Premature CAD tied to frequent ischemic recurrences, premature death
Patients with premature CAD had frequent ischemic recurrences and a high proportion of modifiable CV risk factors, and often died young, researchers reported.
“We observed that young patients with premature obstructive CAD often had numerous modifiable traditional cardiovascular risk factors,” Michel Zeitouni, MD, fellow in the Duke Clinical Research Institute at Duke University School of Medicine, and colleagues wrote. “Premature CAD is a chronic evolving disease with half of patients experiencing a substantial evolution of coronary atherosclerosis within 10 years and 1 of 5 patients dying prematurely.”
Researchers identified 3,655 patients (median age, 45 years; 28% women) admitted to the hospital from 1995 to 2013 with a diagnosis of obstructive CAD before aged 50 years using data from the Duke Databank for Cardiovascular Disease. The outcome of interest was major adverse CV events, defined as death, MI, stroke or revascularization.
The most frequent CV risk factor among the cohort was past or current smoking, identified in 60.8% of patients, followed by hypertension in 52.8% and family history of CAD in 39.8%.
After 10-year 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. Across all years of follow-up, about 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 sex, diabetes, chronic kidney disease, multivessel disease and chronic inflammatory disease as factors most associated with recurrent adverse events.
Death occurred in 20.9% of patients.
According to the researchers, these findings highlight the need for early implementation, multimodal and innovative prevention strategies for younger patients in both primary and secondary prevention.
“Education should be provided to young individuals with several cardiovascular risk factors about their risk of developing CAD and the long-term prognostic of premature CAD,” the researchers wrote. “Specific attention should be brought to the high risk of developing diabetes in this young population and more research is needed to improve care in women with premature CAD, as they are at higher risk to develop subsequent ischemic events than men.”