Background Coronary artery disease (CAD) in the younger adult population has been commonly under-represented in clinical practice and research studies given its early latent asymptomatic course, in addition to the underestimation of this population's CHD lifetime risk by commonly used CHD risk predictors such as Framingham's score.
Objective To assess the risk factor profile for premature coronary artery disease CAD and ACS presentation in younger adults.
Methods Retrospective chart analysis of 393 patient's ≤40 years old admitted from 2005 to 2014 for chest pain and underwent coronary angiography. The implication of modifiable risk factors and non-modifiable risk factors were evaluated in those with obstructive CAD (LM stenosis of ≥50% or stenosis of ≥70% in a major epicardial vessel), non-obstructive CAD (≥1 stenosis ≥20% but no stenosis ≥70%) and normal coronaries (no stenosis >20%). Additionally we evaluated the impact of the same risk factors on ACS presentation (NSTEMI vs STEMI) and the extent of CAD (single-vessel/multi vessel).
Results Of 9012 patients who underwent cardiac catheterization, 393 (4.3%) patients were ≤40 years old.
Out of 393, 212 (54%) had CAD (153 obstructive versus 59 non-obstructive) while 185 (46%) had normal coronaries.
Fifty two (25%) patients presented with STEMI while 140 (66%) patients presented with NSTEMI.
Of 153 patients with obstructive CAD, 87 (57%) patients had single vessel disease vs 66 (43%) multiple vessel disease.
When compared to patients with normal coronaries patients with CAD were more likely to be smokers (p<0.0001), dyslipidemia (p<0.0001), Diabetic (p<0.0001) cocaine users (p 0.4) have a family history of premature CHD (<0.0001) and be males (p<0.0001) (figure=1).
Smokers were more likely to present with acute coronary syndrome; 5 times more likely to present with STEMI (p<0.0001) and 1.7 with NSTEMI (p 0.0003) compared to the control group.
When compared head to head, smokers were 2.2 times more likely to present with STEMI compared to NSTEMI (p<0.001).
Smoking also, alone and with another risk factor increased the risk of obstructive versus no obstructive CAD (p=0.04 and 0.015, respectively).
No significant difference was noted in the single vessel vs multi vessel CAD subgroups.
Coronary artery disease was highest in South Asian population (38.4%), followed by Hispanic (13.7%), African-American (10%) and Caucasian (9%). The main in risk factors in African–American was Hyperlipidemia +/− Diabetes (47.8%) while the main risk factors in Hispanic and white were smoking alone (24.14% and 47.4% respectively). In East Asia population, Smoking with hyperlipidemia was the main risk factors (44%).
Conclusion In our population of young adults, smoking as a single risk factor was the most prevalent for earlier CAD. It was also associated with more STEMIs and obstructive CAD. Healthcare intervention in the general population through screening, counseling and education regarding smoking cessation is warranted to reduce premature coronary artery disease. ⇓
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