Loukianos S Rallidis1, Andreas S Triantafyllis2, Georgios Tsirebolos2, Dimitrios Katsaras2, Maria Rallidi3, Paraskevi Moutsatsou4, Jonh Lekakis2. 1. Second Department of Cardiology, University General Hospital Attikon, Athens, Greece. Electronic address: lrallidis@gmail.com. 2. Second Department of Cardiology, University General Hospital Attikon, Athens, Greece. 3. Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. 4. Department of Clinical Biochemistry, University General Hospital Attikon, Athens, Greece.
Abstract
BACKGROUND AND AIMS: Familial hypercholesterolaemia (FH) is an important cause of early onset coronary artery disease. We assessed the prevalence of clinical heterozygous FH (HeFH) among patients with very early ST-segment elevation myocardial infarction (STEMI), its management and its impact on long-term prognosis in the era of widespread utilization of statins. METHODS: We recruited prospectively 320 consecutive patients who had survived their first STEMI ≤35 years of age. Using the Dutch Lipid Clinic Network algorithm patients having HeFH (possible, probable or definite) were identified. RESULTS: Sixty-five patients (20.3%) had definite/probable HeFH and 163 patients (50.9%) had possible FH. Two years after discharge among 51 patients with definite/probable HeFH and available lipid levels, 43 (84.3%) were taking statins of whom 10 (23.3%) were on high-intensity statin therapy but only 1 (2.3%) of the statin-treated patients had LDL cholesterol levels <1.8 mmol/L (70 mg/dL). After a median follow-up of 9.1 years, major adverse coronary events (MACE) occurred in 99 (38.8%) of 255 patients with available follow-up information. Definite/probable HeFH was associated with an excess risk for recurrence of MACE independently of statin use, continuation of smoking after the STEMI, hypertension, diabetes mellitus, and sex (hazard ratio = 1.615, 95% confidence interval, 1.038 to 2.512, p = 0.03). CONCLUSIONS: One out of five patients who develop STEMI ≤35 years of age has definite/probable HeFH and despite the use of statins there is a therapeutic gap and a high recurrence rate of cardiac events during long-term follow-up.
BACKGROUND AND AIMS: Familial hypercholesterolaemia (FH) is an important cause of early onset coronary artery disease. We assessed the prevalence of clinical heterozygous FH (HeFH) among patients with very early ST-segment elevation myocardial infarction (STEMI), its management and its impact on long-term prognosis in the era of widespread utilization of statins. METHODS: We recruited prospectively 320 consecutive patients who had survived their first STEMI ≤35 years of age. Using the Dutch Lipid Clinic Network algorithm patients having HeFH (possible, probable or definite) were identified. RESULTS: Sixty-five patients (20.3%) had definite/probable HeFH and 163 patients (50.9%) had possible FH. Two years after discharge among 51 patients with definite/probable HeFH and available lipid levels, 43 (84.3%) were taking statins of whom 10 (23.3%) were on high-intensity statin therapy but only 1 (2.3%) of the statin-treated patients had LDL cholesterol levels <1.8 mmol/L (70 mg/dL). After a median follow-up of 9.1 years, major adverse coronary events (MACE) occurred in 99 (38.8%) of 255 patients with available follow-up information. Definite/probable HeFH was associated with an excess risk for recurrence of MACE independently of statin use, continuation of smoking after the STEMI, hypertension, diabetes mellitus, and sex (hazard ratio = 1.615, 95% confidence interval, 1.038 to 2.512, p = 0.03). CONCLUSIONS: One out of five patients who develop STEMI ≤35 years of age has definite/probable HeFH and despite the use of statins there is a therapeutic gap and a high recurrence rate of cardiac events during long-term follow-up.
Authors: Katrina L Ellis; Jing Pang; David Chieng; Damon A Bell; John R Burnett; Carl J Schultz; Graham S Hillis; Gerald F Watts Journal: Clin Cardiol Date: 2018-02-26 Impact factor: 2.882
Authors: Joshua Choi; Amir M Khan; Michael Jarmin; Naila Goldenberg; Charles J Glueck; Ping Wang Journal: Lipids Health Dis Date: 2017-07-24 Impact factor: 3.876
Authors: Parth Shah; Charles J Glueck; Naila Goldenberg; Sarah Min; Chris Mahida; Ilana Schlam; Matan Rothschild; Ali Huda; Ping Wang Journal: Lipids Health Dis Date: 2017-01-23 Impact factor: 3.876