Maternal hypercholesterolemia during pregnancy is associated with severity of myocardial infarction in young adults

Background: Elevated Maternal Cholesterol during Pregnancy (MCP) enhances atherogenesis in childhood, but its impact on acute myocardial infarction (AMI) in adults is unknown. Methods: 89 AMI patients meeting narrow criteria (born after 1945, typical chest pain, transmural infarction Q-waves, elevated creatinine kinase, no cerebrovascular or terminal disease) were identified among patients admitted to coronary care unit in Naples, Italy. Patients were classified by MI severity (severe=involving 3 arteries, left ventricle ejection fraction ≤35, CK-peak >1200 mg/dl, or CK-MB >200 mg/dl). The association of MCP with AMI severity was tested by linear and multiple regression analysis that included conventional cardiovascular risk factors, gender, age, and treatment. Associations of MCP with BMI was assessed by linear correlation. Results: MCP correlated with four measures of AMI severity: number of vessels (β=0.382, p=0.001), ejection fraction (β=-0.315, p=0.003), CK (β=0.260, p=0.014) and CK-MB (β=0.334, p=0.001), as well as survival time (β=-0.252, p=0.031). In multivariate analysis of patients stratified by AMI severity, MCP predicted AMI severity independently of age, gender, and CHD risk factors (OR=1.304, 95% CI 1.107-1.559; p=0.004). Screening for point mutations ruled out that this was due to certain inherited differences in lipid metabolism. Survival was affected mainly by AMI severity. Conclusions: MCP is associated with adult BMI, atherosclerosis-related risk and severity of AMI.