Author + information
- Received October 31, 2017
- Accepted November 7, 2017
- Published online November 14, 2017.
- Avinainder Singh, MBBSa,
- Bradley L. Collins, BAa,
- Ankur Gupta, MD, PhDa,
- Amber Fatima, MBBSb,
- Arman Qamar, MDc,
- David Biery, BSa,
- Julio Baeza,
- Mary Cawleya,
- Josh Klein, BSa,
- Jon Hainer, BSa,
- Jorge Plutzky, MDc,
- Christopher P. Cannon, MDc,
- Khurram Nasir, MD, MPHd,
- Marcelo F. Di Carli, MDa,
- Deepak L. Bhatt, MD, MPHc and
- Ron Blankstein, MDa,∗ ()
- aCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bDepartment of Medicine, Tufts Medical Center, Boston, Massachusetts
- cCardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- dMiami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
- ↵∗Correspondence to: Ron Blankstein, MD Brigham & Women’s Hospital 75 Francis Street Boston, Massachusetts 02115 Telephone: 8573071989 Fax: 8573071955.
Background Despite significant progress in primary prevention, the rate of MI has not declined in young adults.
Objectives We aimed to evaluate statin eligibility based on the 2013 American College of Cardiology / American Heart Association (ACC/AHA) guidelines for treatment of blood cholesterol and 2016 United States Preventive Services Task Force (USPSTF) recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age.
Methods The YOUNG-MI registry is a retrospective cohort study from two large academic centers which includes patients who experienced an MI at 50 years of age or younger. Diagnosis of Type 1-MI was adjudicated by study physicians. Pooled cohort risk equations (PCE) were used to estimate atherosclerotic cardiovascular disease (ASCVD) risk score based on data available prior to MI or at the time of presentation.
Results Of 1685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had STEMI. At least one cardiovascular risk factor was present in 1225 (83%) patients. The median 10-year ASCVD risk score of the cohort was 4.8% (interquartile range: 2.8, 8.0). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 ACC/AHA guidelines and 2016 USPSTF 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%) of men (p<0.001).
Conclusions 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.
Disclosures: Dr. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. Dr. Blankstein discloses the following relationships - Advisory Board: Amgen, Inc. Research Support: Amgen, Inc. Gilead Sciences, Inc. Dr. Ankur Gupta is supported by NIH grant number 5T32HL094301. Dr. Qamar is supported by NIH grant number T32HL007604. Other authors report no relevant disclosures.
- Received October 31, 2017.
- Accepted November 7, 2017.