Risk Factor Burden and Long-Term Prognosis of Patients With Premature Coronary Artery Disease

Abstract

Background Coronary artery disease (CAD) is increasing among young adults. We aimed to describe the cardiovascular risk factors and long-term prognosis of premature CAD. Methods and Results Using the Duke Databank for Cardiovascular Disease, we evaluated 3655 patients admitted between 1995 and 2013 with a first diagnosis of obstructive CAD before the age of 50 years. Major adverse cardiovascular events (MACEs), defined as the composite of death, myocardial infarction, stroke, or revascularization, were ascertained for up to 10 years. Cox proportional hazard regression models were used to assess associations with the rate of first recurrent event, and negative binomial log-linear regression was used for rate of multiple event recurrences. Past or current smoking was the most frequent cardiovascular factor (60.8%), followed by hypertension (52.8%) and family history of CAD (39.8%). Within a 10-year follow-up, 52.9% of patients had at least 1 MACE, 18.6% had at least 2 recurrent MACEs, and 7.9% had at least 3 recurrent MACEs, with death occurring in 20.9% of patients. Across follow-up, 31.7% to 37.2% of patients continued smoking, 81.7% to 89.3% had low-density lipoprotein cholesterol levels beyond the goal of 70 mg/dL, and 16% had new-onset diabetes mellitus. Female sex, diabetes mellitus, chronic kidney disease, multivessel disease, and chronic inflammatory disease were factors associated with recurrent MACEs. Conclusions Premature CAD is an aggressive disease with frequent ischemic recurrences and premature death. Individuals with premature CAD have a high proportion of modifiable cardiovascular risk factors, but failure to control them is frequently observed.

Keywords: cholesterol; heterozygous familial hypercholesterolemia; long‐term evolution; premature coronary artery disease.

Figure 1. Time to first subsequent major adverse cardiovascular event within 10 years after premature coronary artery disease diagnosis.

CABG indicates coronary artery bypass grafting; Cath, catheterization; MI, myocardial infarction; and PCI, percutaneous coronary intervention.

Figure 2. Time to first, second, or third major adverse cardiovascular event within 10 years after premature coronary artery disease diagnosis.

Cath indicates catheterization.

Figure 3. Smoking continuation after premature coronary artery disease (CAD) onset, stratified by baseline smoking status.

Figure 4. Cumulative rate of new‐onset diabetes mellitus after premature coronary artery disease diagnosis.

Cath indicates catheterization.