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 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.