The lipid profile of the young patient with ischemic heart disease. Do these patients meet the goals?

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Virgen Macarena Introduction Ischemic heart disease is becoming increasingly common in young individuals, with dyslipidemia being an important risk factor for developing acute coronary syndrome (ACS). Recently, new analytical parameters of the lipid profile have been described, which are associated with a higher cardiovascular risk. Purpose The aim of the study was to analyse characteristics, lipid profile and, whether LDL goals are achieved in young patients with ACS admitted to our Coronary Care Unit (CCU). Methods Retrospective cohort of all patients with ACS minor than 45 years admitted to a CCU between January 2010 and February 2023. The LDL goals were established according to the European clinical practice guidelines (<70 mg/dL or <55 mg/dL after 2019). Results A total of 287 patients were included, with 82.6% being male and an average age of 41 years. 77% were smokers and 9% were ex-smokers. The prevalence of classic cardiovascular risk factors at admission was as follows: dyslipidemia 105 (37%), overweight 74 (26%), obesity 70 (25%), hypertension 87 (30%), and diabetes 29 (10%). Lipid profile’s results are showed in picture 1. Smoking, gender, as well as obesity or overweight were not significantly associated with a worse lipid profile. Significant differences were also not found based on the extent of coronary involvement (analyzing the number of affected vessels or the presence of coronary occlusion) or the reason for admission (NSTEMI vs. STEMI). As for secondary prevention, 70% of patients completed the cardiac rehabilitation program. The percentage of patients who achieved the LDL goal was 62.4% at 6 months (with an average of 61 mg/dL) and 52.4% at one year (with an average of 72 mg/dL). The majority of patients (74%) who did not meet the goals at 6 months still did not achieve them at one year. A higher initial LDL-C level was associated with a lower likelihood of achieving the goals at 6 months and one year, although it did not reach statistical significance at one year (p = 0.05 and 0.08, respectively). No other predictors of success were found, although participation in a Cardiac Rehabilitation Program was associated with a non-significant trend towards goal attainment, likely due to the small sample size (45% vs. 65%, p = 0.09). Conclusion Young patients with ACS have a good short-term and long-term prognosis, which is why secondary prevention becomes particularly important. However, a significant percentage of patients still do not achieve the recommended LDL-C goals, leaving room for improvement in reducing morbidity and mortality in this population. Larger patient series are needed to gain a better understanding of this population.Table 1.Lipid profile'sLDL and Lipoprotein (a) at admission