Avinainder Singh1, Ankur Gupta2, Bradley L Collins2, Arman Qamar3, Keri L Monda4, David Biery2, J Antonio G Lopez5, Sarah D de Ferranti6, Jorge Plutzky3, Christopher P Cannon3, James L Januzzi7, Marcelo F Di Carli2, Khurram Nasir8, Deepak L Bhatt9, Ron Blankstein10. 1. Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/AvinainderSingh. 2. Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 3. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 4. Center for Observational Research, Amgen Inc., Thousand Oaks, California. 5. Global Development, Amgen Inc., Thousand Oaks, California. 6. Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 7. Cardiovascular Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 8. Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut. 9. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/DLBhattMD. 10. Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rblankstein@bwh.harvard.edu.
Abstract
BACKGROUND: There are limited data on the prevalence and treatment of familial hypercholesterolemia (FH) among U.S. adults who experience a myocardial infarction (MI) at a young age. OBJECTIVES: This study aimed to evaluate the prevalence of clinically defined FH and examine the rates of statin utilization and low-density lipoprotein cholesterol (LDL-C) achieved 1-year post MI. METHODS: The YOUNG-MI registry is a retrospective cohort study that includes patients who experience an MI at or below age 50 years between 2000 and 2016 at 2 academic centers. Probable or definite FH was defined by the Dutch Lipid Clinic criteria. Outcomes included the proportion of patients classified as probable or definite FH, use of lipid-lowering therapy, and LDL-C achieved 1-year post MI. RESULTS: The cohort consisted of 1,996 adults with a median age of 45 years; 19% were women, and 54% had ST-segment elevation MI. Probable/definite FH was present in 180 (9%) of whom 42.8% were not on statins prior to their MI. Of the 1,966 patients surviving until hospital discharge, 89.4% of FH patients and 89.9% of non-FH patients were discharged on statin therapy (p = 0.82). Among FH patients, 63.3% were discharged on high-intensity statin compared with 48.4% for non-FH patients (p < 0.001). At 1-year follow-up, the percent reduction in LDL-C among FH patients was -44.4% compared with -34.5% (p = 0.006) in non-FH patients. The proportion of patients with LDL-C ≥70 mg/dl was higher among FH patients (82.2%) compared with non-FH patients (64.5%; p < 0.001). CONCLUSIONS: Clinically defined FH was present in nearly 1 of 10 patients with MI at a young age. Only two-thirds of FH patients were discharged on high-intensity statin therapy, and the vast majority had elevated LDL-C at 1 year. These findings reinforce the need for more aggressive lipid-lowering therapy in young FH and non-FH patients post-MI.
BACKGROUND: There are limited data on the prevalence and treatment of familial hypercholesterolemia (FH) among U.S. adults who experience a myocardial infarction (MI) at a young age. OBJECTIVES: This study aimed to evaluate the prevalence of clinically defined FH and examine the rates of statin utilization and low-density lipoprotein cholesterol (LDL-C) achieved 1-year post MI. METHODS: The YOUNG-MI registry is a retrospective cohort study that includes patients who experience an MI at or below age 50 years between 2000 and 2016 at 2 academic centers. Probable or definite FH was defined by the Dutch Lipid Clinic criteria. Outcomes included the proportion of patients classified as probable or definite FH, use of lipid-lowering therapy, and LDL-C achieved 1-year post MI. RESULTS: The cohort consisted of 1,996 adults with a median age of 45 years; 19% were women, and 54% had ST-segment elevation MI. Probable/definite FH was present in 180 (9%) of whom 42.8% were not on statins prior to their MI. Of the 1,966 patients surviving until hospital discharge, 89.4% of FHpatients and 89.9% of non-FHpatients were discharged on statin therapy (p = 0.82). Among FHpatients, 63.3% were discharged on high-intensity statin compared with 48.4% for non-FHpatients (p < 0.001). At 1-year follow-up, the percent reduction in LDL-C among FHpatients was -44.4% compared with -34.5% (p = 0.006) in non-FHpatients. The proportion of patients with LDL-C ≥70 mg/dl was higher among FHpatients (82.2%) compared with non-FHpatients (64.5%; p < 0.001). CONCLUSIONS: Clinically defined FH was present in nearly 1 of 10 patients with MI at a young age. Only two-thirds of FHpatients were discharged on high-intensity statin therapy, and the vast majority had elevated LDL-C at 1 year. These findings reinforce the need for more aggressive lipid-lowering therapy in young FH and non-FHpatients post-MI.
Authors: Jelani K Grant; Sarah Snow; Michelle Kelsey; Jennifer Rymer; Anna E Schaffer; Manesh R Patel; Robert W McGarrah; Neha J Pagidipati; Nishant P Shah Journal: Curr Cardiol Rep Date: 2022-07-29 Impact factor: 3.955
Authors: Omar Dzaye; Alexander C Razavi; Zeina A Dardari; Leslee J Shaw; Daniel S Berman; Matthew J Budoff; Michael D Miedema; Khurram Nasir; Alan Rozanski; John A Rumberger; Carl E Orringer; Sidney C Smith; Ron Blankstein; Seamus P Whelton; Martin Bødtker Mortensen; Michael J Blaha Journal: J Am Coll Cardiol Date: 2021-10-19 Impact factor: 27.203
Authors: Adam N Berman; David W Biery; Avinainder Singh; Wanda Y Wu; Sanjay Divakaran; Ersilia M DeFilippis; Jon Hainer; Michael J Blaha; Christopher Cannon; Donna M Polk; Jorge Plutzky; Pradeep Natarajan; Khurram Nasir; Marcelo F Di Carli; Deepak L Bhatt; Ron Blankstein Journal: Eur J Prev Cardiol Date: 2021-07-23 Impact factor: 8.526
Authors: Carlos A Dattoli-García; Cynthia N Jackson-Pedroza; Andrea L Gallardo-Grajeda; Rodrigo Gopar-Nieto; Diego Araiza-Garygordobil; Alexandra Arias-Mendoza Journal: Arch Cardiol Mex Date: 2021-11-01