Environmental and ethnic differences in short-term risk of first acute myocardial infarction: a prospective multiethnic cohort protocol

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Background: Acute myocardial infarction (AMI) remains a leading cause of mortality worldwide, with substantial variation across populations shaped by environmental conditions, geographic context, and healthcare accessibility. However, current risk assessment approaches based on baseline measurements may not adequately capture short-term risk or population heterogeneity. Methods and analysis: This multicentre prospective cohort study will recruit 2,340 adults aged 20-85 years with an estimated 10-year atherosclerotic cardiovascular disease risk ≥20%. Participants will be enrolled from five hospitals in Gansu Province, China, representing variation in ethnicity, altitude, and healthcare access, including Han, Hui, Tibetan, and Kazakh populations. Baseline assessments will include standardized questionnaires, clinical evaluation, and cardiometabolic profiling. Participants will be followed every 3 months for 24 months, with repeated measurements of behavioral, physiological, and biomarker indicators, including wearable electrocardiographic monitoring. Environmental exposures and healthcare accessibility will be assigned using geospatial data. The primary outcome is first incident AMI. Time-to-event models with time-varying variables will be used to examine how within-individual changes in risk indicators are associated with AMI across environmental and ethnic contexts. Ethics and dissemination: The study has been approved by the Ethics Committee of Gansu Provincial Hospital. Written informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications and scientific presentations. Clinical trial registration: ChiCTR2500104518.

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