Trends in cardiovascular risk profi les ■ ABSTRACT Outcomes for patients with coronary artery disease (CAD) have improved in the past 20 years likely due to advances in clinical care such as angiotensin-converting enzyme inhibitors, antiplatelet agents, and reduced time to cardiac cauterization procedures. But how have the risk factors for CAD changed in the past 2 decades? Analysis of nearly 4,000 patients with ST-elevation myocardial infarction (STEMI) at a tertiary care center found that

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... ents presenting with acute STEMI are younger and more obese than in the past. The prevalence of smoking, hypertension, and diabetes mellitus is also increasing. Primary and secondary prevention and aggressive efforts to modify risk factors for CAD is essential for further improvement in cardiovascular outcomes. ■ KEY POINTS Advances in treatment of CAD have improved patient outcomes over the past 20 years. Prevalence of risk factors for CAD has increased over the past 20 years in patients presenting with STEMI with patients now more likely to be younger and with higher prevalence of smoking, obesity, hypertension, and diabetes. Emphasis on primary and secondary prevention to reduce CAD risk factors is needed to improve outcomes and reduce the cost of care. M any clinical improvements in treating patients with acute ST-elevation myocardial infarction (STEMI) have been realized in the past 20 years, including angiotensin-converting enzyme inhibitors, antiplatelet agents, and reduced time to cardiac cauterization procedures for acute myocardial infaction. 1 Presumably, primary and secondary prevention measures have also resulted in changes in coronary artery disease (CAD) risk factors over the past 20 years. We sought to quantify mortality outcomes for patients treated in our catherization laboratory and to investigate trends in cardiovascular risk factors in patients during the same period. 2 ■ STEMI OUTCOMES Data from our catherization laboratory database of 3,913 patients treated for STEMI at our tertiary care center from 1995 through 2014 were analyzed. To evaluate outcomes over time, patients were grouped based on years treated in 5-year increments resulting in 4 groups spanning 20 years. 2 Analysis showed reduced mortality rates for patients with STEMI over the past 20 years: the 30-day mortality rate in patients treated from 2010 to 2014 was 7.8%, nearly half the rate of 14% in patients treated from 1995 to 1999. The trend in reduced mortality rates for patients with STEMI was also noted at 1 year and 3 years (Figure 1) . 3 ■ CARDIOVASCULAR RISK FACTORS A reduction in mortality rates in patients treated for STEMI is to be expected over time, given the improvements in clinical practices and procedures and novel medications developed since 1996. But it is also possible that patients presenting with STEMI are healthier than in the past as a result of primary prevention efforts to minimize CAD risk factors and changes in CAD risk factors over time. To determine whether CAD risk factors have changed over time, we analyzed the risk factors in