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Current Guidelines Fail to Identify Young Adults at Risk for Early Heart Attack

CardioSmart News

We need better tools to identify young adults in need of cholesterol-lowering statins, based on a recent study that found that most patients experiencing a heart attack before the age of 50 aren’t considered for this life-saving therapy.

Published in the Journal of the American College of Cardiology, this study looked at how well statin guidelines perform when applied to young heart attack survivors.

Statins help lower cholesterol levels and drastically reduce risk for life-threatening heart events. In addition to being used in patients with high cholesterol, they’re recommended as a way to prevent heart events in patients at increased risk for heart disease.

However, guidelines fall short in identifying young adults who could benefit from treatment, as recent findings show.

This study analyzed data from the YOUNG-MI registry, which included 1,475 young adults who experienced heart attacks between 2000 and 2016. Participants were 50 years of age or younger at the time of their heart attack and were enrolled at two large medical centers in Boston, MA.

The median age of participants was 45 and 20% were women.

After analysis, researchers found that the average ten-year risk of developing heart disease was low—less than 5%—among participants. 83% had at least one cardiovascular risk factor, such as high blood pressure, diabetes, obesity and family history of heart disease.

Despite these risk factors, current guidelines would have done little to identify these young participants at risk for heart attack.

Current guidelines take into account factors like age, cholesterol, history of heart disease and ten-year risk for developing heart disease. People flagged as having increased risk based on these factors are recommended statins to help lower their risk of heart events.

But when researchers applied the criteria to young heart attack survivors, less than half qualified for taking statins before their heart event. Guidelines performed especially poor for women, as 63% of women in the study would not have qualified for statins based on current criteria.

What this shows, according to authors, is that existing criteria for statin eligibility performs poorly in young adults. Part of the problem, as experts explain, is that age plays a big role in cardiovascular risk calculations. Since ten-year risk for developing heart disease is largely dependent on age, calculations can underestimate cardiovascular risk in young adults. Many young adults with a low ten-year risk of heart disease won’t meet criteria for statin use.

What we need, according to authors, is a better way to assess both cardiovascular risk and the need for statins in young adults. Statins are an important therapy for helping patients reduce risk for heart events. It’s important that all patients, including young adults, receive therapy when needed to help prevent future events.

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