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Introducing the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort: THC-PAC Study
Seyed Hesameddin Abbasi1, Seyed Ebrahim Kassaian1, Saeed Sadeghian1
1Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Younger patients with coronary artery disease (CAD) exhibit numerous risk factors, increasing their likelihood of major adverse cardiac events (MACE). This study highlights the prevalence of these factors in a Middle Eastern cohort.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Limited data exists on premature coronary artery disease (CAD).
- The Tehran Heart Center's Premature Coronary Atherosclerosis Cohort Study (THC-PAC) is the first in the Middle East to investigate major adverse cardiac events (MACE) in young CAD patients.
Purpose of the Study:
- To assess MACE in young patients with premature CAD.
- To identify risk factors associated with MACE in this demographic.
Main Methods:
- A cohort of 1232 premature CAD patients (males ≤ 45, females ≤ 55) residing in Tehran underwent coronary angiography between 2004-2011.
- A 10-year follow-up initiated in 2012, with annual clinical visits or telephone calls.
- MACE endpoint included death, myocardial infarction, stroke, new coronary revascularization (PCI/CABG), or new coronary involvement.
Main Results:
- The cohort (mean age 45.1 years) showed high frequencies of hyperlipidemia (71.8%), hypertension (46.7%), positive family history (43.8%), smoking (38.8%), and diabetes (31.7%).
- Mean BMI was high (29.2 kg/m²), with 43.3% overweight and 35.8% obese.
- Females had higher BMI and abdominal circumference compared to males (P < 0.001 and P = 0.035, respectively).
- Successful follow-up was achieved in 95.2% of patients with a median duration of 55.3 months.
Conclusions:
- Younger CAD patients present with a high burden of conventional risk factors.
- These risk factors may predispose them to a higher incidence of recurrent MACE compared to the general population or older CAD patients.
Background:
Data on premature coronary artery disease (CAD) are scarce. The Tehran Heart Center's Premature Coronary Atherosclerosis Cohort Study (THC-PAC) is the first study of its kind in the Middle East to assess major adverse cardiac events (MACE) in young CAD patients.
Methods:
The cohort consists of CAD patients, males ≤ 45 years old and females ≤ 55 years old. The participants are residents of Tehran or its suburbs and underwent coronary angiography between June 2004 and July 2011. A 10-year follow-up, via either clinical visits or telephone calls at least once a year, was commenced in August 2012. The end point is considered MACE, encompassing death, myocardial infarction, stroke, new coronary involvement, percutaneous coronary intervention, and coronary artery bypass grafting.
Results:
The cohort comprises 1232 eligible patients (613 [49.8%] males) at a mean age of 45.1 years (SD = 5.8). High frequencies of conventional risk factors, including hyperlipidemia (884 [71.8%]), hypertension (575 [46.7%]), positive family history (539 [43.8%]), cigarette smoking (479 [38.8%]), and diabetes mellitus (390 [31.7%]), were seen in the participants. The mean body mass index (BMI) of the enrolled patients was high (29.2 ± 4.8 kg/m(2)), and 532 (43.3%) and 440 (35.8%) of them were overweight and obese, respectively. The females' BMI was higher (30.4 ± 5.3 vs. 28.0 ± 3.9 kg/m2; P < 0.001) and they had a greater mean abdominal circumference (99.9 ± 13.5 vs. 98.1 ± 9.3 cm; P = 0.035). Between August 2012 and August 2013, follow-up was successful in 1173 (95.2%) patients (median follow-up duration = 55.3 months, 95%CI: 53.5-57.0 months).
Conclusion:
Our younger patients with CAD had a high frequency of risk factors compared to the same-age general population and all-age CAD patients, which may predispose them to higher incidence of recurrent MACE.