Objective: Due to devastating consequences of coronary artery disease (CAD) in young population, this study was designed to evaluate the prevalence of preventable risk factors and severity of atherosclerosis for Iranian young adults (≤45 years) diagnosed with premature CAD. Method: A cross sectional, descriptive study comprised 1093 consecutive patients (≤45 years), with a diagnosis of CAD, who underwent percutaneous intervention (PCI) or coronary bypass graft (CABG) from 2010 to 2012. Data on demographic features, cardiovascular risk factors, and angiographic findings were studied. Result: There were 1093 young patients (234 females, 859 males) with proven CAD; the mean age of 39 ± 3 years and the mean BMI were 28 ± 4.7 kg/m2. According to the treatment plan, patients were classified into two groups: PCI and CABG groups (n = 898,195 respectively). Obesity was the most prevalent risk factor (73.6%). In the risk factor assessment, it was noticed: 27% with diabetes mellitus, 37% with hypertension, 38% with family history, 39% with hyperlipidimia, and 54% smokers. Angiographic study revealed that 10 (1%) had left main coronary disease, 747 (68%) patients had single vessel disease, 181 (17%) had two-vessel disease and that 155 (14%) had three-vessel disease. The most common anatomical involvement was the anterior wall territory. Conclusion: Young CAD patients from Iran have different risk profile. Although atherosclerosis of the coronary arteries is less prominent in young patients, more often it is accompanied by decreased left ventricular function. There is a need for prevention plan to control obesity by targeting young adults in the population.
References
[1]
Choudhury, L. and Marsh J.D. (1999) Myocardial infarction in young patients. American Journal of Medicine, 107, 254-261.
http://dx.doi.org/10.1016/S0002-9343(99)00218-1
[2]
Trzos, E., Uznańska, B., Rechciński, T., Krzemińska-Pakula, M., Bugala, M. and Kurpesa, M. (2009) Myocardial infarction in young people. Cardiology Journal, 16, 307-311.
[3]
Mukherjee, D., Hsu, A., Moliterno, D.J., Lincoff, A.M., Goormastic, M. and Topol, E.J. (2003) Risk factors for premature coronary artery disease and determinants of adverse outcomes after revascularization in patients <40 years old. American Journal of Cardiology, 92, 1465-1467. http://dx.doi.org/10.1016/j.amjcard.2003.08.062
[4]
Odden, M.C., Coxson, P.G., Moran, A., Lightwood, J.M., Goldman, L. and Bibbins-Domingo, K. (2011) The impact of the aging population on coronary heart disease in the United States. American Journal of Medicine, 124, 827-833. http://dx.doi.org/10.1016/j.amjmed.2011.04.010
[5]
Cole, J.H. and Sperling, L.S. (2004) Premature coronary artery disease: Clinical risk factors and prognosis. Current Atherosclerosis Reports, 6, 121-125.
http://dx.doi.org/10.1007/s11883-004-0100-z
[6]
Koz, C., Celebi, H., Yokusoglu, M., Baysan, O., Hasimi, A., Serdaroglu, M. and Uzun, M. (2009) The relation between coronary lesion distribution and risk factors in young adults. Anadolu Kardiyoloji Dergisi, 9, 91-95.
[7]
Noeman, A., Ahmad, N. and Azhar, M. (2007) Coronary artery disease in young: faulty life style or heredofamilial or both. Annals, 13, 162-164.
[8]
Shemirani, H. and Separham, K.H. (2007) The relative impact of smoking or Hypertension on severity of premature coronary artery disease. Iranian Red Crescent Medical Journal, 9, 177-181.
[9]
Hosseini, S.K., Soleimani, A., Salarifar, M., Pourhoseini, H., Nematipoor, E. and Abbasi, S.H. (2011) Demographics and angiographic findings in patients under 35 years of age with acute ST elevation myocardial infarction. Journal of Tehran University Heart Center, 6, 62-67.
[10]
Klein, L.W. and Nathan, S. (2003) Coronary artery disease in young adults. Journal of the American College of Cardiology, 41, 529-531.
http://dx.doi.org/10.1016/S0735-1097(02) 02861-9
[11]
Dudina, A., Cooney, M.T., Bacquer, D.D., et al. (2011) Relationships between body mass index, cardiovascular mortality, and risk factors: A report from the SCORE investigators. European Journal of Cardiovascular Prevention and Rehabilitation, 18, 731-742.
http://dx.doi.org/10.1177/1741826711412039
[12]
Wen, C.P., David Cheng, T.Y., Tsai, S.P., et al. (2009) Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutrition, 12, 497-506.
http://dx.doi.org/10.1017/S1368980008002802
[13]
Panduranga, P., Sulaiman, K., Al-Zakwani, I. and Abdelrahman, S. (2010) Acute coronary syndrome in young adults from Oman: Results from the gulf registry of acute coronary events. Heart Views, 11, 93-98.
http://dx.doi.org/10.4103/1995-705X.76799
[14]
Christus, T., Shukkur, M., Rashdan, I., et al. (2011) Coronary artery disease in patients aged 35 or less—A different beast? Heart Views, 12, 7-11.
http://dx.doi.org/10.4103/1995-705X.81550
[15]
Farhan, H.A. and Al-Saffar, H.B. (2010) Coronary artery disease: Conventional risk factors & angiographic findings among young Iraqi adults.
http://www.uobabylon.edu.iq/publications/applied_edition3/paper_ed3_3.doc
[16]
Yasir, A.S., Turhan, H., Basir, N., et al. (2008) Comparison of major coronary risk factors in female and male patients with premature coronary artery disease. Acta Cardiologica, 63, 19-25.
http://dx.doi.org/10.2143/AC.63.1.2025327
[17]
Abu Siddique, M., Shrestha, M.P., Salman, M., et al. (2010) Age-related differences of risk profile and angiographic findings in patients with coronary heart disease. Bangabandhu Sheikh Mujib Medical University Journal, 3, 13-17.
[18]
Fang, C., Chen, Y., Nie, R., Li, G., Xu, G., Zhou, S. and Wang, J. (2009) Retrospective analysis of risk factors in young patients with coronary artery disease in Guangdong and Zhejiang, China. Acta Cardiologica, 64, 195-199. http://dx.doi.org/10.2143/AC.64.2.2036137
[19]
Jeemon, P., Prabhakaran, D., Huffman, M., et al. (2011) Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results). BMJ Open, 1, Article ID: e000068.
http://dx.doi.org/10.1136/bmjopen-2011-000068
[20]
Gupta, R., Misra, A., Vikram, N.K., et al. (2009) Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovascular Disorders, 9, 28.
http://dx.doi.org/10.1186/1471-2261-9-28
[21]
Sharma, M. and Ganguly, N.K. (2005) Premature coronary artery disease in Indians and its associated risk factors. Vascular Health and Risk Management, 13, 217-225.
[22]
Schoenenberger, A.W., Radovanovic, D., Stauffer, J.-Ch, et al. (2011) Acute coronary syndromes in young patients: Presentation, treatment and outcome. International Journal of Cardiology, 148, 300-304.
http://dx.doi.org/10.1016/j.ijcard.2009.11.009
[23]
Arzamendi, D., Benito, B., Tizon-Marcos, H., et al. (2011) Increase in sudden death from coronary artery disease in young adults. America Heart Journal, 161, 574-580.
http://dx.doi.org/10.1016/j.ahj.2010.10.040
[24]
Badran, H.M., Elnoamany, M.F., Khalil, T.S. and Eldin, M.M. (2009) Age-related alteration of risk profile, inflammatory response, and angiographic findings in patients with acute coronary syndrome. Clinical Medicine: Cardiology, 3, 15-28.
[25]
Cole, J.H., Miller, 3rd, J.I., Sperling, L.S. and Weintraub, W.S. (2003) Long-term follow-up of coronary artery disease presenting in young adults. Journal of the American College of Cardiology, 41, 521-528.
http://dx.doi.org/10.1016/S0735-1097(02) 02862-0
[26]
Rohrer-Gubler, I., Niederhauser, U. and Turina, M.I. (1998) Late outcome of coronary artery bypass grafting in young versus older patients. The Annals of Thoracic Surgery, 65, 377-382.
http://dx.doi.org/10.1016/S0003-4975(97) 01082-5
