Familial Hypercholesterolemia Associated With Increased Mortality Risk After Acute Myocardial Infarction

Patients with familial hypercholesterolemia (FH) were found to be at increased risk for long-term mortality and cardiovascular events after acute myocardial infarction, according to study results published in Journal of Clinical Lipidology.

The data of 5147 individuals from the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction cohorts were examined. Of those individuals, 146 (2.8%; 22% women) were diagnosed with FH. Patients with vs without FH were 12 years younger on average.

A greater number of patients with vs without FH were on statin therapy before the indexed myocardial infarction, and had statin prescriptions at discharge (with higher doses prescribed). Patients with vs without FH had comparable crude 5-year survival (87% vs 82%, respectively) and event-free survival (73.5% vs 74%, respectively). However, after multivariate adjustment, all-cause mortality (hazard ratio [HR], 1.82; 95% CI, 1.15-2.89; P =.011) and the combined endpoint of death, acute myocardial infarction, or stroke (HR, 2.22; 95% CI, 1.51-3.26; P <.001) were both higher in patients with vs without FH.

After adjusting for age, sex, comorbidities, and high-intensity lipid-lowering therapy prescription at discharge, FH was still associated with an increased risk for death, acute myocardial infarction, or stroke (HR, 2.27; 95% CI, 1.54-3.35; P <.001).

Study limitations include its observational nature which prevents to establish causal relationships, and the fact that FH diagnosis was not determined with genetic testing, which may have resulted in misdiagnoses.

“[B]eyond an increased risk in cardiovascular events, patients with probable/definite FH (about 3% of patients with [acute myocardial infarction]) also have an increased risk [for] death at 5 years, observed even in patients who received high intensity statins or combined statin/ezetimibe therapy,” noted the study authors. “This population of young patients therefore warrants specific therapeutic measures, such as more potent non-statin agents, as currently used secondary prevention medications do not suffice to lower their risk compared [with] that of patients [without FH].”

Disclosure: Several authors report affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Danchin N, Farnier M, Zeller M, et al. Long-term outcomes after acute myocardial infarction in patients with familial hypercholesterolemia: The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction program [published online April 8, 2020]. Journal of Clinical Lipidology. doi:10.1016/j.jacl.2020.03.008

This article originally appeared on The Cardiology Advisor