A younger trend in acute myocardial infarction in China and a novel classification of clinical risk factors: “A single center retrospective study”

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However, little is known about the age trend and comprehensive clinical risk factors (CRF). Here, data on the ages of AMI patients in China from 1990 to 2019 were collected and divided groups: 1990s, 1995s, 2000s, 2005s, 2010s, 2015s and 2020s. The mean minimum age for each group was approximately 55.0 (1990s), 46.4 (1995s), 48.2 (2000s), 55.0 (2005s), 47.1 (2010s), 43.9 (2015s), and 52.8 (2020s) years. The median minimum ages for each group were about 55.0, 58.0, 61.0, 62.0, 59.0, 61.0, and 59.0 years, respectively. Both the mean and median curves showed a trend towards younger for AMI. Additionally, a novel classification for CRF in AMI was developed. In conclusion, there is a younger trend in AMI due to unhealthy E(e)SEEDi lifestyle. The novel CRF classification is helpful in better prevention of AMI globally. Health sciences/Diseases/Cardiovascular diseases/Acute coronary syndromes/Myocardial infarction Health sciences/Risk factors Biological sciences/Biological techniques Physical sciences/Engineering/Biomedical engineering Scientific community and society/Social sciences/Interdisciplinary studies acute myocardial infarction age cardiovascular disease lifestyle risk factor Figures Figure 1 Figure 2 Figure 3 Introduction It is well known that more than 40% deaths each year are attributed to cardiovascular disease (CVD) in China. Acute myocardial infarction (AMI) is a leading cause of death in adults with CVD. It is also a major “killer” in young adults. Mortality of AMI in both urban and rural population in China is more than 1.1‰ 1 . However, previous studies on trends in AMI focused mainly on its sex-specific or gender differences 2,3 , clinical risk factors (CRF), and mortality 4-6 . In fact, little is known about data of evidence-based age trend in AMI in China, and there is also lack of a novel classification of CRF based on a comprehensive analysis and “the Essential 5” for better control and prevent AMI. Results Data on ages of patients with AMI were collected from original research articles published in Chin Med J (Engl) during 1990 to 2019 (Table 1 ). Means of minimum ages of each group were about 55.0 (1990s), 46.4 (1995s), 48.2 (2000s), 55.0 (2005s), 47.1 (2010s), 43.9 (2015s), and 52.8 (2020s) years old, respectively. According to the means curve on minimum ages of each group, it’s easy to find a younger trend in AMI in China from 2003 to 2017 (Fig. 1 ). According to data on ages in AMI from 1990 to 2019 (1990s-2020s), medians were about 55.0 (1990s), 58.0 (1995s), 61.0 (2000s), 62.0 (2005s), 59.0 (2010s), 61.0 (2015s), and 59.0 (2020s) years, respectively. At the same time, to prevent these data skewed, a medians curve on ages of patients with AMI in China is also presented (Fig. 2 ). This medians curve also showed that there is indeed a younger trend in AMI in China from 2005s to 2020s. Table 1 Ages of patients with AMI in China during 1990–2019 Time Literatures on ages of patients with AMI Ages (yrs) Mean of mini ages (yrs) 2020s ... Chin Med J (Engl) 2019;132(9):1037-44 Chin Med J (Engl) 2019;132(5):519 − 24 56–74 62.02 ± 12.47 ≈ 52.8 2015s Chin Med J (Engl) 2017;130(13):1534-39 Chin Med J (Engl) 2017;130(5):542-8 Chin Med J (Engl) 2017;130(1):77–82 Chin Med J (Engl) 2017;130(1):51 − 6 Chin Med J (Engl) 2016;129(5):518 − 22 Chin Med J (Engl) 2015;128(18):2415-9 Chin Med J (Engl) 2014;127(6):1008-11 Chin Med J (Engl) 2013;126(21):4105-8 Chin Med J (Engl) 2013;126(18):3481-5 Chin Med J (Engl) 2013;126(16):3079-86 Chin Med J (Engl) 2013;126(12):2281-5 Chin Med J (Engl) 2013;126(3):464 − 70 44.4 ± 4.1 62.86 ± 14.98 38.68 ± 4.44 58 ± 12 61.5 ± 11.1 53.78 ± 11.02 62.1 ± 7.3 68.1 ± 8.5 58.2 ± 11.2 62.8 ± 12.3 61.8 ± 9.6 60.1 ± 14.4 ≈ 43.9 2010s Chin Med J (Engl) 2012;125(8):1405-9 Chin Med J (Engl) 2011;124(20):3275-80 Chin Med J (Engl) 2011;124(14):2083-8 Chin Med J (Engl) 2011;124(6):825 − 30 Chin Med J (Engl) 2010;123(20):2807-11 Chin Med J (Engl) 2010;123(14):1840-5 Chin Med J (Engl) 2010;123(14):1833-9 Chin Med J (Engl) 2009;122(22):2718-23 Chin Med J (Engl) 2009;122(14):1610-4 Chin Med J (Engl) 2009;122(6):665-9 Chin Med J (Engl) 2009;122(6):636 − 42 Chin Med J (Engl) 2008;121(23):2384-7 Chin Med J (Engl) 2008;121(9):771-5 56 ± 12 60.5 ± 10.1 62.1 ± 11.7 59 ± 11.7 56.61 ± 11.44 59 ± 12 57.8 ± 2.5 52 ± 11 40–79 36–82 68.0 ± 10.6 60 ± 10 60.1 ± 12.1 ≈ 47.1 2005s Chin Med J (Engl) 2007;120(14):1226-31 Chin Med J (Engl) 2006;119(1):26–31 Chin Med J (Engl) 2004;117(10):1443-8 62.3 ± 9.3 62.3 ± 11.3 58 ± 7 ≈ 55.0 2000s Chin Med J (Engl) 2002;115(2):163-5 Chin Med J (Engl) 2001;114(7):698–702 Chin Med J (Engl) 2000;113(8):733-6 Chin Med J (Engl) 2000;113(8):702-5 Chin Med J (Engl) 1999;112(1):18–21 69 ± 11 55 ± 8.6 61.7 ± 10.2 27–86 65 ± 7 ≈ 48.2 1995s Chin Med J (Engl) 1997;110(11):839 − 42 Chin Med J (Engl) 1997;110(11):834-8 Chin Med J (Engl) 1997;110(3):184-6 Chin Med J (Engl) 1997;110(1):56 − 8 Chin Med J (Engl) 1997;110(1):50 − 2 Chin Med J (Engl) 1995;108(7):501-5 Chin Med J (Engl) 1993;106(6):410-4 60 ± 10.2 61.2 ± 10.6 36–78 40–74 61.0 ± 9.4 58 ± 12 42 ≈ 46.4 1990s Chin Med J (Engl) 1990;103(7):541-5 55 = 55.0 However, current data on ages of AMI in China in 2020s are incomplete since these data were adopted by the author in 2019. Moreover, according to the comprehensive analysis of CRF in AMI based on “the Essential 5”, there is a novel classification of CRF (Table 2 ) for better control and prevent AMI. Figure 3 shows that these CRF mainly link to modern unhealthy E(e)SEEDi lifestyle, such as air pollution, chronic infection, poor quality of sleep, anxiety and depression, physical inactivity, and unbalancing diets. Table 2 Clinical risk factors (CRF) of AMI related to unhealthy E(e)SEEDi lifestyle E(e)SEED Major risk factors of AMI Notes External environment Abnormal climate and environment 7 , e.g., cold or hot weather 8 , lower ambient temperature 9 traffic noise or e-noise 10 , 11 dust 12 , 13 radiation short-term 14 /long term 15 air pollution 16 – 18 A low socioeconomic status 19 , including Low education 20 , 21 Internal environment Abnormal blood pressure hypotension or hypertension 22 , 23 Acute and chronic heart failure Acute and chronic kidney disease a family history of ischaemic heart disease 24 A history of coronary heart disease (angina) 24 Atrial fibrillation Congenital coronary abnormalities or *ANOCOR Coronary thrombosis and/or spasm, plaque Genetic or family history of AMI 22 Hypercoagulable state Inflammation & infection 25 , 26 , e.g., influenza epidemics 27 acute respiratory-tract infections 28 asthma (active and poor control) 29 , *COPD COVID-19 infection 30 , 31 *HIV infection 32 Dyslipidemia or hyperlipidemia 22 , 33 , e.g., elevated apolipoprotein B/apolipoprotein A ratio fasting serum triglyceride values 24 serum total cholesterol values 24 serum LDL-C levels familial-combined hyperlipidaemia 34 hyperuricaemia 24 Excess BMI (overweight and obesity) 24 , 35 *T1D (women) or T2D 22 , 23 , 36 , particular with heat and cold 37 Menopause 38 Unprovoked venous thromboembolism 39 *Anomalous connections of the coronary arteries *Chronic obstructive pulmonary disease *Human immunodeficiency virus *Type 1 diabetes Sleep Insomnia with long sleep duration 40 *OSA Stay up late or work in shifts *Obstructive sleep apnoea Emotion Anxiety and depression 41 – 43 Physical exertion, anger or emotional upset 44 Stress (psychological or emotional) 23 at work or home, e.g., soccer related cardiovascular events 45 Exercise Low physical activity 46 or physical inactivity Sedentary habits Diet Inadequate daily intake of fresh, fruits and vegetables 47 , e.g., foods with beta-carotene 48 Low Mg and high Ca:Mg ratio 49 Margarine intake 50 Se deficiency Smoking 22 in both men 51 , 52 and female (heavy and long-term) 53 , particularly combined with high coffee intake 54 , and no smoking ban 55 or smoke-free legislation 56 Heavy alcohol consumption Drugs, e.g. cocaine abuse *OC use outpatient clarithromycin use 57 post menopausal hormone replacement therapy 58 *SSRI use in an elderly population 59 Underuse or stopping evidence-based pharmacotherapy 60 , e.g. beta-blockers, clopidogrel, and statin Increasing fish, fruit and vegetables, would reduce AMI risk of about 50%. *Oral contraceptive or oral corticosteroid *Selective serotonin reuptake inhibitor Discussion Currently, a younger trend in AMI in China mainly results from “the Essential 5” based modern unhealthy E(e)SEEDi lifestyle, and evidence-based CRF are highly associated with AMI onset. First, abnormal external environment. There is increased risk of AMI due to exposure to abnormal climate 7 – 9 , e.g., cold or hot weather, lower ambient temperature, radiation, traffic noises or e-noise 10 , 11 , Asian dust 12 , 13 , short-term 14 and/or long-term 15 air pollution 16 – 18 (such as particulate matter exposure or PM2.5), and a low socioeconomic status 19 , e.g., low education 20 , 21 ; And abnormal internal environment, for example, hypotension or hypertension 22 , 23 , a family history of AMI and ischaemic heart disease or a history of coronary heart disease (angina) 22 , 24 , inflammation & infection 25 , 26 , acute infection including influenza epidemics 27 . Previous studies showed that acute respiratory-tract infections 28 and asthma (active and poor control) 29 were associated with an increased risk of first-time AMI, in particular the COVID-19 pandemic 30 , 31 . HIV infection also increases the risk of AMI 32 . Dyslipidemia or hyperlipidemia 22 , 33 , e.g., elevated apolipoprotein B/apolipoprotein A ratio, fasting serum triglyceride values 24 , serum total cholesterol values 24 , serum LDL-C levels, familial-combined hyperlipidaemia 34 , and hyperuricaemia 24 , excess BMI (overweight and obesity) 24 , 35 , type 1 diabetes (T1D) (women) or T2D 22 , 23 , 36 , particular with heat and cold 37 , menopause 38 , and unprovoked venous thromboembolism 39 are traditional CRF highly linked to AMI. Second, poor quality of sleep and insomnia with long sleep duration 40 can induce AMI. Many young and middle-aged adults often stay up late, some work in shifts, and many adults suffer from severe obstructive sleep apnea (OSA). Third, bad emotion (such as anxiety and depression) and stress (psychological or emotional) 23 at work or home. Screening for depression is necessary because patients with untreated depression are associated with increased long-term mortality of AMI 41 . Self-reported symptoms of depression and anxiety, especially if recurrent, were also moderately associated with the risk of incident AMI 42 . HIV-infected individuals with depression have a 30% increased risk for AMI than without depression 43 . In fact, physical exertion and anger or emotional upset are triggers associated with first AMI in all regions of the world, in men and women, and in all age groups 44 . For example, there are often soccer related emotion and stress-induced cardiovascular events including AMI 45 . However, antipsychotic use is also associated with a transient increase in risk for AMI. Fourth, low physical activity or physical inactivity and sedentary habits 46 linked to obesity and T2D may induce AMI due to popularization of cars, urban buses, subways, and elevators as well as lasting watching TV at home and mobile-phone entertainment. Lastly, there are unbalance of diet and nutrition including higher “salt, fat, and sugar” and inadequate water and fresh fruits intake 47 , e.g., foods with beta-carotene 48 , heavy alcohol consumption. But there is a protective role of Mg and low Ca:Mg ratio against coronary heart disease (CHD) 49 . Margarine intake 50 is also a common risk factor. Tobacco use is one of the most important causes of AMI globally 22 , in both men 51 , 52 and female (heavy and long-term) 53 , particularly combined with high coffee intake 54 . In contrast, smoking ban 55 or smoke-free legislation 56 was associated with a reduction in AMI incidence. Some drugs, e.g. cocaine abuse, oral contraceptive use, outpatient clarithromycin use 57 , post menopausal hormone replacement therapy 58 and use of selective serotonin reuptake inhibitor in an elderly population 59 may increase the risk of AMI. Incidence of AMI also associates with stopping evidence-based pharmacotherapy 60 , e.g., statin, beta-blockers and clopidogrel. Moreover, early initiation of statin treatment and beta-blockers for primary and secondary prevention of CHD before the first AMI are often underused. But use of evidence-based drug treatment may reduce the risk of AMI and has more survival benefit 61 . In addition, the rates of awareness, treatment, and control of hypertension were not high enough in China 62 . This may also link to more cases of AMI in China. Herein, these modifiable risk factors highly link to the incidence of AMI. And the EPIC-Heidelberg cohort study confirmed the strong primary preventive potential of healthy lifestyle (such as regular physical activity, control BMI, and no smoking) on AMI in middle-aged men 63 . And there are indeed significant gender differences in the risk factors and clinical outcomes of young AMI 64 . In fact, there were AMI patients aged 18 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study 65 , 66 . Of course, there is the geographical inequalities in incident AMI. Thus, there is arising need for control of AMI younger by more health coverage and essential health service since it is far from reality for poor and rural regions, and modifying modern unhealthy E(e)SEEDi lifestyle and reducing major CRF related to these lifestyles. So far, a number of CRF have been identified to link with AMI, and higher CRF levels at younger ages associate with the earlier age of AMI 67 – 69 . Modern unhealthy E(e)SEEDi lifestyle results in not only CHD and C-type hypertension, but also AMI younger. Thus, a new program is indeed necessary for prevention and management of AMI. Without doubt, the standardized comprehensive iRT-ABCDEFG program for AMI and diabetes is worthy of conduction in the globe 70 , 71 . As a magic and novel “polypill” 72 , healthy E(e)SEEDi lifestyle can help to halt AMI younger and reduce its morbidity and mortality due to better self-management of major CRF. Thus, the iRT-ABCDEFG program will help us to realize these goals. Because the SPRINT (Systolic Blood Pressure Intervention Trial) showed that a lower systolic blood-pressure is better for less AMI and other adverse outcomes, “clinical trial will change practice” 73 it helps us to understand and support not only more aggressive treatment of hypertension but also the renewed American Heart Association (AHA) Guideline on a more strict definition of hypertension (130/80 mmHg). It can be said that more coverage by healthy E(e)SEEDi lifestyle and application of the iRT-ABCDEFG program, more effectiveness in prevention of AMI younger. Active cardiovascular prevention will help reducing the first AMI among high risk individuals, new targets and treatments will help to develop novel cardiovascular protective strategies 74 – 78 better biomarkers for screening, diagnosis or prognosis for AMI. Since the China AMI Registry is a good platform for evaluation, healthcare, investigation and prevention, it will help to improve quality of life (QoL) and better prevent AMI 79 , 80 . For example, invasive coronary angiography should be used rationally according to patients’ clinical presentation so as to get better diagnosis and care. With further understanding of cellular and molecular mechanisms as well as analysis of human atlases on cardiac cell and the adult heart 81 , 82 , more therapeutic targets and strategies will be developed for better control and prevention of AMI. Definitely, both external and internal environmental changes may induce or reduce the onset of AMI. For example, recent studies showed that exposure to ambient air pollutant may trigger the onset of AMI 17 , 18 , patients with coronary artery ectasia showed higher rates of adverse outcomes included AMI 83 . In addition, sociopolitical environment or stress may also induce major adverse cardiocerebrovascular events (MACCE) including stroke and AMI 84 . But smoking ban 55 or smoking-free legislation 56 may reduce hospitalization rates for AMI and incidence. In addition, safer agents for anticoagulation therapy may improve AMI patients’ outcomes and QoL, and statin therapy for patients with AMI is also associated with improved outcomes 85 , since these evidence-based optical medical treatment improves individuals’ internal environment. In fact, like in a Japanese population 86 , there is also an increasing trend of AMI in China. The iRT-ABCDEFG program for management or self-management of AMI not only helps to control and prevent AMI and but also halt its younger trend, and improve QOL in patients with history of AMI. Herein, both the iRT-ABCDEFG program 71 and healthy E(e)SEEDi lifestyle 72 are worthy of conduction not only in the Asia but also in the globe, in particular the COVID-19 era 87 , since COVID-19 has been a high risk factor of MACCE 88 , but targeting the inflammasome 89 could be a unique therapeutic strategy for experimental AMI. In addition, plasma carboxypeptidase U levels, extracellular vesicles concentrations, and thrombin generation testing may serve as diagnosis and evaluation of AMI treatment 90 – 92 . Since there are more patients with ST-segment elevation myocardial infarction (STEMI) than non-STEMI 93 , new biomarkers for early diagnosis and prognostic evaluation 94 , 95 , shorter time to hospital arrival 96 , and more rational fibrinolytic therapy 97 , will help to improve outcomes for AMI. In fact, clinical trials confirmed that novel agents offer new and more choices for AMI prevention. For example, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) is effective in short-term lipid control among AMI patients 98 , 99 , factor XI inhibitor (abelacimab, a monoclonal antibody) is effective for the prevention of venous thromboembolism 100 , and sacubitril-valsartan may be more effective in preventing heart failure induced AMI than AMI induced heart failure 101 . In addition, because of greater risk of death among in-hospital-onset AMI than those outpatient-onset AMI 102 , better management of related risk factors (for example, circulating blood urea nitrogen on admission 103 , an independent predictor of long-term cardiovascular mortality in AMI; New-onset atrial fibrillation 104 and antidepressant medication at discharge 105 , both common and independently associated with poor prognosis in AMI), early use of sacubitril/valsartan medication (low or high dosage) 106 , and persisting diets of natural marine products 107 are vital strategies for improvement of AMI outcomes. There were some limitations in this study. Although data on ages of patients with AMI in this study were only collected (see the Table 1 ) from original research articles published in Chin Med J (Engl) , and don’t cover in those published in other international journals, it may be understood as “a single center retrospective study”. In fact, it’s also “multi-center data” from at least 43 institutions/units with the time span of a full 30 years from 1990s to 2020s due to 43 literatures. Herein, this study is enough strength. Moreover, Chin Med J (Engl) is highly authority and has a history of over a hundred and thirty years. Selection bias is possible, but the conclusions is reliable, especially in line with real-world conditions, and aren’t misleading. As to the total number of patients, it’s not necessary to show since 30 years’ data from 1990s-2020s are enough to support this study. Although the curves in Figs. 1 & 2 in this study showed a fluctuating appearance, the overall trend is towards younger, particularly from 2003 to 2017 and in the real-world. Data in the 2020s were incomplete since this article was wroten in 2019, hence, there was no data from 2020 to 2022. In addition, this study didn’t involve in data on patients’ gender, treatment and mortality, and other potential biases for this study include selection bias, missing data, selecting reporting, and others. As to which one was the worst among these comprehensive risk factors, the author didn’t discuss it in this manuscript, since it needs further clinical studies to test or clinical trials to confirm. Overall, the unhealthy lifestyle is the worst cause or total risk factor. Conclusion This study used a novel and simple design and methods, and confirmed that there is indeed a younger trend in AMI in China due to major CRF related to modern unhealthy E(e)SEEDi lifestyle, such as air pollution, chronic inflection, poor quality of sleep, anxiety and depression, physical inactivity, and unbalancing diets. The novel classification of CRF based on the systemic analysis and “the Essential 5” is worthy of inclusion in clinical guidelines/expert consensus or professional textbooks, and contributes to the establishment of a new scoring system or algorithms for control and prevention of AMI in both China and the globe. It will help to halt the younger trend and improve individuals’ QOL as well as develop a system (robodoctor) for prediction, diagnosis and evaluation of CVD in the future and innovate artificial intelligence medicine as a new discipline. Methods Study design, data search and collection Literatures on AMI were checked from PubMed according to key words “AMI and Chin Med J (Engl)” and to collect data on ages from original research articles on AMI published in Chin Med J (Engl). Data on ages of patients with AMI were divided into seven groups: 1990s (1988-1992), 1995s (1993-1997), 2000s (1998-2002), 2005s (2003-2007), 2010s (2008-2012), 2015s (2013-2017), and 2020s (2018-2022), respectively, and recorded these data in a table. The trend of ages in AMI in China was expressed with both means and medians curves on minimum ages of each group so as to prevent these data skewed. Moreover, there is also a comprehensive analysis and a novel classification of CRF according to “the Essential 5”, that is modern unhealthy “environment-sleep-emotion-exercise-diet” intervention [E(e)SEEDi] lifestyle, such as air pollution, chronic infection, poor quality of sleep, anxiety and depression, physical inactivity, and unbalancing diets. Ethics statement and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the local Ethics Committee (with reference numbers 0312/2019) for studies involving human subjects. Human studies were also approved by the Ethics committee of Nanchang University (with reference numbers 0312/2019). But it’s actually not applicable due to data from published literatures. And informed consent was not required as the study was conducted retrospectively using anonymised data and without direct patient involvement. Statistical analysis The results of original records were used. Data were statistically analyzed using the Statistical Package for the Social Sciences (SPSS version 17.0, SPSS Inc., Chicago, IL, USA) with t-test for comparisons between two groups. A P-value of < 0.05 was considered statistically significant. Declarations Role of the funding source No funding was received for this study. The author had full access to all study data, and the corresponding author had final responsibility for the decision to submit for publication. Reporting Summary. Further information on research design is available in the Nature Research Reporting Summary linked to this article. Data availability The data that support the findings of this study are not publicly available but are available upon reasonable request from the corresponding author. Acknowledgments The reviewers and editors are gratefully acknowledged for critical review. Contributions The manuscript was written with contributions from the author who has given approval to the final version of the manuscript. C.H. conceived the original idea and contributed to review of the literatures and data collection, design of the Figures and Table. Ethics declarations Competing interests The author declares no competing interests. Additional information Correspondence should be addressed to Chunsong Hu. 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Nat Prod Bioprospect 14:12 Additional Declarations There is NO Competing Interest. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5006475","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":349652972,"identity":"15dcd11c-2538-4a42-becf-af6de50bf87e","order_by":0,"name":"Chunsong Hu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoUlEQVRIiWNgGAWjYFACHhBhw8PP30CaljQZyRkHSNNy2MagIYFIDfyze49J/PhznseA4QDjh485RGiRuHMuTbK37TaPOXMDs+TMbURoMZDIMZNmbLjNY9lwgI2Zl2gtDH/O8RgcSCBJC9sBErRI3MgxtuxtS+aRnHGwmTi/8M/IMbzx44+dPT9/88EPH4nRggQYG0hTPwpGwSgYBaMANwAACH8w2Xwlf3UAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-0590-3909","institution":"Nanchang University","correspondingAuthor":true,"prefix":"","firstName":"Chunsong","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2024-08-31 02:00:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5006475/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5006475/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74919873,"identity":"c7ce3393-490b-442e-a04f-21bbf50353e0","added_by":"auto","created_at":"2025-01-28 10:30:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":86892,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA means curve on ages of patients with AMI in China\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to data on ages in AMI from 1990 to 2019 (1990s-2020s), it’s easy to find that ages of AMI decreased from 2005s to 2015s (2003 to 2017). Here, data of 2020s (2018-2022) is incomplete since they were adopted in 2019. This curve showed that there is indeed a younger trend in AMI in China due to more cases of AMI reported in younger adults since 2003 and major clinical risk factors (CRF) related to modern unhealthy “environment-sleep-emotion-exercise-diet” intervention [E(e)SEEDi] lifestyle.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5006475/v1/975cfbb85781ae36da9cf039.png"},{"id":74919875,"identity":"a580c29f-0b03-45ff-8352-813c742f4e33","added_by":"auto","created_at":"2025-01-28 10:30:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72420,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA medians curve on ages of patients with AMI in China\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eAccording to data on ages in AMI from 1990 to 2019 (1990s-2020s), medians were about 55.0 (1990s), 58.0 (1995s), 61.0 (2000s), 62.0 (2005s), 59.0 (2010s), 61.0 (2015s), and 59.0 (2020s) years, respectively. This curve also showed that there is indeed a younger trend in AMI in China since 2005.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5006475/v1/95d91c68900aa468c14a1a0b.png"},{"id":74920563,"identity":"f8292b52-90df-483f-98d2-cd7f43cce878","added_by":"auto","created_at":"2025-01-28 10:38:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":170667,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMajor clinical risk factors (CRF) of AMI in both China and the globe\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eA novel classification based on a systemic analysis and “the Essential 5”. These CRF link to modern unhealthy “environment-sleep-emotion-exercise-diet” intervention [E(e)SEEDi] lifestyle, such as air pollution, chronic infection, poor quality of sleep, anxiety and depression, physical inactivity, and unbalancing diets. Here, AMI: acute myocardial infarction; CRF: clinical risk factors.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5006475/v1/f8b18ee24a521276fd652a8c.png"},{"id":74921517,"identity":"e394d1a2-7441-42c2-9e76-b7949902e430","added_by":"auto","created_at":"2025-01-28 10:46:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1097332,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5006475/v1/3ca91382-aca9-4c9e-a842-f1cfae1f7e4c.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e Competing Interest.","formattedTitle":"A younger trend in acute myocardial infarction in China and a novel classification of clinical risk factors: “A single center retrospective study”","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIt is well known that more than 40% deaths each year are attributed to cardiovascular disease (CVD) in China. Acute myocardial infarction (AMI) is a leading cause of death in adults with CVD. It is also a major \u0026ldquo;killer\u0026rdquo; in young adults. Mortality of AMI in both urban and rural population in China is more than 1.1\u0026permil;\u003csup\u003e1\u003c/sup\u003e. However, previous studies on trends in AMI focused mainly on its sex-specific or gender differences\u003csup\u003e2,3\u003c/sup\u003e, clinical risk factors (CRF), and mortality\u003csup\u003e4-6\u003c/sup\u003e.\u003csup\u003e\u0026nbsp;\u003c/sup\u003eIn fact, little is known about data of evidence-based age trend in AMI in China, and there is also lack of a novel classification of CRF based on a comprehensive analysis and \u0026ldquo;the Essential 5\u0026rdquo; for better control and prevent AMI.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eData on ages of patients with AMI were collected from original research articles published in Chin Med J (Engl) during 1990 to 2019 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Means of minimum ages of each group were about 55.0 (1990s), 46.4 (1995s), 48.2 (2000s), 55.0 (2005s), 47.1 (2010s), 43.9 (2015s), and 52.8 (2020s) years old, respectively. According to the means curve on minimum ages of each group, it\u0026rsquo;s easy to find a younger trend in AMI in China from 2003 to 2017 (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e). According to data on ages in AMI from 1990 to 2019 (1990s-2020s), medians were about 55.0 (1990s), 58.0 (1995s), 61.0 (2000s), 62.0 (2005s), 59.0 (2010s), 61.0 (2015s), and 59.0 (2020s) years, respectively. At the same time, to prevent these data skewed, a medians curve on ages of patients with AMI in China is also presented (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This medians curve also showed that there is indeed a younger trend in AMI in China from 2005s to 2020s.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAges of patients with AMI in China during 1990\u0026ndash;2019\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiteratures on ages of patients with AMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAges (yrs)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean of mini ages (yrs)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e...\u003c/p\u003e \u003cp\u003eChin Med J\u0026nbsp;(Engl)\u0026nbsp;2019;132(9):1037-44\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2019;132(5):519\u0026thinsp;\u0026minus;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u0026ndash;74\u003c/p\u003e \u003cp\u003e62.02\u0026thinsp;\u0026plusmn;\u0026thinsp;12.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;52.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChin Med J (Engl) 2017;130(13):1534-39\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChin Med J (Engl)\u003c/span\u003e 2017;130(5):542-8\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2017;130(1):77\u0026ndash;82\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2017;130(1):51\u0026thinsp;\u0026minus;\u0026thinsp;6\u003c/p\u003e \u003cp\u003eChin Med J (Engl)\u0026nbsp;2016;129(5):518\u0026thinsp;\u0026minus;\u0026thinsp;22\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2015;128(18):2415-9\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2014;127(6):1008-11\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2013;126(21):4105-8\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2013;126(18):3481-5\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2013;126(16):3079-86\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2013;126(12):2281-5\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2013;126(3):464\u0026thinsp;\u0026minus;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003cp\u003e62.86\u0026thinsp;\u0026plusmn;\u0026thinsp;14.98\u003c/p\u003e \u003cp\u003e38.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e \u003cp\u003e58\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003cp\u003e61.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003cp\u003e53.78\u0026thinsp;\u0026plusmn;\u0026thinsp;11.02\u003c/p\u003e \u003cp\u003e62.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003cp\u003e68.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003cp\u003e58.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003cp\u003e62.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e \u003cp\u003e61.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e \u003cp\u003e60.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;43.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2010s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChin Med J (Engl) 2012;125(8):1405-9\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2011;124(20):3275-80\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2011;124(14):2083-8\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2011;124(6):825\u0026thinsp;\u0026minus;\u0026thinsp;30\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2010;123(20):2807-11\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2010;123(14):1840-5\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2010;123(14):1833-9\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2009;122(22):2718-23\u003c/p\u003e \u003cp\u003eChin Med J (Engl)\u0026nbsp;2009;122(14):1610-4\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2009;122(6):665-9\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2009;122(6):636\u0026thinsp;\u0026minus;\u0026thinsp;42\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2008;121(23):2384-7\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2008;121(9):771-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003cp\u003e60.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e \u003cp\u003e62.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e \u003cp\u003e59\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e \u003cp\u003e56.61\u0026thinsp;\u0026plusmn;\u0026thinsp;11.44\u003c/p\u003e \u003cp\u003e59\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003cp\u003e57.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003cp\u003e52\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003cp\u003e40\u0026ndash;79\u003c/p\u003e \u003cp\u003e36\u0026ndash;82\u003c/p\u003e \u003cp\u003e68.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003cp\u003e60\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003cp\u003e60.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2005s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChin Med J (Engl) 2007;120(14):1226-31\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2006;119(1):26\u0026ndash;31\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2004;117(10):1443-8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003cp\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e \u003cp\u003e58\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;55.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2000s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChin Med J (Engl) 2002;115(2):163-5\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2001;114(7):698\u0026ndash;702\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2000;113(8):733-6\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 2000;113(8):702-5\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 1999;112(1):18\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003cp\u003e55\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003cp\u003e27\u0026ndash;86\u003c/p\u003e \u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;48.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1995s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChin Med J (Engl) 1997;110(11):839\u0026thinsp;\u0026minus;\u0026thinsp;42\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 1997;110(11):834-8\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 1997;110(3):184-6\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 1997;110(1):56\u0026thinsp;\u0026minus;\u0026thinsp;8\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 1997;110(1):50\u0026thinsp;\u0026minus;\u0026thinsp;2\u003c/p\u003e \u003cp\u003eChin Med J (Engl) 1995;108(7):501-5\u003c/p\u003e \u003cp\u003eChin Med J (Engl)\u0026nbsp;1993;106(6):410-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003cp\u003e61.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003cp\u003e36\u0026ndash;78\u003c/p\u003e \u003cp\u003e40\u0026ndash;74\u003c/p\u003e \u003cp\u003e61.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003cp\u003e58\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1990s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChin Med J (Engl) 1990;103(7):541-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e=\u0026thinsp;55.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHowever, current data on ages of AMI in China in 2020s are incomplete since these data were adopted by the author in 2019. Moreover, according to the comprehensive analysis of CRF in AMI based on \u0026ldquo;the Essential 5\u0026rdquo;, there is a novel classification of CRF (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) for better control and prevent AMI. Figure\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that these CRF mainly link to modern unhealthy E(e)SEEDi lifestyle, such as air pollution, chronic infection, poor quality of sleep, anxiety and depression, physical inactivity, and unbalancing diets.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical risk factors (CRF) of AMI related to unhealthy E(e)SEEDi lifestyle\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE(e)SEED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMajor risk factors of AMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExternal\u003c/p\u003e \u003cp\u003eenvironment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbnormal climate and environment\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e,\u003c/p\u003e \u003cp\u003ee.g., cold or hot weather\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, lower ambient temperature\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003etraffic noise or e-noise\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003edust\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eradiation\u003c/p\u003e \u003cp\u003eshort-term\u003csup\u003e14\u003c/sup\u003e/long term\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e air pollution\u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA low socioeconomic status\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, including\u003c/p\u003e \u003cp\u003eLow education\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal\u003c/p\u003e \u003cp\u003eenvironment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbnormal blood pressure\u003c/p\u003e \u003cp\u003ehypotension or hypertension\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAcute and chronic heart failure\u003c/p\u003e \u003cp\u003eAcute and chronic kidney disease\u003c/p\u003e \u003cp\u003ea family history of ischaemic heart disease\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA history of coronary heart disease (angina)\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003cp\u003eCongenital coronary abnormalities or *ANOCOR\u003c/p\u003e \u003cp\u003eCoronary thrombosis and/or spasm, plaque\u003c/p\u003e \u003cp\u003eGenetic or family history of AMI\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHypercoagulable state\u003c/p\u003e \u003cp\u003eInflammation \u0026amp; infection\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, e.g.,\u003c/p\u003e \u003cp\u003einfluenza epidemics\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eacute respiratory-tract infections\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003easthma (active and poor control)\u003csup\u003e29\u003c/sup\u003e, *COPD\u003c/p\u003e \u003cp\u003eCOVID-19 infection\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e*HIV infection\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDyslipidemia or hyperlipidemia\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, e.g.,\u003c/p\u003e \u003cp\u003eelevated apolipoprotein B/apolipoprotein A ratio\u003c/p\u003e \u003cp\u003efasting serum triglyceride values\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eserum total cholesterol values\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eserum LDL-C levels\u003c/p\u003e \u003cp\u003efamilial-combined hyperlipidaemia\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ehyperuricaemia\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eExcess BMI (overweight and obesity)\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e*T1D (women) or T2D\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, particular with heat and cold\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMenopause\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUnprovoked venous thromboembolism\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*Anomalous\u0026nbsp;connections\u003c/p\u003e \u003cp\u003eof the\u0026nbsp;coronary\u0026nbsp;arteries\u003c/p\u003e \u003cp\u003e*Chronic obstructive pulmonary disease\u003c/p\u003e \u003cp\u003e*Human immunodeficiency virus\u003c/p\u003e \u003cp\u003e*Type 1 diabetes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsomnia with long sleep duration\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e*OSA\u003c/p\u003e \u003cp\u003eStay up late or work in shifts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*Obstructive sleep apnoea\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety and depression\u003csup\u003e\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePhysical exertion, anger or emotional upset\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStress (psychological or emotional)\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e at work or home, e.g., soccer related cardiovascular events\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow physical activity\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e or physical inactivity\u003c/p\u003e \u003cp\u003eSedentary habits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate daily intake of fresh, fruits and vegetables\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e, e.g., foods with beta-carotene\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLow Mg and high Ca:Mg ratio\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMargarine intake\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSe deficiency\u003c/p\u003e \u003cp\u003eSmoking\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e in both men\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e and female (heavy and long-term)\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e, particularly combined with high coffee intake\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e, and no smoking ban\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e or smoke-free legislation\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHeavy alcohol consumption\u003c/p\u003e \u003cp\u003eDrugs, e.g.\u003c/p\u003e \u003cp\u003ecocaine abuse\u003c/p\u003e \u003cp\u003e*OC use\u003c/p\u003e \u003cp\u003eoutpatient clarithromycin use\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003epost menopausal hormone replacement therapy\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e*SSRI use in an elderly population\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eUnderuse or stopping evidence-based pharmacotherapy\u003c/span\u003e\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e, \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ee.g.\u003c/span\u003e\u003c/p\u003e \u003cp\u003ebeta-blockers, clopidogrel, and statin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreasing fish, fruit and vegetables, would reduce AMI risk of about 50%.\u003c/p\u003e \u003cp\u003e*Oral contraceptive or oral corticosteroid\u003c/p\u003e \u003cp\u003e*Selective serotonin reuptake inhibitor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, a younger trend in AMI in China mainly results from \u0026ldquo;the Essential 5\u0026rdquo; based modern unhealthy E(e)SEEDi lifestyle, and evidence-based CRF are highly associated with AMI onset. First, abnormal external environment. There is increased risk of AMI due to exposure to abnormal climate\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, e.g., cold or hot weather, lower ambient temperature, radiation, traffic noises or e-noise\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, Asian dust\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, short-term\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e and/or long-term\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e air pollution\u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e (such as particulate matter exposure or PM2.5), and a low socioeconomic status\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, e.g., low education\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e; And abnormal internal environment, for example, hypotension or hypertension\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, a family history of AMI and ischaemic heart disease or a history of coronary heart disease (angina)\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, inflammation \u0026amp; infection\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, acute infection including influenza epidemics\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Previous studies showed that acute respiratory-tract infections\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e and asthma (active and poor control)\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e were associated with an increased risk of first-time AMI, in particular the COVID-19 pandemic\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. HIV infection also increases the risk of AMI\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Dyslipidemia or hyperlipidemia\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, e.g., elevated apolipoprotein B/apolipoprotein A ratio, fasting serum triglyceride values\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, serum total cholesterol values\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, serum LDL-C levels, familial-combined hyperlipidaemia\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e, and hyperuricaemia\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, excess BMI (overweight and obesity)\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, type 1 diabetes (T1D) (women) or T2D\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, particular with heat and cold\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e, menopause\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, and unprovoked venous thromboembolism\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e are traditional CRF highly linked to AMI.\u003c/p\u003e \u003cp\u003eSecond, poor quality of sleep and insomnia with long sleep duration\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e can induce AMI. Many young and middle-aged adults often stay up late, some work in shifts, and many adults suffer from severe obstructive sleep apnea (OSA). Third, bad emotion (such as anxiety and depression) and stress (psychological or emotional)\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e at work or home. Screening for depression is necessary because patients with untreated depression are associated with increased long-term mortality of AMI\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. Self-reported symptoms of depression and anxiety, especially if recurrent, were also moderately associated with the risk of incident AMI\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. HIV-infected individuals with depression have a 30% increased risk for AMI than without depression\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. In fact, physical exertion and anger or emotional upset are triggers associated with first AMI in all regions of the world, in men and women, and in all age groups\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. For example, there are often soccer related emotion and stress-induced cardiovascular events including AMI\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. However, antipsychotic use is also associated with a transient increase in risk for AMI.\u003c/p\u003e \u003cp\u003eFourth, low physical activity or physical inactivity and sedentary habits\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e linked to obesity and T2D may induce AMI due to popularization of cars, urban buses, subways, and elevators as well as lasting watching TV at home and mobile-phone entertainment. Lastly, there are unbalance of diet and nutrition including higher \u0026ldquo;salt, fat, and sugar\u0026rdquo; and inadequate water and fresh fruits intake\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e, e.g., foods with beta-carotene\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e, heavy alcohol consumption. But there is a protective role of Mg and low Ca:Mg ratio against coronary heart disease (CHD)\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. Margarine intake\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e is also a common risk factor. Tobacco use is one of the most important causes of AMI globally\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, in both men\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e and female (heavy and long-term)\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e, particularly combined with high coffee intake\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. In contrast, smoking ban\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e or smoke-free legislation\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e was associated with a reduction in AMI incidence.\u003c/p\u003e \u003cp\u003eSome drugs, e.g. cocaine abuse, oral contraceptive use, outpatient clarithromycin use\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e, post menopausal hormone replacement therapy\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e and use of selective serotonin reuptake inhibitor in an elderly population\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e may increase the risk of AMI. Incidence of AMI also associates with stopping evidence-based pharmacotherapy\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e, e.g., statin, beta-blockers and clopidogrel. Moreover, early initiation of statin treatment and beta-blockers for primary and secondary prevention of CHD before the first AMI are often underused. But use of evidence-based drug treatment may reduce the risk of AMI and has more survival benefit\u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e. In addition, the rates of awareness, treatment, and control of hypertension were not high enough in China\u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e. This may also link to more cases of AMI in China.\u003c/p\u003e \u003cp\u003eHerein, these modifiable risk factors highly link to the incidence of AMI. And the EPIC-Heidelberg cohort study confirmed the strong primary preventive potential of healthy lifestyle (such as regular physical activity, control BMI, and no smoking) on AMI in middle-aged men\u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e. And there are indeed significant gender differences in the risk factors and clinical outcomes of young AMI\u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e. In fact, there were AMI patients aged 18 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study\u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e. Of course, there is the geographical inequalities in incident AMI. Thus, there is arising need for control of AMI younger by more health coverage and essential health service since it is far from reality for poor and rural regions, and modifying modern unhealthy E(e)SEEDi lifestyle and reducing major CRF related to these lifestyles.\u003c/p\u003e \u003cp\u003eSo far, a number of CRF have been identified to link with AMI, and higher CRF levels at younger ages associate with the earlier age of AMI\u003csup\u003e\u003cspan additionalcitationids=\"CR68\" citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. Modern unhealthy E(e)SEEDi lifestyle results in not only CHD and C-type hypertension, but also AMI younger. Thus, a new program is indeed necessary for prevention and management of AMI. Without doubt, the standardized comprehensive iRT-ABCDEFG program for AMI and diabetes is worthy of conduction in the globe\u003csup\u003e\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e,\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u003c/sup\u003e. As a magic and novel \u0026ldquo;polypill\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u003c/sup\u003e, healthy E(e)SEEDi lifestyle can help to halt AMI younger and reduce its morbidity and mortality due to better self-management of major CRF. Thus, the iRT-ABCDEFG program will help us to realize these goals.\u003c/p\u003e \u003cp\u003eBecause the SPRINT (Systolic Blood Pressure Intervention Trial) showed that a lower systolic blood-pressure is better for less AMI and other adverse outcomes, \u0026ldquo;clinical trial will change practice\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e it helps us to understand and support not only more aggressive treatment of hypertension but also the renewed American Heart Association (AHA) Guideline on a more strict definition of hypertension (130/80 mmHg). It can be said that more coverage by healthy E(e)SEEDi lifestyle and application of the iRT-ABCDEFG program, more effectiveness in prevention of AMI younger.\u003c/p\u003e \u003cp\u003eActive cardiovascular prevention will help reducing the first AMI among high risk individuals, new targets and treatments will help to develop novel cardiovascular protective strategies\u003csup\u003e\u003cspan additionalcitationids=\"CR75 CR76 CR77\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u003c/sup\u003e better biomarkers for screening, diagnosis or prognosis for AMI. Since the China AMI Registry is a good platform for evaluation, healthcare, investigation and prevention, it will help to improve quality of life (QoL) and better prevent AMI\u003csup\u003e\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e,\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u003c/sup\u003e. For example, invasive coronary angiography should be used rationally according to patients\u0026rsquo; clinical presentation so as to get better diagnosis and care. With further understanding of cellular and molecular mechanisms as well as analysis of human atlases on cardiac cell and the adult heart\u003csup\u003e\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e,\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u003c/sup\u003e, more therapeutic targets and strategies will be developed for better control and prevention of AMI.\u003c/p\u003e \u003cp\u003eDefinitely, both external and internal environmental changes may induce or reduce the onset of AMI. For example, recent studies showed that exposure to ambient air pollutant may trigger the onset of AMI\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, patients with coronary artery ectasia showed higher rates of adverse outcomes included AMI\u003csup\u003e\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e\u003c/sup\u003e. In addition, sociopolitical environment or stress may also induce major adverse cardiocerebrovascular events (MACCE) including stroke and AMI\u003csup\u003e\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e\u003c/sup\u003e. But smoking ban\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e or smoking-free legislation\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e may reduce hospitalization rates for AMI and incidence. In addition, safer agents for anticoagulation therapy may improve AMI patients\u0026rsquo; outcomes and QoL, and statin therapy for patients with AMI is also associated with improved outcomes\u003csup\u003e\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e\u003c/sup\u003e, since these evidence-based optical medical treatment improves individuals\u0026rsquo; internal environment.\u003c/p\u003e \u003cp\u003eIn fact, like in a Japanese population\u003csup\u003e\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e\u003c/sup\u003e, there is also an increasing trend of AMI in China. The iRT-ABCDEFG program for management or self-management of AMI not only helps to control and prevent AMI and but also halt its younger trend, and improve QOL in patients with history of AMI. Herein, both the iRT-ABCDEFG program\u003csup\u003e\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u003c/sup\u003e and healthy E(e)SEEDi lifestyle\u003csup\u003e\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u003c/sup\u003e are worthy of conduction not only in the Asia but also in the globe, in particular the COVID-19 era\u003csup\u003e\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e\u003c/sup\u003e, since COVID-19 has been a high risk factor of MACCE\u003csup\u003e\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e\u003c/sup\u003e, but targeting the inflammasome\u003csup\u003e\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e\u003c/sup\u003e could be a unique therapeutic strategy for experimental AMI. In addition, plasma carboxypeptidase U levels, extracellular vesicles concentrations, and thrombin generation testing may serve as diagnosis and evaluation of AMI treatment\u003csup\u003e\u003cspan additionalcitationids=\"CR91\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSince there are more patients with ST-segment elevation myocardial infarction (STEMI) than non-STEMI\u003csup\u003e\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e\u003c/sup\u003e, new biomarkers for early diagnosis and prognostic evaluation\u003csup\u003e\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e,\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e\u003c/sup\u003e, shorter time to hospital arrival\u003csup\u003e\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e\u003c/sup\u003e, and more rational fibrinolytic therapy\u003csup\u003e\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e\u003c/sup\u003e, will help to improve outcomes for AMI. In fact, clinical trials confirmed that novel agents offer new and more choices for AMI prevention. For example, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) is effective in short-term lipid control among AMI patients\u003csup\u003e\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e,\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e\u003c/sup\u003e, factor XI inhibitor (abelacimab, a monoclonal antibody) is effective for the prevention of venous thromboembolism\u003csup\u003e\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e\u003c/sup\u003e, and sacubitril-valsartan may be more effective in preventing heart failure induced AMI than AMI induced heart failure\u003csup\u003e\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, because of greater risk of death among in-hospital-onset AMI than those outpatient-onset AMI\u003csup\u003e\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e\u003c/sup\u003e, better management of related risk factors (for example, circulating blood urea nitrogen on admission\u003csup\u003e\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e\u003c/sup\u003e, an independent predictor of long-term cardiovascular mortality in AMI; New-onset atrial fibrillation\u003csup\u003e\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e\u003c/sup\u003e and antidepressant medication at discharge\u003csup\u003e\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e\u003c/sup\u003e, both common and independently associated with poor prognosis in AMI), early use of sacubitril/valsartan medication (low or high dosage)\u003csup\u003e\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e\u003c/sup\u003e, and persisting diets of natural marine products\u003csup\u003e\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e\u003c/sup\u003e are vital strategies for improvement of AMI outcomes.\u003c/p\u003e \u003cp\u003eThere were some limitations in this study. Although data on ages of patients with AMI in this study were only collected (see the Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) from original research articles published in \u003cem\u003eChin Med J (Engl)\u003c/em\u003e, and don\u0026rsquo;t cover in those published in other international journals, it may be understood as \u0026ldquo;a single center retrospective study\u0026rdquo;. In fact, it\u0026rsquo;s also \u0026ldquo;multi-center data\u0026rdquo; from at least 43 institutions/units with the time span of a full 30 years from 1990s to 2020s due to 43 literatures. Herein, this study is enough strength. Moreover, \u003cem\u003eChin Med J (Engl)\u003c/em\u003e is highly authority and has a history of over a hundred and thirty years. Selection bias is possible, but the conclusions is reliable, especially in line with real-world conditions, and aren\u0026rsquo;t misleading. As to the total number of patients, it\u0026rsquo;s not necessary to show since 30 years\u0026rsquo; data from 1990s-2020s are enough to support this study. Although the curves in Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e in this study showed a fluctuating appearance, the overall trend is towards younger, particularly from 2003 to 2017 and in the real-world. Data in the 2020s were incomplete since this article was wroten in 2019, hence, there was no data from 2020 to 2022. In addition, this study didn\u0026rsquo;t involve in data on patients\u0026rsquo; gender, treatment and mortality, and other potential biases for this study include selection bias, missing data, selecting reporting, and others. As to which one was the worst among these comprehensive risk factors, the author didn\u0026rsquo;t discuss it in this manuscript, since it needs further clinical studies to test or clinical trials to confirm. Overall, the unhealthy lifestyle is the worst cause or total risk factor.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study used a novel and simple design and methods, and confirmed that there is indeed a younger trend in AMI in China due to major CRF related to modern unhealthy E(e)SEEDi lifestyle, such as air pollution, chronic inflection, poor quality of sleep, anxiety and depression, physical inactivity, and unbalancing diets. The novel classification of CRF based on the systemic analysis and \u0026ldquo;the Essential 5\u0026rdquo; is worthy of inclusion in clinical guidelines/expert consensus or professional textbooks, and contributes to the establishment of a new scoring system or algorithms for control and prevention of AMI in both China and the globe. It will help to halt the younger trend and improve individuals\u0026rsquo; QOL as well as develop a system (robodoctor) for prediction, diagnosis and evaluation of CVD in the future and innovate artificial intelligence medicine as a new discipline.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design, data search and collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiteratures on AMI were checked from PubMed according to key words \u0026ldquo;AMI and Chin Med J (Engl)\u0026rdquo; and to collect data on ages from original research articles on AMI published in Chin Med J (Engl). Data on ages of patients with AMI were divided into seven groups: 1990s (1988-1992), 1995s (1993-1997), 2000s (1998-2002), 2005s (2003-2007), 2010s (2008-2012), 2015s (2013-2017), and 2020s (2018-2022), respectively, and recorded these data in a table. The trend of ages in AMI in China was expressed with both means and medians curves on minimum ages of each group so as to prevent these data skewed. Moreover, there is also a comprehensive analysis and a novel classification of CRF according to \u0026ldquo;the Essential 5\u0026rdquo;, that is modern unhealthy \u0026ldquo;environment-sleep-emotion-exercise-diet\u0026rdquo; intervention [E(e)SEEDi] lifestyle, such as air pollution, chronic infection, poor quality of sleep, anxiety and depression, physical inactivity, and unbalancing diets.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the local Ethics Committee (with reference numbers 0312/2019) for studies involving human subjects. Human studies were also approved by the Ethics committee of Nanchang University (with reference numbers 0312/2019). But it\u0026rsquo;s actually not applicable due to data from published literatures. And informed consent was not required as the study was conducted retrospectively using anonymised data and without direct patient involvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of original records were used. Data were statistically analyzed using the Statistical Package for the Social Sciences (SPSS version 17.0, SPSS Inc., Chicago, IL, USA) with t-test for comparisons between two groups. A P-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eRole of the funding source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study. The author had full access to all study data, and the corresponding author had final responsibility for the decision to submit for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReporting Summary.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurther information on research design is available in the Nature Research Reporting Summary linked to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not publicly available but are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reviewers and editors are gratefully acknowledged for critical review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript was written with contributions from the author who has given approval to the final version of the manuscript. C.H. conceived the original idea and contributed to review of the literatures and data collection, design of the Figures and Table.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrespondence\u0026nbsp;\u003c/strong\u003eshould be addressed to Chunsong Hu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePeer review information\u0026nbsp;\u003c/strong\u003e\u003cem\u003eNature\u0026nbsp;\u003c/em\u003e\u003cem\u003eBiotechnology\u0026nbsp;\u003c/em\u003ethanks ..., ... and ... for their contribution to the peer review of this work. Primary Handling Editor: ..., in collaboration with the \u003cem\u003eNature\u003c/em\u003e\u003cem\u003e\u0026nbsp;Biotechnology\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eteam.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support:\u0026nbsp;\u003c/strong\u003eNo funding for this study was received.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen WW et al (2017) China cardiovascular diseases report 2015: a summary. J Geriatr Cardiol 14:1\u0026ndash;10\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNielsen S et al (2014) Sex-specific trends in 4-year survival in 37 276 men and women with acute myocardial infarction before the age of 55 years in Sweden, 1987\u0026ndash;2006: a register-based cohort study. 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Nat Prod Bioprospect 14:12\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"acute myocardial infarction, age, cardiovascular disease, lifestyle, risk factor","lastPublishedDoi":"10.21203/rs.3.rs-5006475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5006475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThere has been a significant increase in the number of acute myocardial infarction (AMI) in China. However, little is known about the age trend and comprehensive clinical risk factors (CRF). Here, data on the ages of AMI patients in China from 1990 to 2019 were collected and divided groups: 1990s, 1995s, 2000s, 2005s, 2010s, 2015s and 2020s. The mean minimum age for each group was approximately 55.0 (1990s), 46.4 (1995s), 48.2 (2000s), 55.0 (2005s), 47.1 (2010s), 43.9 (2015s), and 52.8 (2020s) years. The median minimum ages for each group were about 55.0, 58.0, 61.0, 62.0, 59.0, 61.0, and 59.0 years, respectively. Both the mean and median curves showed a trend towards younger for AMI. Additionally, a novel classification for CRF in AMI was developed. In conclusion, there is a younger trend in AMI due to unhealthy E(e)SEEDi lifestyle. The novel CRF classification is helpful in better prevention of AMI globally.\u003c/p\u003e","manuscriptTitle":"A younger trend in acute myocardial infarction in China and a novel classification of clinical risk factors: “A single center retrospective study”","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-28 10:30:13","doi":"10.21203/rs.3.rs-5006475/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e3eea575-ae9e-48e3-b71a-0348df107f74","owner":[],"postedDate":"January 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":37113641,"name":"Health sciences/Diseases/Cardiovascular diseases/Acute coronary syndromes/Myocardial infarction"},{"id":37113642,"name":"Health sciences/Risk factors"},{"id":37113643,"name":"Biological sciences/Biological techniques"},{"id":37113644,"name":"Physical sciences/Engineering/Biomedical engineering"},{"id":37113645,"name":"Scientific community and society/Social sciences/Interdisciplinary studies"}],"tags":[],"updatedAt":"2025-01-28T10:30:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-28 10:30:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5006475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5006475","identity":"rs-5006475","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}