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Coronary Artery Disease in Very Young Patients: Analysis of Risk Factors and Long-Term Follow-Up
Pablo Juan-Salvadores1,2, Víctor Alfonso Jiménez Díaz1,2,3, Cristina Iglesia Carreño4
1Cardiovascular Research Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, 36213 Vigo, Spain.
Insights
Early-onset coronary artery disease (CAD) in patients under 40 is linked to smoking, dyslipidemia, and family history. These factors increase the risk of major adverse cardiovascular events (MACE), highlighting the need for early intervention.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Coronary artery disease (CAD) typically affects the elderly, but early onset significantly impacts lifestyle and healthcare costs.
- Understanding risk factors and outcomes in younger populations is crucial for effective prevention strategies.
Purpose of the Study:
- To analyze clinical and angiographic features of very young patients (≤40 years) with suspected CAD.
- To identify risk factors associated with significant stenosis and major adverse cardiovascular events (MACE) in this demographic.
- To evaluate the long-term outcomes of early-onset CAD.
Main Methods:
- A retrospective analysis of 19,321 coronary angiographies, identifying 504 (2.6%) in patients ≤40 years.
- A nested case-control study comparing patients with significant stenosis (cases) to those without (controls).
- Statistical analysis including odds ratios (OR) and hazard ratios (HR) to determine risk factor associations and event incidence.
Main Results:
- Smoking (OR 2.96), dyslipidemia (OR 2.18), and family history of CAD (OR 1.95) were significant risk factors for early CAD.
- Patients with significant stenosis experienced a higher incidence of MACE (HR 2.71) compared to controls.
- Dyslipidemia and hypertriglyceridemia were associated with long-term MACE.
Conclusions:
- Conventional risk factors like smoking, dyslipidemia, and family history are strongly linked to early-onset CAD.
- Early detection and management of CAD in young patients are essential due to the high risk of MACE and significant socio-medical costs.
Abstract:
Coronary artery disease (CAD) is a common chronic condition in the elderly. However, the earlier CAD begins, the stronger its impact on lifestyle and costs of health and social care. The present study analyzes clinical and angiographic features and the outcome of very young patients undergoing coronary angiography due to suspected CAD, including a nested case-control study of ≤40-year-old patients referred for coronary angiography. Patients were divided into two groups: cases with significant angiographic stenosis, and controls with non-significant stenosis. Of the 19,321 coronary angiographies performed in our center in a period of 10 years, 504 (2.6%) were in patients ≤40 years. The most common cardiovascular risk factors for significant CAD were smoking (OR 2.96; 95% CI 1.65-5.37), dyslipidemia (OR 2.18; 95% CI 1.27-3.82), and family history of CAD (OR 1.95; 95% CI 1.05-3.75). The incidence of major adverse cardiovascular events (MACE) at follow-up was significantly higher in the cases compared to controls (HR 2.71; 95% CI 1.44-5.11). Three conventional coronary risk factors were directly related to the early signs of CAD. MACE in the long-term follow-up is associated to dyslipidaemia and hypertriglyceridemia. Focusing efforts for the adequate control of CAD in young patients is a priority given the high socio-medical cost that this disease entails to society.
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