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Researchers presented a smattering of intriguing observational findings at a press briefing ahead of presentation at the in New Orleans. They touched on myocardial infarction (MI) in young adults, the interplay of mid-day sleep with blood pressure, and the benefits of in-patient flu vaccination.

Early MI

Substance abuse is the key predictor of heart attack before age 40, researchers found.

Marijuana or cocaine use were reported by 17.9% of the very young group versus 9.3% among those ages 40 to 50 (P<0.001), reported Ron Blankstein, MD, of Harvard Medical School in Boston.

Typical predictors, including hypertension, peripheral vascular disease, and atherosclerotic cardiovascular disease score were less common or lower than seen among 40- to 50-year-olds who had MI.

"Despite being on average 10 years younger, they had similar long-term all-cause and CV death as those who were over 40," Blankstein noted. "Our findings suggest the need for aggressive secondary prevention measures in all patients who experience an MI at a young age, with particular attention to substance abuse among those who are under age 40."

The Young-MI registry included all 3,929 adults ages 50 and younger who had an MI or unstable angina at Brigham and Women's Hospital and Massachusetts General Hospital from 2000 through 2016. Among them, 20% were age 40 or younger.

Flu Shots

In-patient influenza vaccination was associated with fewer subsequent heart attacks, a study showed.

Myocardial infarction prevalence was 3.4% versus 4.4% among those whose hospitalization didn't include it, corresponding to about 5,000 fewer cases among the roughly 30 million patients included in the analysis of the 2014 U.S. National Inpatient Sample (NIS) database.

Adjusting for confounders like age and gender, the relative risk was 0.91 (95% CI 0.87-0.96), reported Mariam Khandaker, MD, of the Icahn School of Medicine at Mount Sinai in New York City.

She called it a low-cost but underutilized preventive measure. "Given the benefits of this vaccine, I feel it should be considered as an integral part of patient management and prevention."

Notably, only 2% of the in-patient sample was vaccinated during their stay. However, the study could not rule out the potential for confounding, draw causal conclusions, or determine which patients had already received the flu vaccine outside the hospital.

Indeed, vaccination could be a marker of overall better care, as these patients were probably more likely to get acute therapies as well, commented ACC press briefing moderator Salim Virani, MD, PhD, of Baylor College of Medicine in Houston and chair of the ACC Prevention of Cardiovascular Disease Council.

Siesta Time

A mid-day nap was associated with lower blood pressure among hypertensive individuals, with 3 mm Hg lower 24-hour systolic pressure per 60 minutes of sleep (P<0.001) in a prospective observational study.

"Now someone may argue that this decrease may be small, but we know that a decrease of systolic blood pressure as small as 2 mm Hg may decrease significantly the relative risk of cardiovascular events by up to 10%," said presenter Manolis Kallistratos, MD, of Asklepieion General Hospital in Voula, Greece.

Overall, people with a habit for a mid-day nap among the 212 hypertensive patients studied had average morning systolic and diastolic blood pressures that were significantly lower (128.7/76.2 vs 134.5/79.5), with a nonsignificant trend for lower average 24-hour diastolic pressure, too.

"After listening to your presentation, anyone who wants to take an afternoon siesta can. There's a medical reason for it now. Obviously, it does not take the emphasis away from other risk factors. You should not take time away from physical activity and take a nap. Everything else is as important -- whether it's diet, exercise, weight reduction -- but in addition there are other considerations clinicians can take into account to further control blood pressure in their patients," Virani commented.

The observational study didn't show a difference between nappers and non-nappers in terms of number of antihypertensives used, pulse wave velocity, augmentation index, or echocardiographic indices.

No information was provided on efforts to control for potential confounders.