Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/AvinainderSingh.
Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Cardiol. 2019 May 21;73(19):2439-2450. doi: 10.1016/j.jacc.2019.02.059.
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.
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.
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.
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).
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.
在美国，年轻时发生心肌梗死 (MI) 的成年人中，家族性高胆固醇血症 (FH) 的患病率和治疗情况数据有限。
本研究旨在评估临床上定义的 FH 的患病率，并检查 MI 后 1 年他汀类药物的使用率和低密度脂蛋白胆固醇 (LDL-C) 的达标率。
YOUNG-MI 登记研究是一项回顾性队列研究，纳入了 2000 年至 2016 年期间在 2 个学术中心发生年龄<50 岁的 MI 的患者。采用荷兰血脂临床标准定义可能的或明确的 FH。主要结局包括将患者归类为可能的或明确的 FH 的比例、使用降脂治疗的情况，以及 MI 后 1 年 LDL-C 的达标情况。
该队列纳入了 1996 例中位年龄为 45 岁的成年人，其中 19%为女性，54%为 ST 段抬高型心肌梗死。180 例（9%）患者存在可能/明确的 FH，其中 42.8%在 MI 之前未服用他汀类药物。在 1966 例存活至出院的患者中，89.4%的 FH 患者和 89.9%的非 FH 患者出院时接受了他汀类药物治疗（p=0.82）。在 FH 患者中，63.3%出院时服用高强度他汀类药物，而非 FH 患者中这一比例为 48.4%（p<0.001）。在 1 年随访时，FH 患者 LDL-C 的降低百分比为-44.4%，而非 FH 患者为-34.5%（p=0.006）。FH 患者中 LDL-C≥70mg/dl 的比例（82.2%）高于非 FH 患者（64.5%；p<0.001）。
近 10%的年轻 MI 患者存在临床上定义的 FH。只有 2/3 的 FH 患者出院时接受高强度他汀类药物治疗，绝大多数患者在 1 年内 LDL-C 水平升高。这些发现强调了年轻 FH 和非 FH 患者 MI 后更积极的降脂治疗的必要性。
