Evaluation of Clinical Features including the frequency of Familial Hypercholesterolemia, and 2-Year Cardiovascular Outcomes in Patients with Early Acute Coronary Syndrome: Real-Life Data from a Retrospective Cohort

Familial Hypercholesterolemia in patients with early ACS

Meral Kayikcioglu
Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey
Bahadir Alan
Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey
Burcu Yağmur
Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey


Objective: This retrospective study, based on real-life data, aimed to evaluate the clinical characteristics and 2-year cardiovascular outcomes in patients presenting with early acute coronary syndrome (ACS) in a tertiary healthcare center.
Methods: Information including at least 2-year endpoint data after index ACS event was retrieved from hospital records. Age limit for early ACS was considered <55 years for males and <60 years for females.
Results: Of 985 consecutive ACS patients (770 males; age range, 21-93 years) 361 (36.6%) met early ACS  criteria. Frequency familial hypercholesterolemia (FH) was 7.6% and higher in the young-age group (15.5%) than in the old-age group (3%) (p<0.001). During the follow-up (30 monts), the risk predictors for cardiovascular events were the index event being ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction and the presence of hypertension, and the risk predictors for mortality were female sex, older age, in-hospital cardiovascular complications.
Conclusion: A very high rate of early ACS (36.6%) was observed in this retrospective ACS cohort of a single center from Turkey. Compared to older patients, young patients were more smoking, more obese, less diabetic, and less hypertensive. High total cholesterol, high triglycerides, low HDL-cholesterol levels, high non-HDL cholesterol, family history of CAD, and FH were also more commonly observed in the young group. High FH prevalence might be a major factor of the high prevalence of premature ACS in this population. Both the in-hospital and 2-year follow-up mortality rates were significantly lower in the old-age group.


  1. Kayikcioglu M, Tetik Vardarli A. How to Generate Unbiased Data in Molecular Genetic Studies in Patients with Early Onset Coronary Artery Disease or Premature Myocardial Infarction? Turk Kardiyol Dern Arsivi-Archives Turkish Soc Cardiol. 2022 Sep 2;50(6):404–6. http://doi.org/10.5543/tkda.2022.22586
  2. Kayikcioglu M, Ozkan HS, Yagmur B. Premature Myocardial Infarction: A Rising Threat. Balkan Med J. 2022;39(2):83–95. http://doi.org/10.4274/balkanmedj.galenos.2022-2-19
  3. Rallidis LS, Kosmas N, Tsirebolos G, Rallidi M, Kiouri E, Kalpakos D. Prevalence of heterozygous familial hypercholesterolemia and combined hyperlipidemia phenotype in very young survivors of myocardial infarction and their association with the severity of atheromatous burden. J Clin Lipidol. 2019 May;13(3):502–8. http://doi.org/10.1016/j.jacl.2019.02.007
  4. Tokgozoglu L. EUROASPIRE-IV: Study of the European Society of Cardiology on Lifestyle, Risk Factors, and Treatment Approaches in Patients with Coronary Artery Disease: Data from Turkey. Turk Kardiyol Dern Arsivi-Archives Turkish Soc Cardiol. 2016; http://doi.org/10.5543/tkda.2016.82352
  5. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018 Nov 13;138(20). http://doi.org/10.1161/CIR.0000000000000617
  6. Austin MA, Hutter CM, Zimmern RL, Humphries SE. Genetic causes of monogenic heterozygous familial hypercholesterolemia: a HuGE prevalence review. Am J Epidemiol. 2004 Sep 1;160(5):407–20. http://doi.org/10.1093/aje/kwh236
  7. Haase A, Goldberg AC. Identification of people with heterozygous familial hypercholesterolemia. Curr Opin Lipidol. 2012 Aug;23(4):282–9. http://doi.org/10.1097/MOL.0b013e3283556c33
  8. Nordestgaard BG, Chapman MJ, Humphries SE, Ginsberg HN, Masana L, Descamps OS, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: Consensus Statement of the European Atherosclerosis Society. Eur Heart J. 2013 Dec 1;34(45):3478–90. http://doi.org/10.1093/eurheartj/eht273
  9. De Backer G, Besseling J, Chapman J, Hovingh GK, Kastelein JJP, Kotseva K, et al. Prevalence and management of familial hypercholesterolaemia in coronary patients: An analysis of EUROASPIRE IV, a study of the European Society of Cardiology. Atherosclerosis. 2015 Jul;241(1):169–75. http://doi.org/10.1016/j.atherosclerosis.2015.04.809
  10. Besseling J, Kindt I, Hof M, Kastelein JJP, Hutten BA, Hovingh GK. Severe heterozygous familial hypercholesterolemia and risk for cardiovascular disease: a study of a cohort of 14,000 mutation carriers. Atherosclerosis. 2014 Mar;233(1):219–23. http://doi.org/10.1016/j.atherosclerosis.2013.12.020
  11. Ertaş FS, Tokgözoğlu L, EPICOR Study Group. Pre- and in-hospital antithrombotic management patterns and in-hospital outcomes in patients with acute coronary syndrome: data from the Turkish arm of the EPICOR study. Anatol J Cardiol. 2016 Dec;16(12):900–15. http://doi.org/10.14744/AnatolJCardiol.2016.6755
  12. Enar R. TUMAR Akut Miyokard İnfarktüsü. 1st ed. Istanbul; 2004.
  13. Erol MK, Kayıkçıoğlu M, Kılıçkap M, Arın CB, Kurt İH, Aktaş İ, et al. Baseline clinical characteristics and patient profile of the TURKMI registry: Results of a nation-wide acute myocardial infarction registry in Turkey. Anatol J Cardiol. 2020;24(1):43–53. http://doi.org/10.14744/AnatolJCardiol.2020.69696
  14. Tokgözoǧlu L, Kaya EB, Erol Ç, Ergene O, Aydoǧdu S, Tekin M, et al. EUROASPIRE III: A comparison between Turkey and Europe | EUROASPIRE III: Türkiye ile Avrupa’nin karşilaştirilmasi. Turk Kardiyol Dern Ars. 2010;38(3). https://archivestsc.com/jvi.aspx?un=TKDA-19942&volume=38&issue=3
  15. Hirota Y, Sawano M, Numasawa Y, Ueda I, Noma S, Suzuki M, et al. Characteristics and in-hospital outcomes in young patients presenting with acute coronary syndrome treated by percutaneous coronary intervention. Cardiovasc Interv Ther. 2018 Apr 5;33(2):154–62. http://doi.org/10.1007/s12928-017-0471-z
  16. Matsis K, Holley A, Al-Sinan A, Matsis P, Larsen PD, Harding SA. Differing Clinical Characteristics Between Young and Older Patients Presenting with Myocardial Infarction. Heart Lung Circ. 2017 Jun;26(6):566–71. http://doi.org/10.1016/j.hlc.2016.09.007
  17. Kawamoto KR, Davis MB, Duvernoy CS. Acute Coronary Syndromes: Differences in Men and Women. Curr Atheroscler Rep. 2016 Dec;18(12):73. http://doi.org/10.1007/s11883-016-0629-7
  18. Erol MK, Kayıkçıoğlu M, Kılıçkap M. Rationale and design of the Turkish acute myocardial infarction registry: The Turkmi study. Anatol J Cardiol. 2020;23(3):169–75. http://doi.org/10.14744/AnatolJCardiol.2019.57522
  19. Kilickap M, Erol MK, Kayikcioglu M, Kocayigit I, Gitmez M, Can V, et al. Short and Midterm Outcomes in Patients With Acute Myocardial Infarction: Results of the Nationwide TURKMI Registry. Angiology. 2021;72(4):339–47. http://doi.org/10.1177/0003319720975302
  20. Chan MY, Du X, Eccleston D, Ma C, Mohanan PP, Ogita M, et al. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol. 2016 Jan 1;202:861–9. http://doi.org/10.1016/j.ijcard.2015.04.073
  21. Gabet A, Danchin N, Juillière Y, Olié V. Acute coronary syndrome in women: rising hospitalizations in middle-aged French women, 2004-14. Eur Heart J. 2017 Apr 7;38(14):1060–5. http://doi.org/10.1093/eurheartj/ehx097
  22. Casula M, Catapano AL, Rossi Bernardi L, Visconti M, Aronica A. Detection of familial hypercholesterolemia in patients from a general practice database. Atheroscler Suppl. 2017 Oct;29:25–30. http://doi.org/10.1016/j.atherosclerosissup.2017.07.004
  23. Zamora A, Masana L, Comas-Cufí M, Vila À, Plana N, García-Gil M, et al. Familial hypercholesterolemia in a European Mediterranean population-Prevalence and clinical data from 2.5 million primary care patients. J Clin Lipidol. 2017;11(4):1013–22. http://doi.org/10.1016/j.jacl.2017.05.012
  24. Faggiano P, Pirillo A, Griffo R, Ambrosetti M, Pedretti R, Scorcu G, et al. Prevalence and management of familial hypercholesterolemia in patients with coronary artery disease: The heredity survey. Int J Cardiol. 2018 Feb 1;252:193–8. http://doi.org/10.1016/j.ijcard.2017.10.105
  25. Gencer B, Nanchen D. Identifying familial hypercholesterolemia in acute coronary syndrome. Curr Opin Lipidol. 2016 Aug;27(4):375–81. http://doi.org/10.1097/MOL.0000000000000311
  26. Kayikçioǧlu M, Uzun HG, Vardarli AT, Tokgözoǧlu L. Monozygotic twins with familial hypercholesterolemia and high lipoprotein(a) levels leading to identical cardiovascular outcomes: Case report and review of the literature. Turk Kardiyol Dern Ars. 2020;48(5):531–8. http://doi.org/10.5543/tkda.2020.62185
  27. Nanchen D, Gencer B, Muller O, Auer R, Aghlmandi S, Heg D, et al. Prognosis of Patients With Familial Hypercholesterolemia After Acute Coronary Syndromes. Circulation. 2016 Sep 6;134(10):698–709. http://doi.org/10.1161/CIRCULATIONAHA.116.023007
  28. Li S, Zhang Y, Zhu CG, Guo YL, Wu NQ, Gao Y, et al. Identification of familial hypercholesterolemia in patients with myocardial infarction: A Chinese cohort study. J Clin Lipidol. 2016;10(6):1344–52. http://doi.org/10.1016/j.jacl.2016.08.013
  29. Mortensen MB, Kulenovic I, Klausen IC, Falk E. Familial hypercholesterolemia among unselected contemporary patients presenting with first myocardial infarction: Prevalence, risk factor burden, and impact on age at presentation. J Clin Lipidol. 2016;10(5):1145-1152.e1. http://doi.org/10.1016/j.jacl.2016.06.002
  30. Pang J, Poulter EB, Bell DA, Bates TR, Jefferson VL, Hillis GS, et al. Frequency of familial hypercholesterolemia in patients with early-onset coronary artery disease admitted to a coronary care unit. J Clin Lipidol. 2015;9(5):703–8. http://doi.org/10.1016/j.jacl.2015.07.005
  31. Koivisto UM, Hämäläinen L, Taskinen MR, Kettunen K, Kontula K. Prevalence of familial hypercholesterolemia among young north Karelian patients with coronary heart disease: a study based on diagnosis by polymerase chain reaction. J Lipid Res. 1993 Feb;34(2):269–77.
  32. Brænne I, Kleinecke M, Reiz B, Graf E, Strom T, Wieland T, et al. Systematic analysis of variants related to familial hypercholesterolemia in families with premature myocardial infarction. Eur J Hum Genet. 2016 Feb;24(2):191–7. http://doi.org/10.1038/ejhg.2015.100
  33. Peng Y, Du X, Rogers KD, Wu Y, Gao R, Patel A, et al. Predicting In-Hospital Mortality in Patients With Acute Coronary Syndrome in China. Am J Cardiol. 2017 Oct 1;120(7):1077–83. http://doi.org/10.1016/j.amjcard.2017.06.044

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