Coarctation of the aorta and coronary artery disease: fact or fiction?
Idan Roifman1, Judith Therrien, Raluca Ionescu-Ittu
1McGill Adult Unit for Congenital Heart Disease, McGill University Health Center, Montreal, QC, Canada.
Insights
Aortic coarctation (CoA) does not independently predict coronary artery disease (CAD). Traditional risk factors are key predictors, suggesting improved outcomes with focused risk factor management in CoA patients.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
Background:
- Aortic coarctation (CoA) is often thought to increase the risk of coronary artery disease (CAD).
- Clinical observations suggest this premise may not be accurate.
- This study investigates the prevalence of CAD in adults with CoA and its independent predictive value.
Purpose of the Study:
- To determine the prevalence of CAD in adults with aortic coarctation.
- To assess if aortic coarctation is an independent predictor of CAD or premature CAD.
Main Methods:
- Utilized the Quebec Congenital Heart Disease Database.
- Compared CAD prevalence in patients with CoA versus ventricular septal defect (VSD).
- Employed a nested case-control design to evaluate CoA as an independent predictor.
Main Results:
- Prevalence of CAD was 4.9% in CoA patients versus 3.5% in VSD patients (P=0.04).
- Male sex, hypertension, diabetes, age, and hyperlipidemia independently predicted CAD.
- Aortic coarctation did not independently predict CAD (OR, 1.04; 95% CI, 0.68-1.57) or premature CAD (OR, 1.44; 95% CI, 0.79-2.64).
Conclusions:
- Traditional cardiovascular risk factors, not aortic coarctation alone, independently predict CAD development.
- Tight control of traditional risk factors is recommended to improve cardiovascular outcomes in patients with CoA.
Background:
Aortic coarctation (CoA) is reported to predispose to coronary artery disease (CAD). However, our clinical observations do not support this premise. Our objectives were to describe the prevalence of CAD among adults with CoA and to determine whether CoA is an independent predictor of CAD or premature CAD.
Methods And Results:
The study population was derived from the Quebec Congenital Heart Disease Database. We compared patients with CoA and those with a ventricular septal defect, who are not known to be at increased risk of CAD. The prevalence of CAD in patients with CoA compared with those with ventricular septal defect was determined. We then used a nested case-control design to determine whether CoA independently predicted for the development of CAD. Of 756 patients with CoA who were alive in 2005, 37 had a history of CAD compared with 224 of 6481 patients with ventricular septal defect (4.9% versus 3.5%; P=0.04). Male sex (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.62-2.80), hypertension (OR, 1.95; 95% CI, 1.44-2.64), diabetes mellitus (OR, 1.68; 95% CI, 1.09-2.58), age (OR per 10-year increase, 2.28; 95% CI, 2.09-2.48), and hyperlipidemia (OR, 11.58; 95% CI, 5.75-23.3) all independently predicted for the development of CAD. CoA did not independently predict for the development of CAD (OR, 1.04; 95% CI, 0.68-1.57) or premature CAD (OR for CoA versus ventricular septal defect, 1.44; 95% CI, 0.79-2.64) after adjustment for other factors.
Conclusions:
Although traditional cardiovascular risk factors independently predicted for the development of CAD, the diagnosis of CoA alone did not. Our findings suggest that cardiovascular outcomes of these patients may be improved with tight risk factor control.
More Related Videos
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Aneurysm I: Introduction