The prevalence and prognostic importance of possible familial hypercholesterolemia in patients with myocardial infarction.
OBJECTIVE
Familial hypercholesterolemia (FH) is a common genetic disorder causing accelerated atherosclerosis and premature cardiovascular disease. The aim of this study was to examine the prevalence and prognostic significance of possible FH in patients with myocardial infarction (MI).


RESULTS
By individual-level linkage of data from the Eastern Danish Heart Registry and national administrative registries, a study population of patients referred for coronary angiography due to MI was selected. The study population was divided into "unlikely FH" and "possible FH" based on the Dutch Lipid Clinic Network criteria, which included a plasma low-density lipoprotein cholesterol (LDL-C) and age for onset of cardiac disease. A score of ≥3 points was used as the cutpoint between the 2 groups. Among the study population of 13,174 MI patients, 1,281 (9.7%) had possible FH. These patients were younger (59.1 vs 65.7 years, P ≤ .0001), had similar levels of comorbidities, and were treated more aggressively with cholesterol-lowering drugs compared with patients with unlikely FH. During a median of 3.3 years of follow-up, the unadjusted and adjusted event rates of recurrent MI were higher in patients with possible FH compared with unlikely FH (16% vs 11%, adjusted hazard ratio 1.28, 95% CI 1.09-1.51, P = .003.). Differences in adjusted all-cause mortality were not statistically significant (17% vs 23%, adjusted hazard ratio 0.89 [0.74-1.04], P = .1).


CONCLUSIONS
We found that MI patients with possible FH have higher risk of recurrent MI but similar risk of mortality compared with unlikely FH patients. Further studies on secondary prevention are warranted.
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark. Electronic address: tmj949@alumni.ku.dk.
Sofie Aagaard
SA
Rerup
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark.
Lia E
LE
Bang
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark.
Ulrik M
UM
Mogensen
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark.
Thomas
T
Engstrøm
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark.
Erik
E
Jørgensen
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark.
Frants
F
Pedersen
Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark.
Christian
C
Torp-Pedersen
Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark.
Gunnar
G
Gislason
Dept. of Medical Sciences, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.
Stefan
S
James
Dept. of Medical Sciences, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.
Emil
E
Hagström
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark.
Lars
L
Køber
The Heart Center, University Hospital of Copenhagen, Rigshospitalet, København Ø, Denmark.
Emil L
EL
Fosbøl
D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL