Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform?

OBJECTIVES The purpose of this study was to investigate the utility of the new National Cholesterol Education Program (NCEP) III guidelines in a group of young adults. BACKGROUND These guidelines have been hailed as an improvement in their potential to identify individuals at risk for coronary heart disease (CHD) complications. Compared with the NCEP II, the new guidelines will increase the number of patients who qualify for medical management. However, the effectiveness of these guidelines to identify young adults at risk for a cardiac event is yet to be studied. METHODS A retrospective review of clinical data from young adults (age <or=55 years for men and <or=65 years for women) hospitalized for acute myocardial infarction over a three-year period was conducted. Patients with a history of CHD or CHD equivalent were excluded. Using the NCEP III guidelines, we calculated a 10-year risk for coronary events on all patients. RESULTS A total of 222 patients met criteria for inclusion. The mean age was 50 years and 25% were women. Mean lipid levels were all within the normal range; however, rates of smoking and obesity were high. When the 10-year risk of these patients was stratified by the number of risk factors and low-density lipoprotein cholesterol level, only 25% met criteria to qualify for pharmacotherapy. For women in this population, only 18% met criteria for treatment. CONCLUSIONS The new guidelines offer multiple new features but have a tendency to underappreciate the risk for disease in young adults. To improve performance in young adults, statistical adjustments may be necessary.