Cardiovascular Risk and Statin Eligibility of Young Adults After an MI: Partners YOUNG-MI Registry.
Cardiovascular Risk and Statin Eligibility of Young Adults After an MI: Partners YOUNG-MI Registry.
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DOI：
10.1016/j.jacc.2017.11.007
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发表时间：
2018-01-23
影响因子：
24
通讯作者：
Blankstein R
中科院分区：
文献类型：
--
作者：
Singh A;Collins BL;Gupta A;Fatima A;Qamar A;Biery D;Baez J;Cawley M;Klein J;Hainer J;Plutzky J;Cannon CP;Nasir K;Di Carli MF;Bhatt DL;Blankstein R
尽管在一级预防方面取得了重大进展，但年轻人的MI发生率并未下降。本研究的目的是根据2013年美国心脏病学会/美国心脏协会血胆固醇治疗指南和2016年美国预防服务工作组关于他汀类药物在年轻时首次发生心肌梗死（MI）的成年人队列中用于一级预防的建议，评估他汀类药物的合格性。YOUNG-MI登记研究是来自2个大型学术中心的回顾性队列，包括年龄≤50岁时发生MI的患者。1型MI的诊断由研究医生裁定。根据MI前或MI发生时的可用数据，使用合并队列风险方程估计动脉粥样硬化性心血管疾病风险评分。在符合入选标准的1，685例患者中，210例（12.5%）在MI前接受他汀类药物治疗并被排除。在其余1,475例患者中，中位年龄为45岁，其中294例（20%）为女性，846例（57%）为ST段抬高型心肌梗死。1，225例（83%）患者至少存在1种心血管风险因素。该队列的中位10年动脉粥样硬化性心血管疾病风险评分为4.8%（四分位距：2.8%至8.0%）。根据2013年美国心脏病学会/美国心脏协会指南和2016年美国预防服务工作组的建议，分别只有724人（49%）和430人（29%）符合他汀类药物的资格标准。这一发现在女性中更为明显，其中184人（63%）不符合任何一项指南，而男性为549人（46%）（p < 0.001）。绝大多数在年轻时出现MI的成年人在MI之前不符合目前基于指南的他汀类药物治疗阈值。这些发现强调了在年轻人中需要更好的风险评估工具。
Despite significant progress in primary prevention, the rate of MI has not declined in young adults. The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age. The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation. Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001). The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.
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影响因子：
5.4
作者：
Kandula NR;Kanaya AM;Liu K;Lee JY;Herrington D;Hulley SB;Persell SD;Lloyd-Jones DM;Huffman MD
通讯作者：
Huffman MD
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Berry JD;Liu K;Folsom AR;Lewis CE;Carr JJ;Polak JF;Shea S;Sidney S;O'Leary DH;Chan C;Lloyd-Jones DM
通讯作者：
Lloyd-Jones DM