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. 2019 Jul 16;8(14):e012178.
doi: 10.1161/JAHA.119.012178. Epub 2019 Jul 8.

Premature Atherosclerotic Cardiovascular Disease: Trends in Incidence, Risk Factors, and Sex-Related Differences, 2000 to 2016

Diana N Vikulova  1   2 , Maja Grubisic  3 , Yinshan Zhao  3 , Kelsey Lynch  2 , Karin H Humphries  3   4 , Simon N Pimstone  1   2 , Liam R Brunham  1   2
Affiliations

Premature Atherosclerotic Cardiovascular Disease: Trends in Incidence, Risk Factors, and Sex-Related Differences, 2000 to 2016

Diana N Vikulova et al. J Am Heart Assoc. .

Abstract

Background The incidence of atherosclerotic cardiovascular disease has declined in the past 2 decades. However, these benefits may not extend to young patients. The objective of this work was to assess temporal trends in the incidence, risk profiles, sex-related differences, and outcomes in a contemporary population of young patients presenting with coronary artery disease ( CAD ) in British Columbia, Canada. Methods and Results We used a provincial cardiac registry to identify young patients (men aged <50 years, women aged <55 years), with a first presentation of CAD between 2000 and 2016, who had either ≥50% stenosis of ≥1 coronary arteries on angiography or underwent coronary revascularization. A total of 12 519 patients (30% women) met our inclusion criteria. The incidence of CAD remained stable and was higher for men than women (46-53 versus 18-23 per 100 000). Of patients, 92% had at least one traditional cardiovascular risk factor and 67% had multiple risk factors. The prevalence of diabetes mellitus, obesity, and hypertension increased during the study period and was higher for women. Women had fewer emergent procedures and revascularizations. Mortality rates decreased by 31% between 2000 and 2007, then were stable for the remaining 9 years. Mortality was significantly higher for women aged <45 years compared with men. Conclusions The incidence of premature CAD has not declined, and the prevalence of 3 major cardiovascular risk factors increased between 2000 and 2016. The risk burden and mortality rates were worse for women. These data have important implications for the design of strategies to prevent CAD in young adults.

Keywords: cardiovascular disease; cardiovascular disease risk factors; sex specific; trends; young.

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Figures

Figure 1
Figure 1
Patient flow through inclusion/exclusion procedure. Stepwise analysis of data provided by the CSBC (Cardiac Services of British Columbia) Registry to identify young adults with a first presentation of angiographically documented coronary artery disease (CAD) between January 1, 2000, and December 31, 2016, in British Columbia (BC), Canada.
Figure 2
Figure 2
The age‐standardized incidence rate with 95% CI of premature coronary artery disease (CAD) by sex (A) and by sex and age group (B). The incidence rates of premature CAD were stable for both sexes during the observed period. The incidence rate was greater for men than women in all age groups.
Figure 3
Figure 3
Temporal trends for key cardiovascular risk factors by sex, 2000 to 2016: hyperlipidemia (A), hypertension (B), diabetes mellitus (C), obesity (D), and current smoking (E). The prevalence decreased for hyperlipidemia and smoking and increased for hypertension, diabetes mellitus, and obesity over the 17 years of the study period.
Figure 4
Figure 4
The prevalence of multiple risk factors by age group, for women (A) and men (B). The proportion of patients with 0, 1, 2, 3, 4, or 5 baseline comorbidities among young patients (men aged <50 years, women aged <55 years) with a first presentation of coronary artery disease.
Figure 5
Figure 5
Temporal trends in average risk burden. The average number of risk factors per person per year among young patients (men aged <50 years, women aged <55 years) with a first presentation of coronary artery disease, by sex.
Figure 6
Figure 6
All‐cause mortality by sex (A) and by sex and age group (B). Kaplan‐Meier estimation of unadjusted mortality rates.
See this image and copyright information in PMC

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