Max-Paul Winter1, Franz Wiesbauer1, Hermann Blessberger2, Noemi Pavo1, Patrick Sulzgruber1, Kurt Huber3, Johann Wojta1,4,5, Klaus Distelmaier1, Irene M Lang1, Georg Goliasch1. 1. Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria. 2. Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria. 3. Third Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria. 4. Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria. 5. Core Facilities, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: Premature myocardial infarction (≤40 years) represents a rare disease with a distinct risk factor profile and a lipid phenotype that is characterized by a predominance of elevated triglyceride-rich lipoproteins. So far high-density and low-density lipoproteins remain the primary targets for risk stratification and treatment evaluation in coronary artery disease, but this strategy might be insensitive in patients with premature myocardial infarction. AIM: Aim of this study was to investigate the predictive value of different lipid fractions on long-term cardiovascular outcome in patients with premature myocardial infarction. METHODS: We prospectively enrolled 102 consecutive AMI survivors (≤40 years) in this prospective multicentre study and investigated the influence of the familial combined hypercholesterolaemia phenotype and a corresponding multimarker panel of different lipid fractions on cardiovascular outcome. RESULTS: Total cholesterol, non-HDL cholesterol, remnant cholesterol and Apo B lipoprotein were significantly higher in patients experiencing MACE as compared to those who did not. The familial combined hypercholesterolaemia phenotype was associated with an unfavourable cardiovascular outcome even after adjustment for potential cofounders (adjusted HR 3.04,95% CI, 1.26-7.34, P = 0.013). Remnant cholesterol revealed the strongest association with MACE (adj.HR 1.94, 95%CI. 1.30-2.99, P = 0.001). Interestingly LDL and HDL revealed no significant impact on cardiovascular outcome in this study cohort. CONCLUSION: Non-HDL and remnant cholesterol are strongly associated with an unfavourable outcome in patients with premature myocardial infarction and might be the preferred treatment target for lipid-lowering therapy.
BACKGROUND:Premature myocardial infarction (≤40 years) represents a rare disease with a distinct risk factor profile and a lipid phenotype that is characterized by a predominance of elevated triglyceride-rich lipoproteins. So far high-density and low-density lipoproteins remain the primary targets for risk stratification and treatment evaluation in coronary artery disease, but this strategy might be insensitive in patients with premature myocardial infarction. AIM: Aim of this study was to investigate the predictive value of different lipid fractions on long-term cardiovascular outcome in patients with premature myocardial infarction. METHODS: We prospectively enrolled 102 consecutive AMI survivors (≤40 years) in this prospective multicentre study and investigated the influence of the familial combined hypercholesterolaemia phenotype and a corresponding multimarker panel of different lipid fractions on cardiovascular outcome. RESULTS: Total cholesterol, non-HDL cholesterol, remnant cholesterol and Apo B lipoprotein were significantly higher in patients experiencing MACE as compared to those who did not. The familial combined hypercholesterolaemia phenotype was associated with an unfavourable cardiovascular outcome even after adjustment for potential cofounders (adjusted HR 3.04,95% CI, 1.26-7.34, P = 0.013). Remnant cholesterol revealed the strongest association with MACE (adj.HR 1.94, 95%CI. 1.30-2.99, P = 0.001). Interestingly LDL and HDL revealed no significant impact on cardiovascular outcome in this study cohort. CONCLUSION: Non-HDL and remnant cholesterol are strongly associated with an unfavourable outcome in patients with premature myocardial infarction and might be the preferred treatment target for lipid-lowering therapy.
Authors: Jun Liu; Liangqiu Tang; Qiqi Lu; Yi Yu; Qiu-Gui Xu; Shanqiang Zhang; Yun-Xian Chen; Wen-Jie Dai; Ji-Cheng Li Journal: Front Cardiovasc Med Date: 2022-04-11