RESUMO
AIMS: Familial hypercholesterolemia (FH) is a common genetic disorder causing accelerated atherosclerosis and premature cardiovascular disease. The aim of this study was to examine the prevalence and prognostic significance of possible FH in patients with myocardial infarction (MI). METHODS AND RESULTS: By individual-level linkage of data from the Eastern Danish Heart Registry and national administrative registries, a study population of patients referred for coronary angiography due to MI was selected. The study population was divided into "unlikely FH" and "possible FH" based on the Dutch Lipid Clinic Network criteria, which included a plasma low-density lipoprotein cholesterol (LDL-C) and age for onset of cardiac disease. A score of ≥3 points was used as the cutpoint between the 2 groups. Among the study population of 13,174 MI patients, 1,281 (9.7%) had possible FH. These patients were younger (59.1 vs 65.7 years, P ≤ .0001), had similar levels of comorbidities, and were treated more aggressively with cholesterol-lowering drugs compared with patients with unlikely FH. During a median of 3.3 years of follow-up, the unadjusted and adjusted event rates of recurrent MI were higher in patients with possible FH compared with unlikely FH (16% vs 11%, adjusted hazard ratio 1.28, 95% CI 1.09-1.51, P = .003.). Differences in adjusted all-cause mortality were not statistically significant (17% vs 23%, adjusted hazard ratio 0.89 [0.74-1.04], P = .1). CONCLUSION: We found that MI patients with possible FH have higher risk of recurrent MI but similar risk of mortality compared with unlikely FH patients. Further studies on secondary prevention are warranted.
Assuntos
Hiperlipoproteinemia Tipo II/epidemiologia , Mortalidade , Infarto do Miocárdio/epidemiologia , Sistema de Registros , Fatores Etários , Idoso , Anticolesterolemiantes/uso terapêutico , Causas de Morte , LDL-Colesterol/sangue , Comorbidade , Dinamarca/epidemiologia , Feminino , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , RecidivaRESUMO
BACKGROUND: The association between low bone mineral density (BMD) and the presence of coronary artery calcium (CAC) as a marker of atherosclerosis is unclear. The aim of this study was to assess the potential relationship between volumetric thoracic bone mineral density and coronary calcification in a large population of men and women. METHODS: Participants from the Copenhagen General Population Study underwent multidetector computed tomography. Volumetric thoracic BMD and CAC were assessed in the same scan. CAC was measured using calibrated mass score (cMS). cMS was dichotomized as cMSâ¯=â¯0 or cMSâ¯>â¯0. The association between BMD and cMS was analyzed using multiple logistic regression in men, premenopausal and postmenopausal women. The model was adjusted for age, BMI, hypertension, hypercholesterolemia, diabetes, known cardiovascular disease and smoking. RESULTS: Of 2548 eligible participants, 1163 men and 1385 women, mean age 61⯱â¯10 were included in the study. Mean BMD was 138⯱â¯46â¯mg/cm3 for men and 151⯱â¯49â¯mg/cm3 women. In 696 men (67%) and 537 women (41%) cMS was found to be above zero. For men, a decrease in BMD of 100â¯mg/cm3 was associated to an odds ratio of 1.49 for cMSâ¯>â¯0 (95% confidence interval: 1.04-2.13, Pâ¯=â¯0.03). In postmenopausal women, a decrease in BMD of 100â¯mg/cm3 was associated to an odds ratio of 1.47 for MSâ¯>â¯0 (95% confidence interval: 1.04-2.08, Pâ¯=â¯0.03). For premenopausal women, no significant association was found between BMD and cMS (odds ratioâ¯=â¯0.74, 95% confidence interval: 0.36-1.52, Pâ¯=â¯0.4). CONCLUSION: Bone mineral density and coronary calcification are inversely related in both men and postmenopausal women, supporting the hypothesis that a direct relation between bone loss and development of atherosclerosis exists irrespective of gender.