Zhongguo quanke yixue (Jun 2023)
Familial Hypercholesterolemia in 45-year-old and Younger Patients with Acute Coronary Syndrome: Clinical Characteristics and Influencing Factors of Blood Lipid Control Effect
Abstract
Background Acute coronary syndrome (ACS) is an acute and critical disease, which has tended to occur in younger people in recent years. Familial hypercholesterolemia (FH) is a hereditary disease characterized by early-onset atherosclerosis. Previous studies have found that the detection rate of FH in young ACS patients is not low, but there are still few studies on the follow-up of lipid-lowering efficacy. At the same time, the reasons of non-attainment for the LDL-C in ≤ 45-year-old ACS patients remain to be analyzed. Objective To study the detection rate and clinical characteristics of FH in ACS patients aged ≤ 45 years, and to observe the short-term lipid-lowering effect and analyze the risk factors for non-attainment of lipid targets. Methods ACS inpatients aged ≤ 45 years with available follow-up blood lipid records were recruited from Fuwai Central China Cardiovascular Hospital from October 2019 to October 2021. Clinical data were collected through the electronic medical record system. Venous blood samples were collected for laboratory test after eight-hour fasting. Gensini score was used to evaluate the severity of coronary artery disease, Gensini score ≥75% was defined as severe coronary artery stenosis. The Dutch Lipid Clinical Network (DLCN) criteria were used to diagnose FH. According to the DLCN score, the subjects were divided into possible FH group (n=57) and non-FH group (n=223). The low-density lipoprotein cholesterol (LDL-C) was followed up to observe the effect of lipid-lowering therapy. LDL-C<1.4 mmol/L was considered as blood lipid control. Multivariate Logistic regression analysis was used to analyze the factors affecting the attainment of LDL-C target level. Results In this study, 280 patients were eventually enrolled. Statin treatment history, family history of coronary heart disease, proportion of high risk coronary heart disease, premature coronary heart disease, type of ACS, total cholesterol, baseline LDL-C and proportion of severe coronary artery stenosis were significantly different between the two groups (P<0.05). LDL-C in follow-up, LDL-C change, LDL-C reduction in FH group were higher than those in non-FH group, the rate of attain of blood lipif was lower than that in non-FH group (P<0.05). Multivaliate Logistic regression analysis showed that receiving coronary artery bypass grafting (CABG) treatment〔OR=4.32, 95%CI (1.21, 15.42) 〕and elevated baseline LDL-C〔OR=2.22, 95%CI (1.62, 3.03) 〕were risk factors for the attainment of blood lipid level (P<0.05), while statins combined with evolocumab〔OR=0.10, 95%CI (0.03, 0.40) 〕was the protective factor (P<0.05) . Conclusion The possible FH is not uncommon in ACS patients aged ≤45 years (20.36%), and its detection rate increases in those also with acute myocardial infarction, which is worthy of clinical attention. The rate of attaining the target LDL-C level is still lower than that of non-FH group. And the rate of attaining the blood lipid level is even more lower in those receiving CABG treatment or with elevated baseline LDL-C level. The use of statins combined with evolocumab can increase the rate of attaining the target LDL-C level.
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