December 22, 2020
1 min read
Source / Disclosures
Disclosures: Zeitouni reports that he has received research grants from the Servier Research Institute and the French Federation of Cardiology; and received conference honoraria from Bristol Myers Squibb / Pfizer. Please see the study for relevant financial information from all other authors.
Patients with premature coronary artery disease had frequent ischemic recurrences and a high proportion of modifiable CV risk factors, and often died young, the researchers reported.
“We observed that young patients with premature obstructive coronary artery disease often had many traditional modifiable cardiovascular risk factors,” Michel Zeitouni, MD, a member of the Duke Clinical Research Institute at the Duke University School of Medicine, and colleagues wrote. “Premature coronary artery disease is a chronic progressive disease with half of the patients showing a substantial progression of coronary atherosclerosis within 10 years and 1 in 5 patients dying prematurely.
Researchers identified 3,655 patients (median age, 45; 28% female) admitted to hospital from 1995 to 2013 with a diagnosis of obstructive coronary artery disease before age 50 using data from the Duke Databank for Cardiovascular Disease. The outcome of interest was major adverse CV events, defined as death, myocardial infarction, stroke, or revascularization.
The most common CV risk factor in the cohort was previous or current smoking, identified in 60.8% of patients, followed by hypertension in 52.8% and a family history of coronary artery disease in 39.8%.
After 10 years of follow-up, 52.9% of patients had at least one major adverse CV event, 18.6% had at least two recurrent events, and 7.9% had at least three recurrent events. Over all years of follow-up, approximately one-third of patients continued to smoke, 81.7% to 89.3% had LDL levels greater than 70 mg / dL, and 16% had new-onset diabetes.
Researchers observed female gender, diabetes, chronic kidney disease, multivascular disease, and chronic inflammatory disease as the factors most associated with recurrent adverse events.
Death occurred in 20.9% of patients.
According to the researchers, these results highlight the need for early implementation of multimodal and innovative prevention strategies for younger patients in primary and secondary prevention.
“Young individuals with multiple cardiovascular risk factors should be informed of their risk of developing coronary artery disease and the long-term prognosis of premature coronary artery disease,” the researchers wrote. “Special attention needs to be paid to the high risk of developing diabetes in this young population, and more research is needed to improve care in women with premature coronary artery disease, as they are at greater risk of developing subsequent ischemic events than those who are men.