Background

Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described, especially for French patients.

Objective

The objective of this study was to assess the prevalence of FH and severity of CAD from a large database of a French regional registry of acute MI.

Methods

All consecutive patients hospitalized for an acute MI in a multicenter database from 2001 to 2017 were considered. FH was diagnosed using an algorithm adapted from the Dutch Lipid Clinic Network criteria. The prevalence and clinical features of FH and the severity of CAD were assessed.

Results

Among the 11,624 patients included in the study, the proportion of “probable/definite”, “possible”, and “unlikely” FH in patients with MI was 2.1% (n = 249), 20.7% (n = 2405), and 77.2% (n = 8970), respectively. When compared with patients with “unlikely” FH, patients with “probable/definite” FH were 20 years younger (51 vs 71, P < .001), with a lower rate of diabetes (17% vs 25%, P = .007) and a higher prevalence of personal and familial history of CAD. Chronic statin treatment was only used in 48% of FH patients and ezetimibe in 8%. After adjustment for age, sex, and diabetes, patients with FH were characterized by increased extent of CAD (SYNTAX score 11 vs 7, P < .001) and multivessel disease (55% vs 40%, P < .001).

Conclusions

In this large cohort of French individuals, FH was common in patients with MI, associated with markedly early age of MI and severity of CAD burden and limited use of preventive lipid-lowering therapy.

中文翻译：

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患有急性心肌梗死的杂合性家族性高胆固醇血症患者的患病率，危险因素负担和冠状动脉疾病的严重程度：来自法国RICO调查的数据。

背景

杂合性家族性高胆固醇血症（FH）的个体有早期心肌梗塞（MI）的高风险。但是，FH的冠状动脉疾病（CAD）负担仍然没有得到很好的描述，尤其是对于法国患者。

客观的

这项研究的目的是从法国急性心肌梗死地区登记处的大型数据库中评估FH的患病率和CAD的严重程度。

方法

考虑了从2001年至2017年在多中心数据库中所有因急性MI住院的连续患者。使用根据荷兰脂质临床网络标准改编的算法诊断为FH。评估了FH的患病率和临床特征以及CAD的严重程度。

结果

在纳入研究的11,624名患者中，MI患者中“可能/确定的”，“可能的”和“不太可能”发生FH的比例分别为2.1％（n = 249），20.7％（n = 2405）和77.2 ％（n = 8970）。与“不太可能” FH的患者相比，“可能/确定” FH的患者年轻20岁（51 vs 71，P  <.001），糖尿病发生率较低（17％vs 25％，P  = .007） ）以及CAD的个人和家族史的患病率较高。慢性他汀类药物仅在48％的FH患者中使用，依泽替米贝在8％中使用。在调整了年龄，性别和糖尿病后，FH患者的特征是CAD程度增加（SYNTAX评分11 vs 7，P  <.001）和多支血管疾病（55％vs 40％，P  <.001）。

结论

在这一庞大的法国人群中，FH在MI患者中很常见，与MI的明显早期年龄和CAD负担的严重性以及预防性降脂治疗的有限使用相关。