socioeconomic status; NS: Not significant; AHA: American Heart Association; BP: Blood pressure; HbA1c: Hemoglobin A1c; CRP: C-reactive protein; RFs: Risk factors.