Effects of Familial Hypercholesterolemia on Major Adverse Cardiac and Cerebrovascular Events in Patients with Premature Coronary Artery Disease: A Retrospective Cohort Study

Background: Evaluating the impact of familial hypercholesterolemia (FH) on the occurrence of major adverse cardiac and cerebrovascular events (MACCE) in patients with premature coronary artery disease. Methods: This retrospective cohort study was conducted at Tehran Heart Center, between 2004 and 2011. 3907 patients with acute coronary syndrome (ACS) who underwent coronary angiography were collected from registry systems. The patients were divided into "Unlikely FH" and "Probable FH" using a modified and simplified version of the Dutch Lipid Clinic Network (DLCN) criteria. After a 10-year follow-up, different components of MACCE between the two groups were evaluated. Results: Data from 3206 premature coronary artery disease patients with baseline LDL values were extracted. 2558 (79.8%) patients were categorized into the Unlikely FH group, and 648 (20.2%) patients were in the probable FH group. In the unlikely FH group, 745 (29.1%) patients experienced at least one of the MACCE events. In the probable FH group, 193 (29.7%) experienced at least one MACCE event. The difference between groups did not reach the level of significance (p>0.05). The mortality rate in the unlikely FH group was 6.9% (n=179), while in the probable FH group, the mortality rate was 7.8% (n=51) (p<0.05). Conclusions: In the present study, patients with probable FH pose a higher risk regarding mortality than unlikely FH patients.