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Myocardial Infarction in Young Adults With Low-Density Lipoprotein Cholesterol Levels 100 mg/dL^*

Clinical Profile and 1-Year Outcomes

^* From the Gundersen Lutheran Medical Center, La Crosse, WI.

Correspondence to: Kwame O. Akosah, MD, Gundersen Lutheran Medical Center, 1836 South Ave, La Crosse, WI 54601; e-mail: kakosah{at}gundluth.org

Study objectives: To define the clinical profile of young adults with optimal low-density lipoprotein (LDL) cholesterol levels who present with acute myocardial infarctions (MIs); to compare and contrast differences in the clinical profiles of young adults admitted to the hospital with MIs who have LDL cholesterol levels 100 mg/dL and those with LDL cholesterol values 160 mg/dL; and to evaluate the clinical outcomes for the two groups at 1 year.

Design: A retrospective chart review was conducted on all young men (55 years) and women (65 years) admitted to the hospital for MIs within a 2-year period (n = 232). A history of cardiovascular risk factors and 1-year outcomes were obtained.

Setting: Rural community medical center serving a tri-state area in the midwestern United States.

Patients: Patients were included in this analysis if (1) a lipid profile was drawn within 24 h of hospital admission and (2) the patient was not receiving a statin medication on hospital admission.

Measurements and results: Of the 183 patients who met the inclusion criteria, as many as 68% (124 patients) had LDL cholesterol levels of 130 mg/dL, 29% (53 patients) had LDL cholesterol level of 100 mg/dL, and only 14% (26 patients) had LDL cholesterol levels of 160 mg/dL. Patients were categorized into group 1 if their LDL cholesterol level was 100 mg/dL and were categorized into group 2 if their LDL cholesterol level was 160 mg/dL. In group 2, 92% of patients were placed on a statin medication. By 1 year, the mean LDL cholesterol level had decreased from 188 to 106 mg/dL. The rate of coronary artery bypass graft and percutaneous coronary intervention procedures was similar between groups. Hospital readmission rates (43.4% vs 50%, respectively) and 1-year mortality rates (9% vs 8%, respectively) were not different between groups group 1 and 2.

Conclusions: Young adults experiencing acute MIs typically have acceptable cholesterol levels (ie, 130 mg/dL) or optimal values (ie, 100 mg/dL). In those patients with abnormal cholesterol levels, a combined strategy of aggressive intervention and adherence to secondary prevention protocols including lipid control is successful in improving outcomes.

Key Words: low-density lipoprotein cholesterol • myocardial infarction • premature coronary artery disease

This article has been cited by other articles:

				K. O. Akosah, A. Schaper, C. Cogbill, and P. Schoenfeld Preventing myocardial infarction in the young adult in the first place: how do the national cholesterol education panel iii guidelines perform? J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1475 - 1479. [Abstract] [Full Text] [PDF]

				B. M. RuDusky and K. O. Akosan Myocardial Infarction in the Very Young Chest, September 1, 2002; 122(3): 1099 - 1100. [Full Text] [PDF]