Fami: Background

FIRST ACUTE MYOCARDIAL INFARCTION (FAMI)

• Myocardial infarction (MI) is the single most critical event in coronary disease (CD) because it can precipitate fatal arrhythmias and cardiac failure and it is a major cause of mortality,morbidity and health care expenditure.

• MI occurs unheralded as the very first clinical manifestation of CD in over 50% of the cases.

• In a substantial percentage of cases the predisposing causes of MI cannot be explained by elevated blood lipids, hypertension, smoking, elevated fibrinogen levels, diabetes, obesity and psychological stress as traditional risk factors account for about 50% of the cases of MI and conversely about 50% of individuals with known risk factors die of non-cardiac causes.

• Rapidly growing evidence indicates that inflammation plays a major role in the precipitation of MI and that the prototypic marker of inflammation, C-Reactive Protein (CRP), is a very strongly predictive marker of the future incidence of MI but elevated CRP levels are found only in about 50% of acute MI cases.

• In man the incidence of MI increases about 10 times from the age of 40 to 80. In women it is about 10 times lower below the age of 50 and gradually becomes similar to man above 80.

• There is a 12 fold difference in the incidence of MI between North European and Oriental countries, with Italy in an intermediate position.