CV Risk and Statin Eligibility of Young Adults After MI

Study Questions:

To what degree does statin eligibility, based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 United States Preventive Services Task Force (USPSTF) recommendations for statin use in primary prevention, identify a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age?

Methods:

The YOUNG-MI registry is a retrospective cohort study from two large academic centers, which includes patients who experienced an MI at ≤50 years of age. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations (PCEs) were used to estimate atherosclerotic cardiovascular disease (ASCVD) risk score, based on data available prior to MI or at the time of presentation. Persons <40 years were assigned an age of 40 years.

Results:

Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. There were 255 patients (17.3%) under the age of 40 at the time of the MI (range 19-39 years). At least one major CV risk factor was present in 83% of patients and 72% had an ASCVD score <7.5%. The median 10-year ASCVD risk score of the cohort was 4.8% (interquartile range, 2.8-8.0). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 PCE and 2016 USPSTF recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) of men (p < 0.001).

Conclusions:

The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.

Perspective:

The authors stressed that the findings reinforce the need for more primordial prevention and widespread use of recommendations for screening for hypertension and diabetes, and earlier screening for dyslipidemias. The value of screening with high-sensitivity C-reactive protein, family history of premature coronary heart disease (CHD), novel risk markers, and coronary artery calcium in young persons is not clear. However, in the Prospective Army Coronary Calcium project, in 2000 US Army personnel with a mean age of 43 years, Taylor and colleagues (J Am Coll Cardiol 2005;46:807-14) demonstrated that coronary calcium independently predicts incident premature CHD over standard CV risk factors (follow-up mean 3 years).

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Hypertension

Keywords: Cardiovascular Diseases, Cholesterol, Coronary Artery Disease, C-Reactive Protein, Diabetes Mellitus, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Metabolic Syndrome X, Myocardial Infarction, Plaque, Atherosclerotic, Primary Prevention, Risk Assessment, Risk Factors, Young Adult


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