Pattern of coronary artery disease with no risk factors under age 35 years
Lubna Noor1, S Sadiq Shah, Yasir Adnan
1Department of Cardiology, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan. lubnanur@hotmail.com
Insights
Coronary artery disease (CAD) affects younger men, often involving a single vessel, predominantly the left anterior descending artery. Non-atherosclerotic conditions and normal coronaries are also observed in this demographic.
Area of Science:
- Cardiology
- Vascular Medicine
- Preventive Cardiology
Background:
- Coronary artery disease (CAD) incidence is increasing in younger populations, challenging traditional age-related perceptions.
- Limited data exists on CAD patterns and pathology in adults under 35 without traditional risk factors.
Purpose of the Study:
- To characterize the pattern of coronary artery disease in individuals younger than 35 years.
- To investigate the underlying pathology of CAD in young adults lacking conventional risk factors.
Main Methods:
- Prospective study conducted in Peshawar, Pakistan, from June 2008 to December 2009.
- 104 patients under 35 years with objective CAD evidence, excluding traditional risk factors, underwent percutaneous coronary angiography.
Main Results:
- 83.7% of patients had significant CAD; 16.3% had non-atherosclerotic coronary artery disease (including normal coronaries, arteritis, ectasia, myocardial bridge).
- Men constituted 81.7% of the cohort. Single-vessel disease predominated (51.9%), primarily involving the left anterior descending artery (LAD).
- Lesions were predominantly osteal to proximal (71%), with LAD involvement in ~50% of cases.
Conclusions:
- In young adults, CAD predominantly affects men, often presenting as single-vessel disease with LAD involvement.
- A significant proportion of young individuals exhibit non-atherosclerotic coronary artery disease or normal coronary arteries.
- Osteal to proximal segments are the most common sites of CAD lesions in this age group.
Background:
Coronary artery disease (CAD) is no more deemed to be an ailment of the 4th or 5th decade; rather an earlier age incidence is not infrequently encountered in our population. However, there are a few data regarding CAD in young adults, and much about its underlying pathology still remains undetermined. The objective of this study was to delineate the coronary arterial disease pattern in adults under the age of 35 years, but having no known coronary risk factors.
Methods:
This prospective study was conducted at the Cardiology Departments of all 3 public sector tertiary care hospitals in Peshawar from Jun 2008 to Dec 2009. After having excluded the traditional risk factors for CAD, patients under the age of 35 years with objective evidence of CAD were subjected to percutaneous coronary angiography.
Results:
Out of a total of 104 patients, 85 (81.73%) patients were men, and 19 (18.27%) were women. The mean age of the whole group was 32.66 +/- 3.237 (22-35) years. Significant CAD (> 50% diameter narrowing of at least one major coronary artery) was found in 87 (83.7%) patients while 17 (16.3%) patients had non-atherosclerotic coronary artery disease, including 12 (11.53%) patients having normal coronary arteries, 1 (1%) patient had anomalous origin of right coronary artery (RCA), 1 (1%) patient had coronary arteritis, 2 (1.92%) patients had coronary artery ectasia, and 1 (1%) patient had a myocardial bridge over left anterior descending artery (LAD). Among the patients with significant CAD, the prevalence rate of one, two and three vessel disease was 54 (51.9%), 22 (21.2%) and 11 (10.6%) respectively. Almost 50% of the lesions occurred in LAD followed by 25% in RCA and 20% in circumflex, while only one patient (1%) had isolated significant CAD of left main coronary artery. Osteal segments were involved in 10%, proximal in 61%, mid in 21% and distal segments in 7% of the lesions.
Conclusion:
In the younger age group, CAD is mostly a disease of men, single vessel CAD predominates with LAD involvement mostly, predominant osteal to proximal segment involvement of vessels, and a much higher incidence of normal coronaries and non-obstructive CAD is met with.
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