Familial hypercholesterolemia in 9% of young adults with ACS; many undertreated afterward
Click Here to Manage Email Alerts
Among younger patients with ACS, approximately one in 11 had familial hypercholesterolemia, researchers reported in The American Journal of Cardiology.
Among those with familial hypercholesterolemia (FH), fewer than half were treated with ezetimibe and/or PCSK9 inhibitors after their ACS event, according to the researchers.
Source: Adobe Stock
Feras Haskiah, MD, from the department of internal medicine D at Meir Medical Center in Kfar Saba, Israel, and colleagues analyzed 687 adults aged 55 years or younger (median age, 48.5 years) who were hospitalized with ACS at Meir Medical Center in 2018 or 2019. All patients were assessed for FH using the Dutch Lipid Clinic criteria.
Outcomes of interest included the proportion of patients with definite or probable FH, rate of use of lipid-lowering therapies, LDL levels at 1 year and major adverse CV and cerebrovascular events at 30 months.
Haskiah and colleagues found that definite or probable FH was present in 8.9% of patients, or approximately one in 11.
At 1 year, patients without FH were more likely to have LDL less than 70 mg/100 mL (55.9% vs. 18%; P < .001) and LDL less than 55 mg/100 mL (35.8% vs. 11.5; P < .001) than patients with FH, according to the researchers.
At 1 year, 47.5% of those with FH were taking ezetimibe and 23% of those with FH were taking PCSK9 inhibitors, which in both cases was a higher rate than those without FH (P < .001 for both). More than 90% of patients in both groups were taking high-intensity statins.
“This pattern of underutilization runs contrary to the American and European guidelines that recommend reevaluation of LDL-C levels 6 to 8 weeks after discharge, whereupon a decision to prescribe ezetimibe or a PCSK9 inhibitor to patients who do not attain the target levels is made,” the researchers wrote.
At 30 months, 70.5% of patients with FH had a major adverse CV or cerebrovascular event compared with 22.8% of those without FH (P < .001), driven by acute MI (36.1% vs. 5.1%; P < .001) and cerebrovascular events (13.1% vs. 1.3%; P < .001), Haskiah and colleagues wrote.
“There is an urgent need for more aggressive lipid-lowering therapies in patients who experience ACS regardless of whether they have FH,” the researchers wrote.
Collapse
Click Here to Manage Email Alerts