COVID-19 associated risks of myocardial infarction in persons with familial hypercholesterolemia with or without ASCVD

Cardiovascular disease (CVD), hypertension, and heart failure are associated with higher rates of coronavirus disease 2019 (COVID-19) related morbidity and mortality [ 1 , 2 ].However, studies have documented fewer individuals presenting to hospitals with acute myocardial infarction (AMI) during the pandemic [ 3 , 4 ].To better understand the impact of COVID-19 on AMI rates in individuals with pre-existing atherosclerotic cardiovascular disease (ASCVD), familial hypercholesterolemia (FH), or both, the FH Foundation performed an analysis in a large longitudinal national database.Data secured from Symphony Health (Blue Bell, PA) consisted of laboratory data and diagnostic, procedural, and prescription claims covering May 1, 2012 through June 30, 2020 ( n = 301,628,074 individuals).This dataset includes all available healthcare encounter data on individuals who are being evaluated or treated for CVD.While the dataset spans 8 years, coverage for each unique individual does not necessarily span the full window.All data were anonymized thus neither informed consent nor IRB approval was necessary.Patients in the study were limited to those ≥ 18 years old, with valid demographic data (age/sex), and with at least one record within both the 'covariates window' and the 'exposure window' ('covariates window': dates prior to the COVID-19 'exposure window', March 1 -June 30).Individuals who qualified ( n = 55,441,462) were further divided into six study groups by combinations of the presence or lack of comorbidities within the covariates window: diagnosed ASCVD, diagnosed FH, probable FH (identified by the FIND FH® machine learning model [5] since 90% of Americans with FH have yet to be diagnosed [6] ), or none of the above ( Table 1 ).Each individual is included in only one of the six groups.We analyzed rates of AMI in all six groups by history of COVID-19 status.Individuals with COVID-19 were identified by the U07.1 ICD-10 code within the exposure window.For individuals with a COVID-19 diagnosis, days of risk in the study started counting 14 days prior to first date of U07.1 coding, reflecting CDC guidance on the average time between exposure and diagnosis.For individuals without a COVID-19 diagnosis, days of risk in the study started counting on March 1, 2020.