Clinical factors and angiographic features associated with premature coronary artery disease.
BACKGROUND
Clinical, angiographic, and biochemical features may differ in young patients with coronary heart disease compared with older patients.


METHODS
We compared clinical and angiographic characteristics in 100 male patients with clinical onset of disease at age < or = 45 years (group 1) with those of 100 older male patients (clinical onset of disease at > or = 60 years) (group 2). All patients had documented coronary artery disease. The two patient groups were compared in terms of the pattern of angina at disease onset, angiographic features, and coronary risk factors.


RESULTS
Seventy-six patients in group 1 and 49 patients in group 2 presented with acute coronary syndromes (unstable angina or myocardial infarction) at clinical disease onset (p < 0.001). Compared with patients in group 2, younger patients (group 1) showed a preponderance of single-vessel disease (54 vs 36%; p < 0.001) and complex stenosis morphologic features (59 vs 36%; p < 0.01). Family history of coronary artery disease (39 vs 11%; p < 0.001) and smoking (73 vs 46%; p < 0.001) were also more prevalent in younger patients. Mean plasma total cholesterol level was 6.4 +/- 1.3 mmol/L in group 1 and 6.1 +/- 1.2 mmol/L in group 2 (p = NS). Younger patients, however, had lower high-density lipoprotein (HDL) cholesterol (0.9 +/- 0.2 mmol/L and 1.1 +/- 0.4 mmol/L; p < 0.01) and higher plasma triglyceride levels compared with patients of group 2 (2.7 +/- 1.3 mmol/L vs 2.1 +/- 1.1 mmol/L; p < 0.001).


CONCLUSIONS
Patients with premature coronary disease referred to coronary angiography commonly have unheralded acute onset of symptoms, angiographically complex stenosis morphologic features, and less extensive coronary artery disease. In addition to previously identified risk factors such as family history and smoking, we observed that high plasma triglyceride and low HDL cholesterol levels are associated with premature coronary artery disease.
Chen
L
L
Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
Chester
M
M
Kaski
J C
JC
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging; D000789:Angina, Unstable / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D015588:Observer Variation; D012307:Risk Factors