The Complexity of Premature Coronary Artery Disease
Abstract
Premature Coronary Artery Disease presents a significant health concern globally, characterized by the onset of coronary atherosclerosis at an early age, typically before the age of 55 in men and 65 in women. This review provides a comprehensive examination of the various aspects of premature CAD, ranging from its underlying pathophysiology to diagnostic modalities such as coronary angiography. Beginning with an overview of the risk factors contributing to premature CAD, including genetic predispositions, lifestyle factors, and metabolic disorders, the review delves into the intricate mechanisms involved in the initiation and progression of atherosclerosis. Furthermore, the review discusses the clinical manifestations and challenges associated with diagnosing premature CAD, particularly in asymptomatic individuals. It examines the utility of non-invasive imaging techniques, stress testing in identifying coronary artery stenosis, cardiovascular risk and the principles of coronary angiography. The review outlines the principles of coronary angiography, including patient preparation, procedural techniques, and interpretation of angiographic findings. In conclusion, this comprehensive review provides insights into the multifaceted nature of premature CAD, elucidating its pathogenesis, clinical presentation, and diagnostic evaluation, with a focus on the pivotal role of coronary angiography in guiding therapeutic interventions and optimizing patient outcomes.
Keywords
Full Text:
PDFReferences
Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. doi:10.1161/CIR.0000000000000659
James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-1858. doi:10.1016/S0140-6736(18)32279-7
Wilmot KA, O’Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary Heart Disease Mortality Declines in the United States From 1979 Through 2011: Evidence for Stagnation in Young Adults, Especially Women. Circulation. 2015;132(11):997-1002. doi:10.1161/CIRCULATIONAHA.115.015293
Mohammad AM, Jehangeer HI, Shaikhow SK. Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq. BMC Cardiovasc Disord. 2015;15(1):1-6.
Christiansen MK. Early-onset Coronary Artery Disease Clinical and Hereditary Aspects. Dan Med J. 2017;64(9):1-18.
Reibis R, Treszl A, Wegscheider K, Bestehorn K, Karmann B, Völler H. Disparity in risk factor pattern in premature versus late-onset coronary artery disease: A survey of 15,381 patients. Vasc Health Risk Manag. 2012;8(1):473-481. doi:10.2147/VHRM.S33305
Pillay AK, Naidoo DP. Atherosclerotic disease is the predominant aetiology of acute coronary syndrome in young adults. Cardiovasc J Afr. 2018;29(1):36-42.
Vikulova DN, Grubisic M, Zhao Y, et al. Premature atherosclerotic cardiovascular disease: trends in incidence, risk factors, and sex‐related differences, 2000 to 2016. J Am Heart Assoc. 2019;8(14):e012178.
Khoja A, Andraweera PH, Lassi ZS, et al. Risk factors for premature coronary artery disease (PCAD) in adults: a systematic review protocol. F1000Res. 2021;10.
Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J. 2005;81(962):741-745.
Christus T, Shukkur AM, Rashdan I, et al. Coronary artery disease in patients aged 35 or less–a different beast? Heart Views. 2011;12(1):7.
Konishi H, Miyauchi K, Kasai T, et al. Long-term prognosis and clinical characteristics of young adults (≤ 40 years old) who underwent percutaneous coronary intervention. J Cardiol. 2014;64(3):171-174.
Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol. 2016;8(12):728.
Kang MK, Chang HJ, Kim YJ, et al. Prevalence and determinants of coronary artery disease in first-degree relatives of premature coronary artery disease. Coron Artery Dis. 2012;23(3):167-173.
CDC C for DC and P. Prevalence of coronary heart disease--United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011;60(40):1377-1381.
Ha EJ, Kim Y, Cheung JY, Shim SS. Coronary artery disease in asymptomatic young adults: its prevalence according to coronary artery disease risk stratification and the CT characteristics. Korean J Radiol. 2010;11(4):425-432.
Sharma M, Ganguly NK. Premature coronary artery disease in Indians and its associated risk factors. Vasc Health Risk Manag. 2005;1(3):217-225.
Poorzand H, Tsarouhas K, Hozhabrossadati SA, et al. Risk factors of premature coronary artery disease in Iran: A systematic review and meta‐analysis. Eur J Clin Invest. 2019;49(7):e13124.
Libby P, Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005;111(25):3481-3488.
Collet JP, Zeitouni M, Procopi N, et al. Long-term evolution of premature coronary artery disease. J Am Coll Cardiol. 2019;74(15):1868-1878.
Kumbhalkar SD, Bisne V V. Clinical and angiographic profile of young patients with ischemic heart disease: A central India study. J Clin Prev Cardiol. 2019;8(1):6.
Wang H, Liu Z, Shao J, et al. Pathogenesis of premature coronary artery disease: Focus on risk factors and genetic variants. Genes Dis. 2022;9(2):370-380.
Ahmadi SH, Abbasi SH, Ugurlucan M, Bina P. Positive family history as the single traditional risk factor for developing extensive very premature coronary artery disease: a case report. The Journal of Tehran University Heart Center. 2013;8(1):54.
Khera A V, Kathiresan S. Genetics of coronary artery disease: discovery, biology and clinical translation. Nat Rev Genet. 2017;18(6):331-344.
Zuk O, Schaffner SF, Samocha K, et al. Searching for missing heritability: designing rare variant association studies. Proceedings of the National Academy of Sciences. 2014;111(4):E455-E464.
Cole CB, Nikpay M, Stewart AFR, McPherson R. Increased genetic risk for obesity in premature coronary artery disease. European Journal of Human Genetics. 2016;24(4):587-591.
McPherson R, Tybjaerg-Hansen A. Genetics of coronary artery disease. Circ Res. 2016;118(4):564-578.
Hu Y, Zong G, Liu G, et al. Smoking cessation, weight change, type 2 diabetes, and mortality. New England Journal of Medicine. Published online 2018.
Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. New England Journal of Medicine. 2018;379(22):2097-2107.
Biery DW, Berman AN, Singh A, et al. Association of smoking cessation and survival among young adults with myocardial infarction in the partners YOUNG-MI registry. JAMA Netw Open. 2020;3(7):e209649-e209649.
Singh A, Collins BL, Gupta A, et al. Cardiovascular risk and statin eligibility of young adults after an MI: partners YOUNG-MI registry. J Am Coll Cardiol. 2018;71(3):292-302.
Navar-Boggan AM, Peterson ED, D’Agostino RB, Pencina MJ, Sniderman AD. Using age-and sex-specific risk thresholds to guide statin therapy: one size may not fit all. J Am Coll Cardiol. 2015;65(16):1633-1639.
Lichtman JH, Leifheit EC, Safdar B, et al. Sex differences in the presentation and perception of symptoms among young patients with myocardial infarction: evidence from the VIRGO study (variation in recovery: role of gender on outcomes of young AMI patients). Circulation. 2018;137(8):781-790.
Schultz WM, Kelli HM, Lisko JC, et al. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation. 2018;137(20):2166-2178.
Avis SR, Vernon ST, Hagström E, Figtree GA. Coronary artery disease in the absence of traditional risk factors: A call for action. Eur Heart J. 2021;42(37):3822-3824. doi:10.1093/eurheartj/ehab474
Bays HE, Kulkarni A, German C, et al. Ten things to know about ten cardiovascular disease risk factors – 2022. Am J Prev Cardiol. 2022;10. doi:10.1016/j.ajpc.2022.100342
Arnold S V., Bhatt DL, Barsness GW, et al. Clinical Management of Stable Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus: A Scientific Statement from the American Heart Association. Circulation. 2020;141(19):E779-E806. doi:10.1161/CIR.0000000000000766
Jin JL, Zhang HW, Cao YX, et al. Association of small dense low-density lipoprotein with cardiovascular outcome in patients with coronary artery disease and diabetes: A prospective, observational cohort study. Cardiovasc Diabetol. 2020;19(1). doi:10.1186/s12933-020-01015-6
Găman MA, Cozma MA, Dobrică EC, Bacalbașa N, Bratu OG, Diaconu CC. Dyslipidemia: A trigger for coronary heart disease in Romanian patients with diabetes. Metabolites. 2020;10(5). doi:10.3390/metabo10050195
Yanai H, Yoshida H. Secondary dyslipidemia: its treatments and association with atherosclerosis. Glob Health Med. 2021;3(1):15-23. doi:10.35772/ghm.2020.01078
Regitz-Zagrosek V, Gebhard C. Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes. Nat Rev Cardiol. 2023;20(4):236-247. doi:10.1038/s41569-022-00797-4
Carvalho V, Pinho D, Lima RA, Teixeira JC, Teixeira S. Blood flow modeling in coronary arteries: A review. Fluids. 2021;6(2):1-15. doi:10.3390/fluids6020053
Jayaram AA, Shah S. Risk factors, clinical features, angiographic characteristics and treatment outcomes of young myocardial infarction patients. journal of indian college of cardiology. 2015;5(3):203-208.
Riaz T, Akram M, Laila U, et al. Causes, risks factors and medical consequences of obesity. IAIM. 2023;10(8):39-48. http://iaimjournal.com/
DOI: https://doi.org/10.21776/ub/hsj.2024.005.03.2
Refbacks
- There are currently no refbacks.
Copyright (c) 2024 Nikhen Noverike
This work is licensed under a Creative Commons Attribution 4.0 International License.