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Characterization of Coronary Artery Disease in Young Adults and Assessment of Long-term Outcomes
Ahmad Hassan1, Ronen Jaffe1, Ronen Rubinshtein1
1Department of Cardiovascular Medicine, Carmel Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Coronary artery disease (CAD) in young adults presents with many risk factors and leads to significant adverse cardiac events. Familial hypercholesterolemia (FH) particularly increases risks, highlighting the need for early detection and intervention.
Area of Science:
- Cardiology
- Vascular Medicine
- Preventive Cardiology
Background:
- Limited contemporary data exists on the clinical profiles and long-term outcomes of young adults diagnosed with coronary artery disease (CAD).
- Understanding CAD in this demographic is crucial for effective early intervention strategies.
Purpose of the Study:
- To investigate the risk profile, clinical presentation, and long-term outcomes of young adults (≤ 35 years) undergoing coronary angiography.
- To identify specific risk factors and patient subgroups associated with adverse cardiac events in this population.
Main Methods:
- Retrospective analysis of 108 patients aged ≤ 35 years who underwent coronary angiography between 2000 and 2017.
- Evaluation of clinical characteristics, risk factors, angiographic findings, and long-term follow-up data (mean 114 months).
Main Results:
- The study included 108 patients (88% male), with 67 presenting with acute coronary syndrome (ACS).
- Common risk factors included dyslipidemia (69%), family history (64%), and smoking (61%).
- Patients with angiographic CAD experienced high rates of revascularization (41-58%) and myocardial infarction (32-33%) over 114 months. Familial hypercholesterolemia (FH) was linked to significantly higher risks of myocardial infarction and revascularization. Only 17% achieved LDL cholesterol goals.
Conclusions:
- Coronary artery disease in young adults is characterized by a substantial burden of traditional risk factors and a high incidence of future adverse cardiac events.
- Outcomes are poor regardless of acute presentation, with familial hypercholesterolemia posing a particularly high risk.
- Early detection of cardiovascular risk factors and aggressive management of atherosclerosis in youth are essential.
Background:
Contemporary data on clinical profiles and long-term outcomes of young adults with coronary artery disease (CAD) are limited.
Objectives:
To determine the risk profile, presentation, and outcomes of young adults undergoing coronary angiography.
Methods:
A retrospective analysis (2000-2017) of patients aged ≤ 35 years undergoing angiography for evaluation and/or treatment of CAD was conducted.
Results:
Coronary angiography was performed in 108 patients (88% males): 67 acute coronary syndrome (ACS) and 41 non-ACS chest pain syndromes. Risk factors were similar: dyslipidemia (69%), positive family history (64%), smoking (61%), obesity (39%), hypertension (32%), and diabetes (22%). Eight of the ACS patients (12%) and 29 of the non-ACS (71%) had normal coronary arteries without subsequent cardiac events. Of the 71 with angiographic evidence of CAD, long-term outcomes (114 ± 60 months) were similar in ACS compared to non-ACS presentations: revascularization 41% vs. 58%, myocardial infarction 32% vs. 33%, and all-cause death 8.5% vs. 8.3%. Familial hypercholesterolemia (FH) was diagnosed in 25% of those with CAD, with higher rates of myocardial infarction (adjusted hazard ratio [HR] 2.62, 95% confidence interval [95%CI] 1.15-5.99) and revascularization (HR 4.30, 95%CI 2.01-9.18) during follow-up. Only 17% of patients with CAD attained a low-density lipoprotein cholesterol treatment goal < 70 mg/dl.
Conclusions:
CAD in young adults is associated with marked burden of traditional risk factors and high rates of future adverse cardiac events, regardless of acuity of presentation, especially in patients with FH, emphasizing the importance of detecting cardiovascular risk factors and addressing atherosclerosis at young age.
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