Clinical FH criteria flag high-risk ACS patients
medwireNews: Patients with acute coronary syndromes (ACS) have a more than doubled risk of recurrent coronary events within the subsequent year if they meet clinical criteria for familial hypercholesterolaemia (FH), research shows.
The unadjusted recurrence rates were similar in patients with and without FH, at around five events per 100 person–years. However, FH patients were more than 10 years younger.
After adjusting for age and other potential confounders, including prescription of high-intensity statins at discharge, the recurrence risk for FH patients was increased 2.46-fold with the American Heart Association definition, 2.73-fold with the Simon Broome criteria and 3.53-fold with the Dutch Lipid Clinic probable/definite FH definition.
These clinical screening criteria are therefore “powerful and efficient tools” to identify patients with probable FH with a particularly high risk of recurrence, say the researchers in Circulation.
The proportion of the 4534 study participants meeting clinical criteria for FH varied according to which criteria were used, ranging from 1.6% (for Dutch Lipid Clinic) to 5.5% (for Simon Broome). These prevalences show that FH is considerably more common among hospitalised ACS patients than in the general population, say David Nanchen (University of Lausanne, Switzerland) and study co-authors.
Between 23% and 43% of the putative FH patients were taking lipid-lowering drugs at admission, but their cholesterol levels were significantly higher than those of patients without FH, with low-density lipoprotein (LDL) cholesterol levels ranging from 166 to 255 mg/dL versus 124 mg/dL.
However, adjusting for admission LDL cholesterol levels did not account for the increased recurrence risk among patients with FH, instead strengthening the associations.
“Based on these results, we propose that the elevated cardiovascular risk in ACS patient with FH may be explained by life-long persistence of elevated LDL-cholesterol levels, as well as familial susceptibility to atherosclerosis”, say the researchers.
At discharge and 1 year later, almost all patients had a statin prescription, with around 70% receiving high-dose statins, yet FH patients had persistently higher LDL cholesterol levels, ranging from 112 to 126 mg/dL versus 83 mg/dL in non-FH patients.
“In the era of systematic prescription of high-dose statins, measuring cholesterol levels at the time of ACS diagnosis has been considered superfluous”, say Nanchen et al.
“On the other hand, our results suggest that patients with FH need to be identified as they are less likely to reach target LDL-cholesterol levels.”
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