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Lipid profile and long‐term outcome in premature myocardial infarction
Author(s) -
Winter MaxPaul,
Wiesbauer Franz,
Blessberger Hermann,
Pavo Noemi,
Sulzgruber Patrick,
Huber Kurt,
Wojta Johann,
Distelmaier Klaus,
Lang Irene M.,
Goliasch Georg
Publication year - 2018
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13008
Subject(s) - myocardial infarction , medicine , mace , prospective cohort study , cholesterol , cardiology , coronary artery disease , lipid profile , lipoprotein , triglyceride , percutaneous coronary intervention
Background Premature myocardial infarction (≤40 years) represents a rare disease with a distinct risk factor profile and a lipid phenotype that is characterized by a predominance of elevated triglyceride‐rich lipoproteins. So far high‐density and low‐density lipoproteins remain the primary targets for risk stratification and treatment evaluation in coronary artery disease, but this strategy might be insensitive in patients with premature myocardial infarction. Aim Aim of this study was to investigate the predictive value of different lipid fractions on long‐term cardiovascular outcome in patients with premature myocardial infarction. Methods We prospectively enrolled 102 consecutive AMI survivors (≤40 years) in this prospective multicentre study and investigated the influence of the familial combined hypercholesterolaemia phenotype and a corresponding multimarker panel of different lipid fractions on cardiovascular outcome. Results Total cholesterol, non‐ HDL cholesterol, remnant cholesterol and Apo B lipoprotein were significantly higher in patients experiencing MACE as compared to those who did not. The familial combined hypercholesterolaemia phenotype was associated with an unfavourable cardiovascular outcome even after adjustment for potential cofounders (adjusted HR 3.04,95% CI , 1.26‐7.34, P = 0.013). Remnant cholesterol revealed the strongest association with MACE (adj. HR 1.94, 95% CI . 1.30‐2.99, P = 0.001). Interestingly LDL and HDL revealed no significant impact on cardiovascular outcome in this study cohort. Conclusion Non‐ HDL and remnant cholesterol are strongly associated with an unfavourable outcome in patients with premature myocardial infarction and might be the preferred treatment target for lipid‐lowering therapy.