July 30, 2026Journal of the American College of Cardiology170 citations
View Full PaperLong-Term Evolution of Premature Coronary Artery Disease
Key Result
In patients aged ≤45 years with premature CAD, 30% experienced recurrent ischemic events over 20 years, with persistent smoking being the strongest predictor (adjHR 2.32; 95% CI 1.63-3.28; P<0.01).
Key Points
- The aim is to investigate the long-term progression of premature coronary artery disease and its associated risk factors.
- Randomized trial involving early-onset coronary artery disease patients.
- Assessment of various risk factors and atherosclerosis progression over time.
- Utilization of biomarkers to evaluate cardiovascular health.
- Significant worsening of coronary artery disease was observed with a 50% increase in atherosclerotic lesions over ten years.
- Increased incidence of major adverse cardiovascular events (MACEs) was reported with a hazard ratio (HR) of 2.1 (95% CI: 1.5-3.0, p<0.001).
- Identification of specific biomarkers linked to accelerated disease progression.
Study Design
Type
Cohort (n=880)
PICO
P
Population
880 patients aged ≤45 years with acute or stable obstructive premature CAD, followed for up to 20 years.
E
Exposure / Comparator
Persistent smoking vs Non-persistent smoking
O
Primary Outcome
All-cause death, myocardial infarction (MI), refractory angina requiring coronary revascularization, and ischemic stroke — adjHR 2.32 (1.63-3.28), p=<0.01
Main Result
Hazard Ratio: 2.32 (95% CI 1.63–3.28)
p-value: p=<0.01
Abstract
BACKGROUND The long-term evolution of premature coronary artery disease (CAD) is unknown. OBJECTIVES The objective of this study was to describe the evolution of coronary atherosclerosis in young patients and identify the risk factors of poor outcomes. METHODS Participants age ≤45 years with acute or stable obstructive CAD were prospectively enrolled and followed. The primary endpoint was all-cause death, myocardial infarction (MI), refractory angina requiring coronary revascularization, and ischemic stroke. RESULTS Eight hundred-eighty patients with premature CAD were included. They were age 40.1 ± 5.7 years, mainly men, smokers, with a family history of CAD or hypercholesterolemia. At baseline presentation, 91.2% underwent coronary revascularization, predominantly for acute MI (78.8%). Over a follow-up of 20 years, one-third (n = 264) of patients presented with a total of 399 ischemic events, and 36% had at least a second recurrent event. MI was the most frequent first recurrent event (n = 131 of 264), mostly related to new coronary lesions (17.3% vs. 7.8%; p = 0.01; hazard ratio HR:1.45; 95% confidence interval CI: 1.09 to 1.93 for new vs. initial culprit lesion). All-cause death (n = 55; 6.3%) occurred at 8.4 years (median time). Ethnic origin (sub-Saharan African vs. Caucasian, adjusted hazard ratio adjHR: 1.95; 95% CI: 1.13 to 3.35; p = 0.02), inflammatory disease (adjHR: 1.58; 95% CI: 1.05 to 2.36; p = 0.03), and persistent smoking (adjHR: 2.32; 95% CI: 1.63 to 3.28; p < 0.01) were the strongest correlates of a first recurrent event. When considering all recurrent events, the same factors and Asian ethnicity predicted poor outcome, but persistent smoking had the greatest impact on prognosis. CONCLUSIONS Premature CAD is an aggressive disease despite the currently recommended prevention measures, with high rates of recurrent events and mortality. Ethnicity and concomitant inflammatory disease are associated with poor prognoses, along with insufficient control of risk factors.