Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey

Abstract

Background Although patients with familial heterozygous hypercholesterolemia (FH) have a high risk of early myocardial infarction (MI), the coronary artery disease (CAD) burden in FH patients with acute MI remains to be investigated. Methods The data for all consecutive patients hospitalized in 2012–2019 for an acute MI and who underwent coronary angiography were collected from a multicenter database (RICO database). FH (n = 120) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥ 6). We compared the angiographic features of MI patients with and without FH (score 0–2) (n = 234) after matching for age, sex, and diabetes (1:2). Results Although LDL-cholesterol was high (208 [174–239] mg/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; P = 0.005), and was associated with more frequent multivessel disease (P = 0.004), multiple complex lesions (P = 0.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (P = 0.021 and P = 0.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090–3.480, P = 0.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014–1.057, P = 0.001). Conclusions FH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.

Various Expressions of PIK3C2A and TXNIP Genes and Their Potential Role as Independent Risk Factors for Chronic Stable Angina and Acute Coronary Syndrome

“…Smoking, hypertension, hyperlipidemia, inflammation caused by oxidative stress, apoptosis, vascular remodeling, plaque stress, blood-flow shear stress, and diabetes mellitus are all risk factors for ACS [39,40]. Moreover, Yao et al (2021) hypothesized that inflammation and a family history of high cholesterol burden, which begins at a young age, are linked to CAD severity [41]. Similarly, our study revealed that hypercholesterolemia among those with CSA is an independent risk factor for the development of ACS.…”

Current US prevalence of myocardial injury patterns and clinical outcomes among hospitalised patients with familial hypercholesterolaemia: insight from the National Inpatient Sample—a retrospective cohort study

“…31 Another review of the RICO database in 2021 by Yao et al found that definite FH, as determined by a Dutch lipid clinic network score Open access >6, was associated with more complex coronary lesions, including a higher syntax score, more bifurcation lesions and more multivessel disease. 32 In addition to the clinical outcomes, it is worth noting the healthcare utilisation among patients with FH. We observed a reduced length of stay in the hospital but no significant difference in total charges.…”