Coronary Artery Disease in Very Young Women: Risk Factors and Prognostic Insights from Extended Follow-Up

Coronary artery disease (CAD) is usually associated with the elderly, but an increase in its incidence has been recently reported among young people, including very young women. The aim of this study is to assess the associations between different clinical variables and the risk of early CAD and occurrence of major adverse cardiovascular events (MACEs) during follow-up. Our cohort consists of women ≤40 years referred for coronary angiography due to suspicion of CAD; a nested case-control study was conducted among these patients. In total, 19,321 coronary angiographies were performed between 2006 and 2015, of which 2.6% were in patients ≤40 years old; 52 women were finally included. Family history of CAD was strongly associated with the early onset of the disease [OR 5.94, 95%CI (1.13-31.15); p = 0.035] in young women. The incidence of MACE was also associated with depression [HR 8.20 95%CI (1.03-65.17); p = 0.047] and Castelli Index [HR 11.49, 95%CI (1.40-94.51); p = 0.023]. Primary prevention focused on genetic analysis for high-risk women with a family history of CAD and secondary prevention, targeting a better cholesterol management and mental health assistance must be considered.