Highlights
- •HeFH and CHL phenotype are common among patients with premature MI.
- •Among patients with early MI, HeFH has more atheromatous burden than CHL phenotype.
- •CHL phenotype is associated with more intense inflammation than HeFH.
- •There is significant overlapping in the clinical diagnosis of HeFH and CHL phenotype.
Background
Heterozygous familial hypercholesterolemia (HeFH) and combined hyperlipidemia (CHL)
phenotype are associated with premature myocardial infarction (MI).
Objective
To assess the prevalence of HeFH and CHL phenotype among young survivors of MI and
compare patients’ characteristics with these 2 lipid disorders.
Methods
We recruited 382 young survivors of MI (≤40 years). Fasting lipids, lipoprotein(a)
[Lp(a)], apolipoprotein A-1, and apolipoprotein B (apoB) levels were determined. Using
the Dutch Lipid Clinic Network (DLCN) algorithm, patients having definite or probable
HeFH were identified. Patients with apoB levels >120 mg/dL and triglyceride levels
>170 mg/dL (1.92 mmol/L) [>90th percentile of 326 age and sex-matched healthy controls]
were classified as having CHL phenotype. Common carotid artery intima-media thickness
(CCA-IMT) was measured by B-mode ultrasonography.
Results
Eighty-one patients (21.2%) had definite/probable HeFH and 62 (16.2%) had CHL phenotype.
Twenty-three patients fulfilled the criteria for both HeFH and CHL phenotype and were
removed from further comparisons. Patients with HeFH (n = 58) had higher levels of
total cholesterol, low-density lipoprotein (LDL)-cholesterol, Lp(a), and apoB, whereas
patients with CHL phenotype (n = 39) had higher levels of triglycerides and lower
high-density lipoprotein (HDL)-cholesterol levels. The prevalence of metabolic syndrome
was higher in patients with CHL phenotype compared to those with HeFH (67.0% vs 16.4%,
P < .001). Patients with HeFH had more extensive coronary artery disease (3-vessel
disease: 36.2% vs 12.8%, P = .011) and greater right CCA-IMT (0.67 ± 0.11 mm vs 0.56 ± 0.09 mm, P < .001) and left CCA-IMT (0.68 ± 0.10 mm vs 0.56 ± 0.08 mm, P < .001) compared to CHL phenotype patients.
Conclusions
Both HeFH and CHL phenotype are common among patients with premature MI. CHL phenotype
compared to HeFH is associated with less atheromatous burden in coronary and carotid
arteries at the time of first MI.
Keywords
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Article info
Publication history
Published online: March 11, 2019
Accepted:
February 25,
2019
Received:
October 3,
2018
Identification
Copyright
© 2019 National Lipid Association. All rights reserved.
