Clinical InvestigationThe prevalence and prognostic importance of possible familial hypercholesterolemia in patients with myocardial infarction
Section snippets
Data sources
The data used in this study were gathered from multiple Danish registries and linked on individual-level by the unique civil registration number that every citizen in Denmark is given by birth or immigration to the country. Information on cardiac procedures was obtained through the Eastern Danish Heart Registry, which is a quality improvement registry that has been collecting data from all patients in eastern Denmark undergoing coronary angiography and percutaneous coronary intervention since
Baseline characteristics
Figure 1 shows the selection of patients for this study. We included 13,174 consecutive patients who were all referred for coronary angiography due to STEMI or NSTEMI. Most patients were included after 2005. Based on data obtained from the Eastern Danish Heart Registry, 1,281 had a DLCN score ≥3 points and hence a possible diagnosis of FH. The median LDL-C in the possible FH group was 5.3 mmol/L (IQR 5.0-5.9; corresponding to 205 mg/dL [IQR 193-228]), whereas it was 3.0 mmol/L (IQR 2.4-3.7;
Discussion
This study examined the prevalence, characteristics, and longitudinal outcomes of patients with MI and possible FH. The main findings included the following: approximately 9.7% of the consecutive acute MI patients had possible FH, probable FH, or definite FH. These patients were characterized by lower age and similar levels of comorbidity, yet similar severity and distribution of CAD. Patients with possible FH were treated more aggressively with cholesterol-lowering pharmacotherapy both before
Conclusions
In this study, we found that possible FH in individuals with MI was associated with a higher risk of recurrent MI compared with unlikely FH. A prevalence of 9.7% of possible FH was obtained in this large cohort of consecutive MI patients, but further research is needed to strengthen this estimate. Future studies on the effect of screening for FH and optimization of secondary prevention are warranted.
The following are the supplementary data related to this article.
Disclosures
Ms Rerup and Drs Bang, Engstrøm, Jørgensen, Pedersen, Gislason, James, Køber, and Fosbøl have no relevant disclosures to report. Dr Mogensen reports personal fees for lectures for Novo Nordisk and MSD. Dr Torp-Pedersen reports grant support from Cardiome, Merck, Sanofi, Daiichi-Sankyo, and BMS and personal fees from Cardiome, Merck, Sanofi, and Daiichi-Sankyo. Dr Hagström reports grant support from AstraZeneca, Amgen, and Zanofi.
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Cited by (35)
Prevalence of familial hypercholesterolaemia in patients presenting with premature acute coronary syndrome
2022, Archives of Cardiovascular DiseasesOutcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia
2021, American Journal of Medicine2.5-fold increased risk of recurrent acute myocardial infarction with familial hypercholesterolemia
2021, AtherosclerosisCitation Excerpt :In this large prospective cohort study, we found that after an incident AMI, the long-term mortality was increased by 45%, and the risk of recurrent AMI was 2.5-fold increased during 17 years of follow-up in individuals with genetically verified FH compared with controls. These results in 232 individuals with genetically verified FH who had experienced a first-time AMI support and extend (with 17 years of follow-up) previous results in individuals with probable FH [7,8,14–19]. Rerup and co-workers found that individuals with probable FH had a 1.28-fold increased risk of recurrent AMI after a median of 3.3 years of follow-up [8], whereas Danchin and co-workers found a 2.2-fold increased risk of the combined outcome death or recurrent major cardiovascular events after 5 years of follow-up in probable FH [7].
Estimating the Prevalence of Familial Hypercholesterolemia in Acute Coronary Syndrome: A Systematic Review and Meta-analysis
2019, Canadian Journal of CardiologyCitation Excerpt :Notably, the cohorts with the 2 highest reported prevalence values out of the 17 studies were those in which the eligibility criteria included patients ≤ 35 years.26,34 For comparison, we assessed the pooled prevalence of all studies for which no upper age limit was specified in the eligibility criteria.20,23-25,28-31,35 Based on these 9 studies, the pooled prevalence in the absence of an upper age restriction was 2.7% (95% CI, 1.6-4.6; range 0.4% to 6.9%) (Supplemental Fig. S4), significantly lower than the value for cohorts that were limited to patients aged ≤ 45 years.