Key result
Prevention guidelines identify only ~49% of young adults as statin-eligible prior to first MI.
Why the study?
Despite progress in primary prevention, the rate of MI has not declined in young adults, motivating an evaluation of statin eligibility under 2013 ACC/AHA guidelines and 2016 USPSTF recommendations among adults experiencing a first-time MI at a young age.
Do the 2013 ACC/AHA and 2016 USPSTF primary prevention guidelines adequately identify young adults (age ≤50 years) for statin therapy prior to experiencing a first-time myocardial infarction?
Cohort (n=1,475)
Yes
Do the 2013 ACC/AHA and 2016 USPSTF primary prevention guidelines adequately identify young adults (age ≤50 years) for statin therapy prior to experiencing a first-time myocardial infarction?
This retrospective cohort study demonstrates that the majority of adults who experience a first-time MI at age ≤50 years—especially women—would not have met 2013 ACC/AHA or 2016 USPSTF guideline thresholds for primary prevention statin therapy prior to their event, highlighting the need for improved cardiovascular risk assessment tools in young adults.
Answers are grounded in this paper and cite their sources.
Guidelines miss most young adults before first MI, especially women; leaves open whether refined risk tools are needed.
BACKGROUND Despite significant progress in primary prevention, the rate of MI has not declined in young adults. OBJECTIVES The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age. METHODS The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation. RESULTS Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001). CONCLUSIONS The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.
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Singh et al. (2017) conducted a cohort in First-time type 1 myocardial infarction at age ≤50 years (n=1,475). 2013 ACC/AHA blood cholesterol guidelines for primary prevention statin eligibility vs. 2016 USPSTF recommendations for primary prevention statin use was evaluated on Pre-MI statin eligibility (statin recommended or considered). Guideline-based criteria identified only 49% (2013 ACC/AHA) and 29% (2016 USPSTF) of young adults as statin-eligible prior to their first myocardial infarction.
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