The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway; Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
Atherosclerosis. 2021 Feb;319:28-34. doi: 10.1016/j.atherosclerosis.2020.12.019. Epub 2020 Dec 21.
A first-time acute myocardial infarction (AMI) is a severe diagnosis that leads to initiation or intensification of lipid-lowering medication to prevent recurrent events. Individuals with familial hypercholesterolemia (FH) already use high-intensity lipid-lowering medication at the time of an incident AMI due to their diagnosis. Hence, we hypothesized that compared with matched non-FH controls, individuals with genetically verified FH have increased mortality and risk of recurrent AMI after their first event.
The study population comprised 4871 persons with genetically verified FH, and 96,251 age and sex matched controls randomly selected from the Norwegian population. Data were obtained from the Cardiovascular Disease in Norway Project, the Norwegian Patient Registry and the Norwegian Cause of Death Registry. Incidence of AMI, all-cause mortality and recurrent AMI after incident AMI were analyzed for the period 2001-2017. Incidence and mortality were compared using hazard ratios (HR) from Cox regression. Risk of recurrent AMI was compared using sub-hazard ratios (SHR) from competing risk regression with death as a competing event.
We identified 232 individuals with FH and 2118 controls with an incident AMI [HR 2.10 (95% CI 1.83-2.41)]. Among survivors ≥29 days after the incident AMI, both mortality [HR = 1.45 (95% CI: 1.07-1.95)] and recurrent AMI [SHR = 2.53 (95% CI: 1.88-3.41)] were significantly increased among individuals with FH compared with non-FH controls.
Individuals with FH have increased mortality and increased risk of recurrent AMI after the first AMI event compared with controls. These findings call for intensive follow-up of individuals with FH following an AMI.
首次急性心肌梗死（AMI）是一种严重的诊断，需要启动或强化降脂药物治疗，以预防再次发生事件。由于家族性高胆固醇血症（FH）的诊断，患有 FH 的个体在发生 AMI 时已经使用高强度降脂药物。因此，我们假设与匹配的非 FH 对照组相比，经基因证实患有 FH 的个体在首次发生 AMI 后，死亡率和再次发生 AMI 的风险增加。
研究人群包括 4871 名经基因证实的 FH 患者和 96251 名年龄和性别匹配的随机从挪威人群中选择的对照者。数据来自挪威心血管疾病项目、挪威患者登记处和挪威死因登记处。分析了 2001 年至 2017 年期间的 AMI 发生率、全因死亡率和再次发生 AMI 后 AMI 的发生率。使用 Cox 回归的风险比（HR）比较发病率和死亡率。使用竞争风险回归（以死亡为竞争事件）的亚风险比（SHR）比较再次发生 AMI 的风险。
我们确定了 232 名 FH 患者和 2118 名发生 AMI 的对照者[HR 2.10（95% CI 1.83-2.41）]。在 AMI 后存活≥29 天的幸存者中，FH 患者的死亡率[HR=1.45（95% CI：1.07-1.95）]和再次发生 AMI 的风险[SHR=2.53（95% CI：1.88-3.41）]均明显高于非 FH 对照组。
与对照组相比，首次 AMI 事件后 FH 患者的死亡率和再次发生 AMI 的风险增加。这些发现呼吁对 AMI 后 FH 患者进行强化随访。
