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RESEARCH PRODUCT

0133 : Identifying familial hypercholesterolemia from registries of patients with acute myocardial infarction: an algorithm-based approach

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Background and aim Familial hypercholesterolemia (FH) is at very high risk of early myocardial infarction (MI). The prevalence of FH, which is estimated to be at least 1:500 in the general population, remains unclear in patients with acute MI. From databases of 3 French regional and nationwide registries of acute MI (RICO and FAST-MI 2005 and 2010, respectively), we aimed to determine FH prevalence by developing a specific algorithm. Methods and results Consecutive patients with AMI ≤48 hours of onset included 1) in FAST-MI : during a one-month period in 223 institutions at the end of 2005 and 213 institutions at the end of 2010, and 2) in RICO :from January 2001 – December 2013 (≈ 13 y), were considered in the 3 databases. The algorithm was adapted from Dutch lipid clinic network criteria and was build upon 4 variables (i.e. LDL level and previous use of lipid lowering medications, premature and family history) to identify FH probability. The LDL level was adjusted on each type of lipid lowering medications and the probability of FH was defined taking into account missing data rate. Among the 7484 patients included in the RICO registry, 29.1% had premature vascular disease, 29.7% had familial history, 19.9% were under lipid lowering medications and 9.7% had LDL ≥5 mmol/L. FH prevalence was calculated as unlikely (72.6%), possible (24.6%) and probable /definite (2.8%). From the 1957 patients from FAST-MI 2005 with all data available, 29.7% had premature CV disease, 23% had a family history, 26.6% were on LLDs, and 5.4% had LDL ≥5 mmol/l. FH prevalence was calculated as unlikely (77.9%), possible (19.4%) and probable /definite (2.7%). In the 2223 patients from FASTMI 2010, 32.2% had premature CV disease, 24.9% had a family history, 28.1% were on LLDs, and 5.0% had LDL ≥5 mmol/l. FH prevalence was calculated as unlikely (75.7%), possible (21.5%) and probable /definite (2.7%). Conclusion Our 4-variable algorithm yielded concordant results to determine FH probability in 3 different cohorts of AMI patients. In this large population reflecting routine clinical practice in acute MI, a high prevalence of FH was found, suggesting the opportunity for prevention strategies. The author hereby declares no conflict of interest