Risk for Recurrent Acute Myocardial Infarction in Familial Hypercholesterolemia

familial hypercholesterolemia
Patients with vs without familial hypercholesterolemia were found to be at increased risk for recurring acute myocardial infarction and mortality.

Patients with vs without familial hypercholesterolemia (FH) were found to be at increased risk for recurring acute myocardial infarction (AMI) and mortality after a first AMI, according to study results published in Atherosclerosis.

In this prospective, matched cohort study, the data of 4871 patients in the Unit for Cardiac and Cardiovascular Genetics database with genetically confirmed FH were analyzed, These patients were age- and sex-matched with random individuals (n=96,251) from the general Norwegian population who were included in the Cardiovascular Disease in Norway Project, Norwegian Patient Registry, and Norwegian Cause of Death Registry. All individuals were assessed for cardiovascular events and mortality.

In this cohort, 53% were women, and 232 patients with FH and 2118 control individuals had incident AMI. Risk for incident AMI was greater in patients with vs without FH (hazard ratio [HR], 2.10; 95% CI, 1.83-2.41), and in men vs women (HR, 2.20; 95% CI, 1.85-2.61 and HR, 1.95; 95% CI, 1.55-2.44, respectively). Patients with vs without FH were hospitalized at younger ages for incident AMI (60.5±15.4 years vs 65.3±12.4 years, respectively).

Of patients who had survived incident AMI 28 days after hospital discharge, 30% and 15% of those with and without FH, respectively were readmitted to the hospital for recurrent AM ( 2.5-fold increased risk for recurrent AMI associated with FH; sub-HR, 2.53; 95% CI, 1.88-3.41). Risk for recurrent AMI was comparable for men and women with FH (sub-HR, 2.68; 95% IC, 1.85-3.87 and sub-HR, 2.24; 95% CI, 1.35-3.69, respectively).

Of patients hospitalized for AMI, 28.5% and 27.2% with and without FH died (HR, 1.32; 95% CI, 1.01-1.71). Men, but not women, with FH were at increased risk for mortality after adjusting for age (adjusted HR [aHR], 1.44; 95% CI, 1.0-2.07 and aHR, 1.20; 95% CI, 0.81-1.76, respectively).

Mortality rate was greater in patients with vs without FH, 29 days after release from the hospital for AMI (increase, 45%; aHR, 1.45; 95% CI, 1.07-1.95).

Study limitations include the lack of information on lipid concentrations or lifestyle characteristics.

“[O]ur results demonstrate that during 17 years of follow-up, individuals with genetically verified FH have a more than doubled risk [for] both incident and recurrent AMI and increased mortality compared with non-FH controls,” concluded the study authors. “These findings therefore demonstrate a poorer prognosis after incident AMI in individuals with FH, underscoring the severity of the FH diagnosis and the need to monitor individuals with FH (even more) closely after their first AMI.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Svendsen K, Krogh H W, Igland J, et al. 2.5-fold increased risk of recurrent acute myocardial infarction with familial hypercholesterolemia. Atherosclerosis. 2020;319:28-34. doi:10.1016/j.atherosclerosis.2020.12.019