Auckle Ranshaka, Su Binjie, Li Hailing, Xu Siling, Xie Mujin, Song Yangchun, Abdul Quddus Mohammed, Xu Yawei, Liu Ban, Che Wenliang
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China.
PLoS One. 2017 Oct 31;12(10):e0186815. doi: 10.1371/journal.pone.0186815. eCollection 2017.
Familial hypercholesterolemia (FH), characterized by elevated plasma low-density lipoprotein-cholesterol (LDL-C) levels and premature coronary artery disease (CAD), remains mostly underdiagnosed and undertreated. We investigated the prevalence of clinical FH among Chinese patients with premature ST-segment-elevation myocardial infarction (STEMI) and one-year follow-up on their lipid management and cardiovascular events.
Four hundred and ninety-eight premature STEMI patients (363men) were enrolled. FH patients were identified using the Dutch Lipid Clinic Network Criteria. Lipid management and cardiovascular events in all patients were assessed.
Nineteen patients (3.8%) were diagnosed as definite/probable FH, 211 (42.4%) as possible FH and 268 (53.8%) as unlikely FH. All patients were divided into two main groups: unlikely FH (0-2 points) and possible FH (≥3 points). Possible FH patients were younger (50.1 years vs. 53.5 years) with higher NT-proBNP level (3014.15 pg/mL vs. 2326.25 pg/mL), occurrence of multi-vessel CAD (37.4% vs. 18.3%), lower LVEF (47% vs. 49%) and more severe Killip classification (Class 3, 20.0% vs. 9.7%). Follow-up data were available for 203 patients from the possible FH group and 243 patients from the unlikely FH group. High intensity statin intake status (%) of possible FH vs. unlikely FH was as follows: 1) on admission: 4.8% vs. 0.4%; 2) at discharge: 10.4% vs. 1.6% and 3) at one year follow-up: 5.4% vs. 0.8%. A significantly low percentage of possible FH patients (18.7% vs. 51.4%) achieved target LDL-C levels. There were no significant differences in MACE defined as a composite of cardiogenic shock or Class IV heart failure, recurrent MI, cardiovascular-related rehospitalization, TLR and CV death between the two groups. However, the proportion of cardiogenic shock or Class IV heart failure was significantly higher in possible FH patients group (5.9% vs.1.2%).
Clinical diagnosis of possible FH is common in Chinese patients with premature STEMI. A low proportion of FH patients were prescribed high intensity statins. Despite aggressive cholesterol-lowering drugs, a significantly lower proportion of FH patients achieved LDL-C targets compared to unlikely FH patients. Possible FH patients were younger with a significantly higher occurrence of multi-vessel CAD and impaired cardiac function.
家族性高胆固醇血症（FH）的特征是血浆低密度脂蛋白胆固醇（LDL-C）水平升高和早发性冠状动脉疾病（CAD），目前大多未得到充分诊断和治疗。我们调查了中国早发性ST段抬高型心肌梗死（STEMI）患者中临床FH的患病率，并对他们的血脂管理和心血管事件进行了一年的随访。
纳入498例早发性STEMI患者（363例男性）。使用荷兰脂质诊所网络标准识别FH患者。评估所有患者的血脂管理和心血管事件。
19例患者（3.8%）被诊断为确诊/可能的FH，211例（42.4%）为可能的FH，268例（53.8%）为不太可能的FH。所有患者分为两个主要组：不太可能的FH（0 - 2分）和可能的FH（≥3分）。可能的FH患者更年轻（50.1岁对53.5岁），NT-proBNP水平更高（3014.15 pg/mL对2326.25 pg/mL），多支血管CAD发生率更高（37.4%对18.3%），左心室射血分数（LVEF）更低（47%对49%），Killip分级更严重（3级，20.0%对9.7%）。有203例可能的FH组患者和243例不太可能的FH组患者的随访数据。可能的FH组与不太可能的FH组高强度他汀类药物摄入情况（%）如下：1）入院时：4.8%对0.4%；2）出院时：10.4%对1.6%；3）一年随访时：5.4%对0.8%。达到LDL-C目标水平的可能的FH患者比例显著较低（18.7%对51.4%）。两组之间定义为心源性休克或IV级心力衰竭、复发性心肌梗死、心血管相关再住院、经皮冠状动脉介入治疗（TLR）和心血管死亡的主要不良心血管事件（MACE）无显著差异。然而，可能的FH患者组中心源性休克或IV级心力衰竭的比例显著更高（5.9%对1.2%）。
在中国早发性STEMI患者中，可能的FH的临床诊断很常见。FH患者中使用高强度他汀类药物的比例较低。尽管使用了积极的降胆固醇药物，但与不太可能的FH患者相比，FH患者达到LDL-C目标的比例显著更低。可能的FH患者更年轻，多支血管CAD发生率显著更高，心脏功能受损。
