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European Heart Journal Advance Access published online on March 10, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp051
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Familial-combined hyperlipidaemia in very young myocardial infarction survivors (≤40 years of age)

Franz Wiesbauer1,*, Hermann Blessberger1, Danyel Azar1, Georg Goliasch1, Oswald Wagner2, Lukas Gerhold3, Kurt Huber8, Kurt Widhalm4, Farshid Abdolvahab5, Gottfried Sodeck6, Gerald Maurer1 and Martin Schillinger7

1 Department of Cardiology, Vienna General Hospital/Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria
2 Department of Laboratory Medicine, Vienna General Hospital/Medical University of Vienna, Vienna, Austria
3 Core Unit for Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria
4 Department of Pediatrics, Vienna General Hospital/Medical University of Vienna, Vienna, Austria
5 Department of Orthopaedic Surgery, Vienna General Hospital/Medical University of Vienna, Vienna, Austria
6 Department of Emergency Medicine, Vienna General Hospital/Medical University of Vienna, Vienna, Austria
7 Department of Angiology, Vienna General Hospital/Medical University of Vienna, Vienna, Austria
8 Wilhelminen Hospital Vienna, Vienna, Austria

Received 25 August 2008; revised 15 December 2008; accepted 22 January 2009 * Corresponding author. Tel: +43 1 40400 4614, Fax: +43 1 40400 4216. Email: franz.wiesbauer{at}meduniwien.ac.at

Aims: Myocardial infarction (MI) in very young individuals is a rare disease associated with an unfavourable prognosis. Familial-combined hyperlipidaemia (FCHL) increases the risk for MI in individuals below 60 years; however, its role in very young MI patients below 40 years is not as well established. We investigated the prevalence and impact of FCHL in these very young MI patients.

Methods and results: We prospectively enrolled 102 consecutive MI survivors (≤40 years) from two high-volume cardiac catheterization centres. Patients were frequency-matched for age, gender, and centre to 200 hospital controls free from coronary heart disease. Myocardial infarction patients were invited to send family members for FCHL screening. Overall, 37 families were screened. Familial-combined hyperlipidaemia was diagnosed using a nomogram, which takes into account total cholesterol, triglycerides, and Apo B100 levels. Thirty-eight acute myocardial infarction (AMI) patients (38%) and five controls (2.5%) displayed the FCHL phenotype, 21 of these MI patients sent family members for screening, and FCHL was confirmed in 16 families (76%). The FCHL phenotype was associated with a 24-fold increased adjusted risk for MI (95% CI 7.5–81, P < 0.001). Of all lipid parameters, VLDL-cholesterol, and non-HDL-cholesterol were most strongly associated with MI.

Conclusions: The present study suggests that the FCHL phenotype seems to be a major risk factor for the occurrence of MI at a very young age. It remains to be determined whether this excessively increased risk can be favourably modified by therapeutic interventions.

Key Words: Premature myocardial infarction • Hyperlipoproteinaemia • Familial combined hyperlipidaemia


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