Myocardial infarction in young adults with low-density lipoprotein cholesterol levels ≤100 mg/dL

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 less than or equal to 100 mg/dL and those with LDL cholesterol values greater than or equal to 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 less than or equal to 130 mg/dL, 29% (53 patients) had LDL cholesterol level of less than or equal to 100 mg/dL, and only 14% (26 patients) had LDL cholesterol levels of greater than or equal to 160 mg/dL. Patients were categorized into group 1 if their LDL cholesterol level was less than or equal to 100 mg/dL and were categorized into group 2 if their LDL cholesterol level was greater than or equal to 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, less than or equal to 130 mg/dL) or optimal values (ie, less than or equal to 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.