Non-HDL Cholesterol is predictive of diffusion of coronary artery disease in young patients presenting with a myocardial infarction

Abstract

Long-term prognosis of myocardial infarction (MI) in young patients is highly pejorative even in non-diabetics or those with preserved left ventricular function. Nevertheless incidence of their admission for MI remained stable suggesting the need for an improvement of preventive strategies and detection of specific risk factors. Consecutive patients ≤ 45 years with a first acute myocardial infarction with (STEMI) or without (NSTEMI) ST elevation and a coronary angiography (angio) performed where included in this study. A post-hoc analysis of angio determined for each a coronary score (score) to reflect extent of coronary atherosclerosis (CAD). Hundred and forty patients where included,113 male (81%), mean age 38 ± 5 years,73 with STEMI (52%). Risk factors were tobacco smoking in 116 (84%), HTN in 18 (13%), diabetes in 21 (15%), family history in 32 (23%) and dyslipidemia in 98 (71%) with no difference between sex. The score was 2.69 ± 1,83 (0–9) not significantly different between STEMI and NSTEMI, higher in male (2.98 ± 1.8 vs. 1.8 ± 1.6; P < 001) and in older ≥ 40 years (3.1 ± 2 vs. 2.3 ± 1.6; P = 0.01). In 85 patients (61%) the score was ≥ 2. In this sub-group (S2) fasting glycaemia was significantly higher (1.1 ± 0.42 g/L vs. 0.94 ± 0.2 g/L; P = 0.008), as well as systolic (147 ± 28 vs. 135 ± 22 mmHg; P = 0.01) or diastolic (90 ± 17 vs. 84 ± 17 mmHg; P = 0.03) blood pressure (BP), non-HDL Cholesterol (1.74 ± 0.62 vs. 1.1.35 ± 0.33) but not HDL Cholesterol. After adjustment with age, gender, BMI, BP and glycaemia, non-HDL Cholesterol was predictive of a higher score (OR = 1.67; P < 0.0001). CAD is already diffused in a majority of young patients with a first MI. Non-HDL Cholesterol is associated with extension of CAD. Prevention should not forget this metabolic risk factor.