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Impact of heterozygous familial hypercholesterolemia on mortality in ST-segment elevation Myocardial Infarction patients
118 ezetimibe. FH was considered as definite or probable for a total > 8 points or equal to 6—8 points, respectively. Results DLCN score was assessed in 7929 participants aged 35—74 (50% were men). The prevalence of definite or probable FH was 0.41% [95% CI: 0.27%—0.56%]. Among subjects with FH, 21% had a history of premature coronary artery disease, cerebral or peripheral vascular disease (versus less than 1% among subjects without FH; P-value < 0.0001) without significant difference for the level of the standard cardiovascular risk factors not including in the DLCN score. At baseline, 74% of the subjects with FH were treated by a statin therapy. Mean LDL-C was 5.4 mmol/L (± 1.0) and 8.1 mmol/L (± 1.1) in subjects with FH with and without treatment, respectively (Pvalue < 0.0001). Conclusion In a sample from the French general population aged 35—74, the prevalence of FH was close to 1/250 and more than 1/4 of the subjects with FH were not treated. Disclosure of interest Amgen, MSD, Sanofi.
Abstracts Conclusion Possible HeFH is frequent in STEMI patients when screened with the Dutch Lipid Clinic Score that allows characterization of a potentially higher risk population. The better prognosis of these patients may be related to their young age and more aggressive treatment.
https://doi.org/10.1016/j.acvdsp.2018.10.259 221
Impact of heterozygous familial hypercholesterolemia on mortality in ST-segment elevation Myocardial Infarction patients B. Lattuca 1,2,∗ , J. Silvain 2 , M. Zeitouni 2 , M. Guerin 3 , M. Kerneis 2 , Paul Guedeney 2 , N. Vignolles 2 , J.P. Collet 2 , P. Lesnik 3 , G. Montalescot 2 1 CHU Caremeau, département de cardiologie Nîmes, Nîmes 2 Sorbonne University, Paris 06 (UPMC), ACTION Study Group, Inserm UMRS 1166, cardiology institute, Pitié-Salpêtrière, University Hospital, AP—HP 3 Inserm, UMRS U1166, team 4 ‘‘Integrative Biology of Atherosclerosis’’, Sorbonne Universités, UPMC Université Paris 6, Paris, France ∗ Corresponding author. E-mail address: [email protected] (B. Lattuca) Background Heterozygous Familial Hypercholesterolemia (HeFH) is an underdiagnosed form of dyslipidemia associated with higher risk of myocardial infarction (MI). Identifying patients with possible HeFH would allow family screening and more aggressive treatment. The aim of this study was to assess the prevalence and impact on outcomes of possible HeFH in ST segment Elevation MI (STEMI) patients. Methods Lipid profiling was performed in consecutive STEMI patients admitted at the Pitié-Salpêtrière Center, with two measurements, one performed on the arterial blood on arrival in the cath-lab and the second after a fasting period during hospitalization. A possible HEFH was defined by a Dutch Lipid Clinic Score ≥ 3, calculated from medical history and LDLcholesterol. Major ischemic events and mortality were assessed at one-year. Results Among 1788 consecutive MI patients, the diagnosis of possible HeFH was reached in 12% of patients. There was no significant difference between LDL-cholesterol measured on admission on anticoagulated arterial blood and non-anticoagulated venous blood after a fasting period (1.18 ± 0.41 g/dL vs. 1.17 ± 0.48 g/dL; P = 0.76). HeFH patients were younger (50.6 ± 10.1 vs. 65.5 ± 13.2 years; P < 0.001), had more frequent familial history of coronary artery disease (65.1% vs. 14.1%; P < 0.001) and had lower rate of prior MI (10.7% vs. 20.3%; P < 0.001). The median LDLcholesterol was higher and discharge treatment by high-dose statin was more frequent in patients with possible HeFH (respectively: 1.4 [1.18—1.65] vs. 1.1 [0.84—1.33] g/dL; P < 0.001 and 92.6% vs. 85.1% [P = 0.012]). At one-year, the mortality rate was lower in patients with possible HeFH (4.3% vs. 12.6%; HR = 1.9 [2.23—3.16]; P = 0.04) (Fig. 1).
Fig. 1 One-year survival curves according to the probability of heterozygous familial hypercholesterolemia (HEFH) defined by Dutch Lipid Clinic Score. Disclosure of interest B. Lattuca has received research grants from Biotronik, Daiichi-Sankyo; consultant fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. https://doi.org/10.1016/j.acvdsp.2018.10.260 003
Big data and severe hypertriglyceridemia: Prevalence in 297,909 individuals J. Ferrières 1,2,∗ , C. Verdier 3 , M.S. Combis 3 , I. Gennero 3 , A.L. Genoux 3 , S. Hamdi 3 , B. Perret 3 , J.B. Ruidavets 2 1 Department of Cardiology, Toulouse Rangueil University Hospital 2 Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm 3 Department of Biochemistry and UMR 1048 Inserm, Toulouse III University, IFB Purpan, Toulouse University Hospital, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (J. Ferrières) Background Severe hypertriglyceridemia (sHTG) is defined as serum concentrations of triglycerides (TG) ≥ than 10 mmol/L. The prevalence of sHTG has rarely been assessed in large databases. Methods Based on a huge sample of 1,003,222 lipid panels, we assessed the prevalence of sHTG. All subjects were recruited in the same University Hospital during visits and hospitalizations and in the same laboratory. Results From 2006 to 2017, 2441 (0.24%) sHTG episodes were observed. During the same period, 297,909 lipid panels were obtained from subjects who had visited various physicians for the first time in our University Hospital. The sample included subjects from 0 to 114 years, 62% aged between 18—70, 51.3% were women, and the mean age was 52.9 ± 23.6. Overall, 403 subjects had sHTG, 303 (75%) in men and 100 (25%) in women. The prevalence of sHTG was 0.135% (95% Confidence Interval: 0.122—0.148); 0.209% (95% CI: 0.186—0.232) in men; 0.065% (95% CI: 0.052—0.078) in women. The prevalence of sHTG was different across gender (P < 0.001) and the prevalence differed across age categories (Cochran Armitage P for trend < 0.001) with the highest (0.33%) prevalence in men aged 40—49 years; 0.08% of subjects younger than 30 years had sHTG. The characteristics of sHTG differed significantly (P < 0.001) across sHTG
Abstracts Conclusion Possible HeFH is frequent in STEMI patients when screened with the Dutch Lipid Clinic Score that allows characterization of a potentially higher risk population. The better prognosis of these patients may be related to their young age and more aggressive treatment.
https://doi.org/10.1016/j.acvdsp.2018.10.259 221
Impact of heterozygous familial hypercholesterolemia on mortality in ST-segment elevation Myocardial Infarction patients B. Lattuca 1,2,∗ , J. Silvain 2 , M. Zeitouni 2 , M. Guerin 3 , M. Kerneis 2 , Paul Guedeney 2 , N. Vignolles 2 , J.P. Collet 2 , P. Lesnik 3 , G. Montalescot 2 1 CHU Caremeau, département de cardiologie Nîmes, Nîmes 2 Sorbonne University, Paris 06 (UPMC), ACTION Study Group, Inserm UMRS 1166, cardiology institute, Pitié-Salpêtrière, University Hospital, AP—HP 3 Inserm, UMRS U1166, team 4 ‘‘Integrative Biology of Atherosclerosis’’, Sorbonne Universités, UPMC Université Paris 6, Paris, France ∗ Corresponding author. E-mail address: [email protected] (B. Lattuca) Background Heterozygous Familial Hypercholesterolemia (HeFH) is an underdiagnosed form of dyslipidemia associated with higher risk of myocardial infarction (MI). Identifying patients with possible HeFH would allow family screening and more aggressive treatment. The aim of this study was to assess the prevalence and impact on outcomes of possible HeFH in ST segment Elevation MI (STEMI) patients. Methods Lipid profiling was performed in consecutive STEMI patients admitted at the Pitié-Salpêtrière Center, with two measurements, one performed on the arterial blood on arrival in the cath-lab and the second after a fasting period during hospitalization. A possible HEFH was defined by a Dutch Lipid Clinic Score ≥ 3, calculated from medical history and LDLcholesterol. Major ischemic events and mortality were assessed at one-year. Results Among 1788 consecutive MI patients, the diagnosis of possible HeFH was reached in 12% of patients. There was no significant difference between LDL-cholesterol measured on admission on anticoagulated arterial blood and non-anticoagulated venous blood after a fasting period (1.18 ± 0.41 g/dL vs. 1.17 ± 0.48 g/dL; P = 0.76). HeFH patients were younger (50.6 ± 10.1 vs. 65.5 ± 13.2 years; P < 0.001), had more frequent familial history of coronary artery disease (65.1% vs. 14.1%; P < 0.001) and had lower rate of prior MI (10.7% vs. 20.3%; P < 0.001). The median LDLcholesterol was higher and discharge treatment by high-dose statin was more frequent in patients with possible HeFH (respectively: 1.4 [1.18—1.65] vs. 1.1 [0.84—1.33] g/dL; P < 0.001 and 92.6% vs. 85.1% [P = 0.012]). At one-year, the mortality rate was lower in patients with possible HeFH (4.3% vs. 12.6%; HR = 1.9 [2.23—3.16]; P = 0.04) (Fig. 1).
Fig. 1 One-year survival curves according to the probability of heterozygous familial hypercholesterolemia (HEFH) defined by Dutch Lipid Clinic Score. Disclosure of interest B. Lattuca has received research grants from Biotronik, Daiichi-Sankyo; consultant fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. https://doi.org/10.1016/j.acvdsp.2018.10.260 003
Big data and severe hypertriglyceridemia: Prevalence in 297,909 individuals J. Ferrières 1,2,∗ , C. Verdier 3 , M.S. Combis 3 , I. Gennero 3 , A.L. Genoux 3 , S. Hamdi 3 , B. Perret 3 , J.B. Ruidavets 2 1 Department of Cardiology, Toulouse Rangueil University Hospital 2 Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm 3 Department of Biochemistry and UMR 1048 Inserm, Toulouse III University, IFB Purpan, Toulouse University Hospital, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (J. Ferrières) Background Severe hypertriglyceridemia (sHTG) is defined as serum concentrations of triglycerides (TG) ≥ than 10 mmol/L. The prevalence of sHTG has rarely been assessed in large databases. Methods Based on a huge sample of 1,003,222 lipid panels, we assessed the prevalence of sHTG. All subjects were recruited in the same University Hospital during visits and hospitalizations and in the same laboratory. Results From 2006 to 2017, 2441 (0.24%) sHTG episodes were observed. During the same period, 297,909 lipid panels were obtained from subjects who had visited various physicians for the first time in our University Hospital. The sample included subjects from 0 to 114 years, 62% aged between 18—70, 51.3% were women, and the mean age was 52.9 ± 23.6. Overall, 403 subjects had sHTG, 303 (75%) in men and 100 (25%) in women. The prevalence of sHTG was 0.135% (95% Confidence Interval: 0.122—0.148); 0.209% (95% CI: 0.186—0.232) in men; 0.065% (95% CI: 0.052—0.078) in women. The prevalence of sHTG was different across gender (P < 0.001) and the prevalence differed across age categories (Cochran Armitage P for trend < 0.001) with the highest (0.33%) prevalence in men aged 40—49 years; 0.08% of subjects younger than 30 years had sHTG. The characteristics of sHTG differed significantly (P < 0.001) across sHTG