Data from the Cleveland Clinic, one the nation’s leading hospitals, show that patients treated for heart attacks, or ST-elevated myocardial infarction (STEMI), are on the whole younger and increasingly obese. Most striking of all, researchers found that smoking rates among those who had heart attacks jumped from 28% to 46%, during a period when overall rates declined.

America’s doctors may know more than ever about how to prevent heart attacks, but that doesn’t mean everyone is following their advice.

This wasn’t what researchers expected to find when they looked through data for 3900 patients gathered from 1995 to 2014, according to the study’s primary investigator, Samir Kapadia, MD, professor of medicine and section head for interventional cardiology at Cleveland Clinic. The study will be presented at the upcoming 65th Scientific Session of the American College of Cardiology, which meets in Chicago April 2-4, 2016.

Researchers divided data from STEMI patients into 4 groups, each representing a 5-year period. Between the first 5-year span and the last, the average age of the patients dropped from 64 years to 60 years, and the share of patients who obese rose from 31% to 40%. (Obesity is defined by CDC as having a body mass index over 30).

Those who had heart attacks were sicker, too. The share with diabetes rose from 24% to 31%, those with high blood pressure rose from 55% to 77%, and the share with chronic obstructive pulmonary disorder (COPD) rose from 5% to 12%. The share with at least 3 major cardiovascular risk factors rose as well, from 65% to 85% of those with heart attacks.

Because researchers do not yet have a socioeconomic analysis on these patients—that’s on the way, Kapadia said—and because the data are all for one hospital, it’s hard to say how much the findings apply nationwide. Also unreported was the patients’ insurance status—so it’s not known if in addition to being fatter and sicker, the patients were increasingly uninsured over the 20-year period.

But the data are sobering nonetheless, as they show just what an urban hospital like Cleveland Clinic faces in this era of value-based care. As Kapadia explained, the world-famous institution draws patients from a wider geographic area than it once did, and some of the sickest patients are flown in. The message, Kapadia said, is that front-line physicians must do more than ever before to promote prevention—better diets, more exercise, and healthier lifestyles are the key to reversing the trends revealed in the study.

“Prevention must be kept in the forefront of primary care,” he said. “Cardiac health is not just dependent on the cardiologist. The primary care physicians and the patient need to take ownership of this problem.”

Patients cannot wait for their health to decline, either. “Don’t wait until you have a diagnosed heart problem to start taking care of yourself and paying attention to your lifestyle and dietary choices. You should be working hard to avoid developing heart disease in the first place,” Kapadia said.

Reference

Mentias AG, Barakat AF, Raza MQ et al. An alarming trend: change in risk profile of patients with ST elevation myocardial infarction over the last two decades. To be presented at the 65th Scientific Session of the American College of Cardiology, April 4, 2016, Chicago. Abstract 16-A-12306.