BACKGROUND Despite significant progress in primary prevention, the rate of MI has not declined in young adults. OBJECTIVES The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in 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 from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation. 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. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force 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%) 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.

中文翻译：

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心肌梗塞后年轻人的心血管风险和他汀类药物的适用性：合作伙伴 YOUNG-MI 登记处

背景尽管在一级预防方面取得了重大进展，但年轻成人的 MI 率并未下降。目的 本研究的目的是根据 2013 年美国心脏病学会/美国心脏协会治疗血胆固醇指南和 2016 年美国预防服务工作组对他汀类药物在一级预防中使用他汀类药物的建议，评估他汀类药物的合格性。年轻时的首次心肌梗塞 (MI)。方法 YOUNG-MI 注册是来自 2 个大型学术中心的回顾性队列，其中包括年龄≤50 岁的 MI 患者。1 型 MI 的诊断由研究医师判定。根据 MI 之前或就诊时可用的数据，使用合并队列风险方程来估计动脉粥样硬化心血管疾病风险评分。结果 在符合纳入标准的 1,685 名患者中，210 名 (12.5%) 在 MI 之前正在接受他汀类药物治疗并被排除在外。在其余 1,475 人中，中位年龄为 45 岁，女性 294 人（20%），ST 段抬高心肌梗死 846 人（57%）。1,225 (83%) 名患者中至少存在 1 个心血管危险因素。该队列的 10 年动脉粥样硬化心血管疾病风险评分中位数为 4.8%（四分位距：2.8% 至 8.0%）。根据 2013 年美国心脏病学会/美国心脏协会指南和 2016 年美国预防服务工作组的建议，只有 724 (49%) 和 430 (29%) 人符合他汀类药物的资格标准，分别。这一发现在女性中更为明显，其中 184 人 (63%) 根据任一指南都不符合他汀类药物的条件，而男性则为 549 人 (46%) (p < 0.001)。结论 绝大多数在年轻时出现 MI 的成年人在其 MI 之前不会达到当前基于指南的他汀类药物治疗阈值。这些发现强调了年轻人需要更好的风险评估工具。