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Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based
Sanjeev K Sharma1, Jitender S Makkar1, Ajeet Bana2
1Departments of Cardiology, Eternal Heart Care Centre & Research Institute, Jaipur, 302017, India.
Insights
Premature coronary artery disease (CAD) affects a third of Indian patients undergoing intervention. High cholesterol and tobacco use are key risk factors, with STEMI presentation more common in men.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Premature coronary artery disease (CAD) is a significant health concern in India.
- Understanding its risk factors and presentation is crucial for targeted interventions.
Purpose of the Study:
- To identify risk factors, clinical presentation, angiographic findings, and interventions in premature CAD.
- To analyze differences between premature, very premature, and non-premature CAD in an Indian population.
Main Methods:
- A study enrolled patients undergoing percutaneous intervention (PCI) between January 2018 and June 2021.
- Premature CAD was defined by age: women 45-59 years, men 40-54 years; very premature: women <45 years, men <40 years.
- Descriptive statistics and univariate odds ratios were calculated to compare groups.
Main Results:
- 1238 (26.5%) patients had premature CAD, and 212 (4.5%) had very premature CAD.
- Higher total cholesterol and non-HDL cholesterol were significant risk factors for premature CAD in both sexes.
- Tobacco use was a notable risk factor in men, and STEMI presentation was more frequent in men with premature and very premature CAD.
Conclusions:
- A third of Indian patients undergoing coronary intervention present with premature CAD.
- Elevated total and non-HDL cholesterol, along with tobacco use (in men), are key risk factors.
- The severity, indicated by STEMI presentation and similar extent/type of disease to non-premature CAD, highlights the aggressive nature of premature CAD.
Background & Aims:
Premature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD.
Methods:
Successive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups.
Results:
4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol ≥200 mg/dl [women 1.52(1.03-2.25) and 1.59(0.79-3.20); men 1.73(1.38-2.17) and 1.92(1.22-3.03)], non-HDL cholesterol ≥130 mg/dl [women 1.84(1.35-2.52) and 1.32(0.72-2.42); men 1.69(1.43-1.90) and 1.67(1.17-2.34)], LDL cholesterol [men 1.10(0.95-1.25) and 1.04(0.77-1.41)], and tobacco [women 1.40(0.84-2.35) and 2.14(0.95-4.82); men 1.63(1.34-1.98) and 1.27(0.81-1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85-1.51)] and very premature [1.29(0.75-2.22)] CAD and was significantly higher in men [1.35(1.16-1.56) and 1.79(1.29-2.49)]. Location and extent of CAD were not different.
Conclusions:
In India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.
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