March 11, 2022Journal of Cardiovascular Development and DiseaseOpen Access

Coronary Artery Disease in Very Young Patients: Analysis of Risk Factors and Long-Term Follow-Up

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Why the study?

Coronary artery disease typically affects the elderly, but earlier onset exerts a stronger impact on lifestyle and healthcare costs, prompting analysis of features and outcomes in very young patients undergoing coronary angiography.

Does significant angiographic stenosis and the presence of traditional risk factors predict long-term MACE in very young patients (≤40 years) with suspected CAD?

Structured PICO

Does significant angiographic stenosis and the presence of traditional risk factors predict long-term MACE in very young patients (≤40 years) with suspected CAD?

Population

504 patients aged ≤40 years referred for coronary angiography due to suspected CAD (representing 2.6% of 19,321 total angiographies at the center).

Intervention

Significant angiographic stenosis (Cases)

Comparator

Non-significant angiographic stenosis (Controls)

Outcome

Major adverse cardiovascular events (MACE) at long-term follow-upcomposite

In very young patients (≤40 years) undergoing coronary angiography, significant CAD is strongly driven by smoking, dyslipidemia, and family history, and is associated with a nearly 3-fold increased risk of long-term MACE.

Implication

Significant stenosis signals higher long-term MACE risk in patients ≤40 years; leaves open whether risk-factor modification improves outcomes.

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.