Heart Attack

Heart attacks among adults younger than 50 years of age are on the rise. In fact, the proportion of very young people has been increasing, rising by 2% each year for the last 10 years, according to a team of investigators a Brigham and Women’s Hospital who are focus on studying heart attacks among young adults.

The research team is now investigating why, by evaluating both risk factors and outcomes for this population in order to help prevent heart attacks in the first place. In a paper publish in the Journal of the American College of Cardiology, the team reports on the prevalence of familial hypercholesterolemia (FH), a genetic disorder that results in high cholesterol, and outcomes for patients.

One of the challenges of familial hyper cholesterolemia is that it is under recognize and under treat; so said corresponding author Ron Blankstein, MD, a preventative cardiology specialist; also associate director of the Cardiovascular Imaging Program at the Brigham. “Only about half of the FH patients in their study were on a statin therapy; so before their first heart attack, and many were not treat aggressively following their event.

Blankstein and colleagues collect data on all patients at the Brigham and Massachusetts General Hospital who had suffer a heart attack before age 50 between 2000 and 2016. Using the Dutch Lipid Clinic (DLC) Network criteria; so the team identify those patients with FH and use electronic medical records; so to determine cardiovascular risk factors as well as what medications the patients had taking prior to their heart attack; also what medications were prescribe at discharge.

Blankstein and colleagues found that nearly 1 in 10 young adults who had suffer a heart attack met the clinical definition for FH. Of those who had elevate LDL cholesterol (greater than or equal to 160 mg/dl); so that proportion increase to 4 out of every 10. And among those who had both family history; its of premature coronary artery disease and high cholesterol, the proportion was 6 in 10.

High density statin therapy

Following their first heart attack, only 49% of FH patients were prescribe a high-density statin therapy. One year after their heart attack, most had elevate cholesterol levels; so with 43% having cholesterol levels greater than 100 mg/dl and 82% having cholesterol levels above 70 mg/dl.

It’s important for both providers and patients to be aware of the real benefit; so associate with reducing cholesterol. It’s important to do so after a heart attack; but even before, if a patient has risk factors; so there’s an important opportunity to avoid heart attacks through aggressive therapy,” said Blankstein. However, there is also an enormous need to improve other risk factors.

Our team is examining both modifiable risk factors; such as smoking, being overweight, or having an elevate blood pressure, as well as well as non-modifiable factors such as genetics. But in this study; they find clinically define FH in only 1 in 10 young patients who have had a heart attack. Other factors beyond FH seem to play a much larger role in explaining; so why individuals in our study cohort experience a myocardial infarction at a young age.