Premature Coronary Artery Disease and Familial Dyslipidemia in Patients Presenting With Acute Coronary Syndrome

Dyslipidaemia and familial hypercholesterolemia (FH) are a common disorder that causes premature coronary artery disease.

The lifelong burden of elevated low-density lipoprotein cholesterol (LDL-C) in FH accelerates endothelial dysfunction and plaque formation, often culminating in acute coronary syndrome (ACS) at a young age. ACS in patients with undiagnosed FH may be their first clinical manifestation, underscoring the importance of early identification and intervention.

Inclusion criteria

• Age ≥18 years at the time of presentation.
• Both sexes.
• Confirmed diagnosis of coronary artery disease (CAD), established by clinical presentation, electrocardiographic findings, elevated cardiac biomarkers, and/or angiographic evidence of ≥50% luminal stenosis in at least one major coronary artery.
• Hospital admission to the participating cardiology department between [insert study period, e.g., January 2020 and December 2024] for acute coronary syndrome (ACS), including unstable angina, non-ST-elevation myocardial infarction (NSTEMI), or ST-elevation myocardial infarction (STEMI).
• Availability of complete clinical, laboratory, and echocardiographic data necessary for classification and analysis.

Exclusion criteria

• Incomplete medical records or missing essential laboratory, imaging, or demographic data.
• Secondary causes of dyslipidemia, including uncontrolled hypothyroidism, nephrotic syndrome, chronic liver disease, or use of lipid-altering medications (other than statins) before presentation.
• Previous congenital or structural heart disease, cardiomyopathy, or significant valvular heart disease unrelated to CAD.
• Severe chronic kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m²) or patients on dialysis.
• Autoimmune, inflammatory, or systemic diseases known to influence vascular inflammation or lipid metabolism.
• Malignancy or life expectancy <6 months due to non-cardiac causes.
• Pregnant or lactating women.
• Non-Saudi patients (focusing on Saudi population in southern region).