Familial Hypercholesterolemia Needs Aggressive Lipid-Lowering Therapy After MI

Cholesterol test, lipids
Cholesterol test, lipids
Researchers assessed the incidence of clinically defined familial hypercholesterolemia and analyzed the rates of statin use and low-density lipoprotein cholesterol 1 year after myocardial infarction.

Approximately one-third of patients with probable or definite familial hypercholesterolemia (FH) and an incidence of myocardial infarction (MI) <50 years are discharged from the hospital without a prescription for high-intensity statins, a new study found. In addition, researchers found that many of these patients presented with increased levels of low-density lipoprotein cholesterol (LDL-C) 1 year after discharge. Findings from this study were published in the Journal of the American College of Cardiology.

A retrospective cohort study of patients from 2 large academic medical centers was conducted. The study included patients who had experienced an MI when they were ≤50 years between 2000 and 2016. The researchers identified patients with probable or definite FH using the Dutch Lipid Clinic criteria and reviewed electronic medical records to determine whether the patients had been prescribed a guideline-directed medical therapy at discharge. The outcomes of the analysis were the use of lipid-lowering therapy, percentage of patients classified as probable or definite FH, and levels of LDL-C at 1 year post-MI.

A total of 1996 patients were included in the retrospective analysis (median age, 45 years), with 180 patients (9%) meeting the criteria for probable/definite FH. Of the patients with probable/definite FH, 42.8% did not receive statins before their MI event.

Statin therapy was prescribed at discharge in the majority of patients with FH (89.4%) and in patients without FH (90%). A higher percentage of patients with FH were discharged on high-intensity statin therapy vs patients without FH (63.3% vs 48.4%, respectively; P <.001).

In addition, a greater percentage reduction in LDL-C was found in patients with FH compared with patients without FH at 1 year (-44.4% vs -34.5%, respectively; P =.006). Despite the higher percentage of patients with FH prescribed high-intensity statins on discharge, more of these patients had LDL-C ≥70 mg/dL at 1 year compared with patients without FH (82.2% vs 64.5%, respectively; P <.001).

Study limitations included the retrospective nature, the sole use of clinical criteria to define FH rather than genetic testing, the inclusion of mostly middle-age patients, and the reliance on medical record data.

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The researchers believe their “findings highlight the need for more aggressive lipid-lowering therapy in both young FH and non-FH patients post-MI.”


Singh A, Gupta A, Collins BL, et al. Familial hypercholesterolemia among young adults with myocardial infarction. J Am Coll Cardiol. 2019;73(19):2439-2450.