More Aggressive Statin Tx Needed After Heart Attack in Young Patients

The majority of young heart attack patients with familial hypercholesterolemia (FH) still have elevated cholesterol levels a year later, according to a study published in the issue of the Journal of the American College of Cardiology.

Avinainder Singh, M.D., from Brigham and Women's Hospital in Boston, and colleagues used data from the YOUNG-MI registry to assess the prevalence and treatment of FH among 1,996 U.S. adults who experienced a myocardial infarction before the age of 50 years. Patients (19 percent female) were treated at two academic medical centers from 2000 to 2016.

The researchers found that probable or definite FH was present in 9 percent of young myocardial infarction patients, of whom 42.8 percent were not on statins prior to their myocardial infarction. Similar rates of surviving FH patients and non-FH patients were discharged with statin therapy; however, FH patients were more likely to be discharged on high-intensity statin therapy versus non-FH patients. The percent reduction in low-density lipoprotein cholesterol (LDL-C) among FH patients at one-year follow-up was 44.4 percent compared with 34.5 percent in non-FH patients. At follow-up, the proportion of patients with LDL-C ≥70 mg/dL was higher among FH patients versus non-FH patients.

"One of the challenges of FH is that it is underrecognized and undertreated," a coauthor said in a statement. "Only about half of the FH patients in our study were on a statin therapy before their first heart attack, and many were not treated aggressively following their event. Intervening to lower cholesterol could mean preventing not only subsequent heart attacks but first heart attacks, too."

Several authors disclosed financial ties to pharmaceutical companies, including Amgen, which funded the study.

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