Familial Hypercholesterolemia Among Young Adults With Myocardial Infarction
Familial Hypercholesterolemia Among Young Adults With Myocardial Infarction
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DOI：
10.1016/j.jacc.2019.02.059
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发表时间：
2019-05-21
影响因子：
24
通讯作者：
Blankstein, Ron
中科院分区：
文献类型：
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作者：
Singh, Avinainder;Gupta, Ankur;Blankstein, Ron
背景 关于在年轻时经历过心肌梗死 (MI) 的美国成年人中，家族性高胆固醇血症 (FH) 的患病率和治疗数据有限。 目的 本研究旨在评估临床定义的 FH 的患病率，并检查他汀类药物的使用率和 MI 后 1 年达到的低密度脂蛋白胆固醇 (LDL-C)。 方法 YOUNG-MI 登记是一项回顾性队列研究，包括经历过 MI 或以下的患者2000 年至 2016 年间在 2 个学术中心年龄 50 岁。可能或明确的 FH 由荷兰脂质诊所标准定义。结果包括被分类为可能或明确 FH 的患者比例、降脂治疗的使用以及 MI 后 1 年达到的 LDL-C。 结果 该队列由 1,996 名成年人组成，中位年龄为 45 岁； 19% 为女性，54% 患有 ST 段抬高 MI。 180 名患者 (9%) 存在可能/确定的 FH，其中 42.8% 在 MI 之前未服用他汀类药物。在出院前存活的 1,966 名患者中，89.4% 的 FH 患者和 89.9% 的非 FH 患者出院后接受他汀类药物治疗（p = 0.82）。在 FH 患者中，63.3% 出院后接受高强度他汀类药物治疗，而非 FH 患者中这一比例为 48.4% (p < 0.001)。 1 年随访时，FH 患者的 LDL-C 降低百分比为 -44.4%，而非 FH 患者的 LDL-C 降低百分比为 -34.5% (p = 0.006)。与非 FH 患者 (64.5%；p < 0.001) 相比，FH 患者中 LDL-C ≥ 70 mg/dl 的患者比例较高 (82.2%)。 结论 在年轻时患有 MI 的 10 名患者中，近 1 名存在临床定义的 FH。只有三分之二的 FH 患者出院后接受高强度他汀类药物治疗，绝大多数患者 1 年时 LDL-C 升高。这些发现强化了年轻 FH 和非 FH 心肌梗死后患者需要更积极的降脂治疗。 (c) 2019 年，美国心脏病学会基金会。
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 lipidlowering 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 STsegment 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. (c) 2019 by the American College of Cardiology Foundation.