Introduction
Aging is a growing process that will allocate a high percentage of the population of different countries, including Iran, soon [1, 2]. The trend of increasing the elderly population in Iran is strongly increasing compared to developed countries [3]. According to the reports of the Iranian Statistics Center, the country’s elderly population in 2006, 2011, and 2016 was equivalent to 5.2%, 5.78%, and 6.1% of the total population of the country, respectively [4]. Cardiovascular diseases, including ST-elevation myocardial infarction (STEMI) heart attack, are common diseases in aging [11], and considering that the prevalence of cardiovascular risk factors is different in the elderly and middle-aged. The present study was conducted to investigate the prevalence of cardiovascular risk factors, the type of treatment, and the mortality rate caused by it.
Methods
The present study is a retrospective cohort. The data of this study was obtained from the registration program of acute STEMI, which was obtained by the Ethics Committee of Kermanshah University of Medical Sciences No. (KUMS.REC.1395.252). In this research, 1071 elderly and middle-aged patients with STEMI admitted to Imam Ali Hospital in Kermanshah Province for 23 months from January 2017 to November 2019 were selected. The information collected from the patients included four categories of demographic information, type of treatment, mortality, and other risk factors of cardiovascular disease. The variables examined in this study include diabetes, hypercholesterolemia, smoking (cigarettes, opium, and both), high blood pressure, history of heart attack and stroke, open heart surgery, history of PCI, body mass index (BMI), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), triglyceride (TG) and glomerular filtration rate (GFR). Demographic information also included gender, level of education, and place of residence, the type of treatment performed was categorized into three categories, thrombolytic treatment, primary angioplasty, and no treatment, and mortality status in both groups as alive, death within 1 year and death in hospital. To calculate the body mass index (BMI), the guidelines of the World Health Organization were used, and to calculate the glomerular filtration, the CKD-EPT formula was used based on the initial serum creatinine level of the patients at the time of admission to the hospital, after measuring the normality of the data with the Kolmogorov-Smirov test, and based on that, to compare quantitative data in two groups of middle-aged and elderly people, independent t test and Mann-Whitney test were used, therefore independent t test was used for GFR and LDL variables, and Mann-Whitney test was used for HDL, TG, and cholesterol. Stata software version 14 was used to analyze data and for all analyses, the significance level of the tests was considered P < 0.05.
Results
According to the results, in the elderly group, 72.6% were men and 27.3% were women, and in the middle-aged group, 85.5% were men and 14.5% were women (P<0.001). More than 75% of the participants were residents of Kermanshah City, 11.5% and 10.2% were residents of cities, and 12.6% and 12.2% were residents of villages. The level of education in the two groups was significantly different from each other, thus 51.9% of the elderly and 13.5% of the middle-aged people were illiterate. A significant difference existed in the mortality rate between the two groups (P<0.001). In the middle-aged, 95.6% of patients were alive, and the in-hospital and one-year mortality rates were 1.5% and 2.8%, respectively. Of the elderly, 84.2% were alive and the death rate during the one-year follow-up period was 8% and in-hospital death was 7.7%. Reperfusion treatment had a significant difference in the two groups (P=0.023). The rate of primary angioplasty in the elderly and middle-aged is 48.5% and 55.3%, respectively. Also, 32.6% of the elderly received thrombolytic treatment, which was 31.45% in the middle-aged group, but in both groups, 18.8% and 13.2% of the people did not receive the treatment. Therefore, the rate of reperfusion therapy in the elderly was 81.1% and in the middle-aged was 86.7%. The prevalence of smoking in the elderly was significantly lower than in the middle-aged (P<0.001) and obesity in the middle-aged (63.51) compared to the elderly (52.57) was significantly more prevalent. The results showed that 13.9% of the elderly and 9.2% of the middle-aged had a history of heart attack, and the history of stroke in the elderly and middle-aged was 8.1% and 2.8%, respectively (P<0.001). The review of percutaneous coronary intervention (PCI) operation records showed that 6.6% of the elderly and 5.6% of the middle-aged had previously performed percutaneous coronary intervention (PCI). The history of coronary artery bypass graft (CABG) surgery was 3.3% and 2.8% in the elderly and middle-aged, respectively, 25% in the elderly group and 22.12% in the middle-aged group had diabetes that the difference was not significant (P=0.271). Blood lipid level was 28.4% in the elderly and 22.8% in the middle-aged, and 57.26% of the elderly and 35.23% of the middle-aged had a history of hypertension (P<0.001). The mean of LDL in the elderly was 96.8±29.5 and in the middle-aged was 99.71±26.69 (P<0.05), and the mean of HDL in the elderly and middle-aged was 42±9.03 and 40±8.31, respectively (P<0.05), the difference between the two groups in terms of cholesterol prevalence was not significant (P=0.076), and the mean TG in the elderly was 118.26±0.66 and in the middle-aged, it was 144.30±91.56, which a significant difference was observed (P<0.001), the Mean GFR was 61.5±16.8 in the elderly and 77.53± 5.6 in the middle-aged (P<0.001).
Discussion
Current findings in this research indicate that the prevalence of some crucial risk factors, such as smoking, triglycerides, overweight, and obesity in the middle-aged group is significantly higher in the middle-aged group, while the elderly significantly suffer from a heart attack, which indicates the lack of control of risk factors in the pre-elderly age. The results of this study are a warning that points out that until the necessary measures are taken in the field of controlling the risk factors of a heart attack in middle-aged people, we cannot expect a change in the increasing trend of heart attack and death caused by it in aging. Therefore, detailed and comprehensive long-term planning, awareness, and training of people to control and reduce the prevalence of risk factors seems necessary; It is hoped that the result of such efforts will reduce the increasing trend of heart attack and death due to it in middle age and old age.
Ethical Considerations
Compliance with ethical guidelines
The Deputy of Research and Technology of Kermanshah University of Medical Sciences (Code: KUMS.REC.1395.252).
Funding
All the facilities used and the costs of this research were provided by the research and technology Department of Kermanshah University of Medical Sciences.
Authors' contributions
All authors contributed to this study.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors thank the Kermanshah University of Medical Sciences for funding this project. We wish to thank all the Imam-Ali hospital staff, especially the Cardiovascular Research Center, Hossein Siabani, Leila Zamzam, Mrs. Hanyeh Charejo and Elaheh Mohammadi for data gathering; without their contribution, this work would not have been accomplished.
 

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