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Jun 19, 2019

Cholesterol Disorder Overlooked in Many Young Heart Attack Patients

Familial hypercholesterolemia is overlooked and undertreated.

One in ten young heart attack survivors have a dangerous cholesterol disorder, yet few are properly treated, finds a recent study of familial hypercholesterolemia. Findings were published in the Journal of the American College of Cardiology and stress the importance of early diagnosis and treatment of this common yet under-recognized condition.

Known as the YOUNG-MI registry, this study followed 1,996 adults who experienced a heart attack before the age of 50. Participants were treated at two academic centers in Boston, MA, between 2000 and 2016 and were followed for one year.

The study was designed to look at a range of risk factors, symptoms and outcomes in this population. The recent analysis, however, looked only at the role of familial hypercholesterolemia—a dangerous genetic cholesterol disorder—in young heart attack survivors.

Familial hypercholesterolemia, often referred to as FH, is a genetic condition that causes dangerously high cholesterol levels beginning at birth. FH increases risk for heart disease and life-threatening heart events, especially at a young age.

In the recent study, experts looked at how common the condition is among young heart attack survivors. Researchers also looked into the diagnosis and treatment of FH in patients after a heart event.

Unfortunately, findings are less than promising.

Based on a review of blood tests, exams and medical histories, researchers estimate that 9% of participants had either probable or definite FH. Of those, less than half were on statins, which are the first line of treatment for cholesterol disorders.

After tracking participants for a year after their heart attack, researchers found that around 90% of all patients were prescribed statins. However, only two-thirds of patients with FH were prescribed high-intensity statins, which are strongly recommended for high-risk patients. As a result, patients with FH were significantly more likely to still have elevated cholesterol levels despite treatment after one year.

What findings show, according to authors, is that FH is common yet underdiagnosed and undertreated. As a result, it could be to blame for many heart attacks in young adults

It’s estimated that FH is relatively common and affects an estimated 1 in 250 Americans. However, FH affected nearly one in ten participants in this study. Very few were treated with statins before their heart attack, suggesting the condition went undiagnosed and untreated. Even after experiencing a heart attack, only two-thirds received ideal treatment to reduce risk for a second event.

According to authors, findings highlight the need for better diagnosis and treatment of FH. When treated early, FH can be closely managed and risk for complications can be reduced. Left undiagnosed, it can lead to heart attacks—especially early in life—as this study shows.

Questions for You to Consider

  • What are symptoms of familial hypercholesterolemia (FH)?
  • Symptoms of FH include fatty skin deposits on or around the hands, elbows, knees, ankles and the eyes, and cholesterol deposits on the eyelids. Individuals with FH may also experience chest pain or other signs of heart disease, even at a young age.
  • How is familial hypercholesterolemia (FH) diagnosed?
  • FH is typically diagnosed through blood tests that measure cholesterol levels, a physical examination and a review of family medical history. Genetic tests may also be used to diagnose FH. Once FH is diagnosed, the goal of treatment is to reduce the risk of heart disease.

Infographic: FH

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Infographic: Cholesterol