TY - JOUR
T1 - Cardiovascular Risk and Statin Eligibility of Young Adults After an MI
T2 - Partners YOUNG-MI Registry
AU - Singh, Avinainder
AU - Collins, Bradley L.
AU - Gupta, Ankur
AU - Fatima, Amber
AU - Qamar, Arman
AU - Biery, David
AU - Baez, Julio
AU - Cawley, Mary
AU - Klein, Josh
AU - Hainer, Jon
AU - Plutzky, Jorge
AU - Cannon, Christopher P.
AU - Nasir, Khurram
AU - Di Carli, Marcelo F.
AU - Bhatt, Deepak L.
AU - Blankstein, Ron
N1 - Funding Information:
Dr. Gupta is supported by National Institutes of Health grant number 5T32HL094301. Dr. Qamar is supported by National Institutes of Health grant number T32HL007604. Dr. Bhatt has served on Advisory Board of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; has served on the Board of Directors of Boston VA Research Institute and the Society of Cardiovascular Patient Care; is Chair of the American Heart Association Quality Oversight Committee; has served on Data Monitoring Committees for Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; has received honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), HMP Communications (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); has received honoraria for serving on clinical trial steering committees of Duke Clinical Research Institute, Harvard Clinical Research Institute, and Population Health Research Institute; has served as Deputy Editor of Clinical Cardiology; has served as chair of the NCDR-ACTION Registry Steering Committee and VA CART Research and Publications Committee; has received research funding from Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has served as site coinvestigator for Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); has served as a trustee of American College of Cardiology; and has performed unfunded research for FlowCo, Merck, PLx Pharma, and Takeda. Dr. Blankstein has served on the advisory board of Amgen; and has received research support from Amgen and Gilead Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This paper was presented on November 14, 2017, at the Ancel Keys Cardiovascular Disease Prevention Session, American Heart Association 2017 Scientific Sessions, Anaheim, California.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/1/23
Y1 - 2018/1/23
N2 - Background: Despite significant progress in primary prevention, the rate of MI has not declined in young adults. Objectives: The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age. Methods: The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation. Results: Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001). Conclusions: The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.
AB - Background: Despite significant progress in primary prevention, the rate of MI has not declined in young adults. Objectives: The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age. Methods: The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation. Results: Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001). Conclusions: The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.
KW - myocardial infarction
KW - prevention
KW - risk
KW - statin
KW - young adults
UR - http://www.scopus.com/inward/record.url?scp=85044506814&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044506814&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2017.11.007
DO - 10.1016/j.jacc.2017.11.007
M3 - Article
C2 - 29141201
AN - SCOPUS:85044506814
VL - 71
SP - 292
EP - 302
JO - Journal of the American College of Cardiology.
JF - Journal of the American College of Cardiology.
SN - 0735-1097
IS - 3
ER -