Impact of age on excess risk of coronary heart disease in patients with familial hypercholesterolaemia

• Published in: Heart (British Cardiac Society) Vol. 104; no. 19; pp. 1600 - 1607
• Main Authors: Mundal, Liv J, Igland, Jannicke, Veierød, Marit B, Holven, Kirsten Bjørklund, Ose, Leiv, Selmer, Randi Marie, Wisloff, Torbjorn, Kristiansen, Ivar S, Tell, Grethe S, Leren, Trond P, Retterstøl, Kjetil
• Format: Journal Article
• Language: English; Norwegian
• Published: England BMJ Publishing Group LTD 01.10.2018; BMJ Publishing Group
• Series: Original research article
• Subjects: Adult; Age Factors; Aged; Cardiovascular disease; Coronary Artery Disease; Coronary Disease - epidemiology; Female; Health risk assessment; Hospitalization - statistics & numerical data; Humans; Hyperlipoproteinemia Type II - diagnosis; Hyperlipoproteinemia Type II - epidemiology; Incidence; Low density lipoprotein; Male; Middle Aged; Mortality; Norway - epidemiology; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Norway; coronary artery disease; genetics; cardiac risk factors and prevention; lipoproteins and hyperlipidemia; acute myocardial infarction
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2017-312706

ObjectiveThe primary objective was to study the risk of acute myocardial infarction (AMI) and coronary heart disease (CHD) in patients with familial hypercholesterolaemia (FH) and compare with the risk in the general population.MethodsPatients with an FH mutation but without prior AMI (n=3071) and without prior CHD (n=2795) were included in the study sample during 2001–2009. We obtained data on all AMI and CHD hospitalisations in Norway. We defined incident cases as first time hospitalisation or out-of-hospital death due to AMI or CHD. We estimated standardised incidence ratios (SIRs) with 95% CIs with indirect standardisation using incidence rates for the total Norwegian population stratified by sex, calendar year and 1 year age groups as reference rates.ResultsSIRs for AMI (95% CIs) were highest in the age group 25–39 years; 7.5 (3.7 to 14.9) in men and 13.6 (5.1 to 36.2) in women and decreased with age to 0.9 (0.4 to 2.1) in men and 1.8 (0.9 to 3.7) in women aged 70–79 years. Similarly, SIRs for CHD were highest among patients 25–39 years old; 11.1 (7.1–17.5) in men and 17.3 (9.6–31.2) in women and decreased 2.4 (1.4–4.2) in men and 3.2 (1.5–7.2) in women at age 70–79. For all age groups, combined SIRs for CHD were 4.2 (3.6–5.0) in men and 4.7 (3.9–5.7) in women.ConclusionPatients with FH are at severely increased risk of AMI and CHD compared with the general population. The highest excess risk was in the youngest group aged 25–39 years, in both sexes.