Cardiovascular Risk and Guideline-Directed Therapy for Risk Reduction Among Young Adults With Myocardial Infarction

Abstract

Background: Despite significant progress in primary prevention, the rate of MI has not declined in young adults. Objectives: We aimed to evaluate statin eligibility based on the 2013 American College of Cardiology / American Heart Association (ACC/AHA) guidelines for treatment of blood cholesterol and 2016 United States Preventive Services Task Force (USPSTF) recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age. Methods: The YOUNG-MI registry is a retrospective cohort study from two large academic centers which includes patients who experienced an MI at 50 years of age or younger. Diagnosis of Type 1-MI was adjudicated by study physicians. Pooled cohort risk equations (PCE) were used to estimate atherosclerotic cardiovascular disease (ASCVD) risk score based on data available prior to MI or at the time of presentation. Results: Of 1685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had STEMI. At least one cardiovascular risk factor was present in 1225 (83%) patients. The median 10-year ASCVD risk score of the cohort was 4.8% (interquartile range: 2.8, 8.0). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 ACC/AHA guidelines and 2016 USPSTF recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) of men (p<0.001). Conclusions: The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.