Author + information
- Received January 1, 2019
- Revision received February 3, 2019
- Accepted February 5, 2019
- Published online May 13, 2019.
- Avinainder Singh, MD, MMSca@AvinainderSingh,
- Ankur Gupta, MD, PhDa,
- Bradley L. Collins, MDa,
- Arman Qamar, MDb,
- Keri L. Monda, PhDc,
- David Biery, BSa,
- J. Antonio G. Lopez, MDd,
- Sarah D. de Ferranti, MD, MPHe,
- Jorge Plutzky, MDb,
- Christopher P. Cannon, MDb,
- James L. Januzzi Jr., MDf,
- Marcelo F. Di Carli, MDa,
- Khurram Nasir, MD, MPHg,
- Deepak L. Bhatt, MD, MPHb@DLBhattMD and
- Ron Blankstein, MDa,∗ (, )@ronblankstein
- aDepartments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bCardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- cCenter for Observational Research, Amgen Inc., Thousand Oaks, California
- dGlobal Development, Amgen Inc., Thousand Oaks, California
- eDepartment of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- fCardiovascular Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- gCenter for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Ron Blankstein, Brigham & Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
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 lipid-lowering 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 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).
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.
- acute coronary syndrome
- familial hypercholesterolemia
- myocardial infarction
- young adult
This work was funded in part by Amgen, Inc. via a grant to Brigham and Women’s Hospital. Dr. Gupta is supported by National Institutes of Health grant number 5T32HL094301. Drs. Monda and Lopez are employees and stockholders of Amgen. Dr. Qamar is supported by National Institutes of Health grant number T32HL007604. Dr. Monda is employed by the Center for Observational Research, Amgen, Inc.; and is a stockholder of Amgen, Inc. Dr. López is an employee and stockholder of Amgen Inc. Dr. de Ferranti has received royalties from UpToDate on topics related to lipid disorders; and has received grant funding from the Pediatric Heart Network and the New England Congenital Cardiology Research Foundation. Dr. Plutzky has served on the Board of Directors of Vivus; has served as a consultant for Aegerion, Amgen, AstraZeneca, BCBS of Massachusetts, Boehringer Ingelheim, CVS CareMark, Janssen, Merck, Novo Nordisk, and Pfizer; has served on the advisory board of Amgen and Sanofi; and has received research support from Boehringer Ingelheim. Dr. Cannon has received grant support from Amgen; has served on the advisory boards for Amgen, Sanofi/Regenron, and Alnylam; and has served on the Steering Committee for Sanofi/Regeneron. Dr. Januzzi has received grant support from Roche Diagnostics, Abbott, Singulex and Prevencio; has received consulting income from Roche Diagnostics, Critical Diagnostics, Janssen, and Novartis; and has participated in clinical endpoint committees/data safety monitoring boards for Novartis, Amgen, Pfizer, Janssen, AbbVie, and Boehringer Ingelheim. Dr. Di Carli has received research grants from Gilead and Spectrum Dynamics; and has received consulting honoraria from Sanofi and General Electric. Dr. Bhatt has served on the Advisory Board of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; has served on the Board of Directors of Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; has served as Chair of the American Heart Association Quality Oversight Committee, NCDR-ACTION Registry Steering Committee, and VA CART Research and Publications Committee; has served on Data Monitoring Committees for Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi-Sankyo), and the Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); has served as Deputy Editor of Clinical Cardiology; has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has served as site co-investigator for Biotronik, Boston Scientific, St. Jude Medical (now Abbott), and Svelte; is a trustee of the American College of Cardiology; and has performed unfunded research for FlowCo, Fractyl, Merck, Novo Nordisk, PLx Pharma, and Takeda. Dr. Blankstein has served on the advisory board of Amgen, Inc.; and has received research support from Amgen, Astellas, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper. John J.P. Kastelein, MD, PhD, served as Guest Associate Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received January 1, 2019.
- Revision received February 3, 2019.
- Accepted February 5, 2019.
- 2019 American College of Cardiology Foundation
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