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Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease
Alexander C Egbe1, William R Miranda1, Francisco Lopez-Jimenez1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Atherosclerotic cardiovascular disease (ASCVD) risk factors are common in adults with congenital heart disease (CHD) and are linked to adverse cardiovascular events. Managing these risk factors may improve outcomes for CHD patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The impact of atherosclerotic cardiovascular disease (ASCVD) on cardiovascular mortality in adults with congenital heart disease (CHD) remains unclear.
- Understanding ASCVD risk factors in adults with CHD is crucial for improving long-term health outcomes.
Purpose of the Study:
- To investigate the prevalence and prognostic significance of ASCVD risk factors in adults with CHD.
- To determine the association between ASCVD risk factors and major adverse cardiovascular events (MACE) in this population.
Main Methods:
- Retrospective cohort study including 5,025 adults with CHD (2003-2019), excluding those with prior coronary artery disease (CAD).
- ASCVD risk factors included hypertension, hyperlipidemia, diabetes, obesity, smoking, and family history of premature CAD.
- Cardiovascular events were defined as heart failure hospitalization, heart transplant, or cardiovascular death.
Main Results:
- Nearly half (47%) of the adult CHD patients had at least one ASCVD risk factor at baseline.
- 16% developed new ASCVD risk factors during follow-up.
- Both baseline ASCVD risk factors (HR 1.27) and new-onset risk factors (HR 1.06) were significantly associated with increased cardiovascular events.
Conclusions:
- ASCVD risk factors are prevalent and associated with adverse cardiovascular events in adults with CHD.
- Interventions targeting ASCVD risk factors are likely to improve clinical outcomes in the CHD population, similar to the general population.
Background:
The effect of atherosclerotic cardiovascular disease (ASCVD) on cardiovascular death in adults with congenital heart disease (CHD) is not well understood.
Objectives:
The purpose of this study was to determine the prevalence and prognostic implications of ASCVD risk factors in adults with CHD. We hypothesized that ASCVD risk factors were associated with cardiovascular events defined as heart failure hospitalization, heart transplant, and cardiovascular death.
Methods:
This is a retrospective cohort study of adults with CHD at the Mayo Clinic (2003-2019). Patients with a history of coronary artery disease (CAD) were excluded. ASCVD risk factors were defined as hypertension, hyperlipidemia, diabetes, obesity, smoking, and family history of premature CAD.
Results:
There were 5,025 patients without a prior history of CAD. The mean age was 35 (23-45) years, and 2,558 (51%) were males. Of 5,025 patients, 2,382 (47%) had ≥1 ASCVD risk factors at baseline, and 16% developed additional ASCVD risk factors within 5 years (new-onset ASCVD risk). ASCVD risk factors at baseline (hazard ratio 1.27, 95% confidence interval 1.06-1.38) and new-onset ASCVD risk factors during follow-up (hazard ratio 1.06, 95% confidence interval 1.02-1.11) were associated with cardiovascular events.
Conclusions:
ASCVD factors were associated with cardiovascular events in adults with CHD. Since interventions that modify ASCVD risk have been shown to decrease cardiovascular death in the general population, it is logical to expect that such interventions would also improve clinical outcomes in the CHD population.
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