title: Disparity in risk factor pattern in premature versus late-onset coronary artery disease: a survey of 15,381 patients.
abstract: BACKGROUND
  There are few data available regarding the specificity and modifiability of major cardiovascular (CV) risk factors in patients with premature versus (vs) late-onset coronary artery disease (CAD). This study was designed to analyze and compare these risk factors.
  
  
  METHODS
  Data from 15,381 consecutive patients (mean age, 62.3 ± 11.7 years; female, 33.8%) hospitalized with CAD were collected from a large-scale registry (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management) and analyzed. The patients were divided into two groups, depending on age at inclusion: group 1 patients (n = 5725; mean age, 50.5 ± 7.2 years) were males aged < 55 years and females aged < 65 years; group 2 patients (n = 9656; mean age, 69.4 ± 7.4 years) were males aged > 55 years and females aged > 65 years and had a low-density lipoprotein cholesterol level of >100 mg/dL on admission to cardiac rehabilitation. Besides the conventional risk factors, lipoprotein(a) concentrations and glucose tolerance were measured facultatively. Univariate (chi-square test) and multivariate logistic regression models were used.
  
  
  RESULTS
  Cigarette smoking (group 1 at 31.5% vs group 2 at 9.4%; P < 0.001), family history of CAD (group 1 at 43.6% vs group 2 at 26.5%; P < 0.001), and dyslipidemia (group 1 at 92.7% vs group 2 at 91.8%; P < 0.001) were dominant risk factors in the younger group. Arterial hypertension (group 1 at 71.4% vs group 2 at 87.0%; P < 0.001) and diabetes (group 1 at 23.5% vs group 2 at 30.1%; P < 0.001) were dominant risk factors in the older group. Impaired glucose tolerance and diabetes were less frequent in the younger group (P(trend) = 0.038), and identical lipoprotein(a) concentration levels of >30 mg/dL were found in both groups (8.0%; P = 0.810). Modification of lipid profile and blood pressure was more effective in the younger group (low-density lipoprotein cholesterol < 100 mg/dL: group 1 at 66.3% vs group 2 at 61.1%; systolic blood pressure < 140 mmHg: group 1 at 91.7% vs group 2 at 83.0%; P < 0.001).
  
  
  CONCLUSIONS
  CV risk factors differ markedly between premature and non-premature CAD. Cardiac rehabilitation provides an opportunity to reinforce secondary prevention after acute coronary syndrome.
authors.affiliation: Department of Cardiology, Klinik am See, Rehabilitation Center of Cardiovascular Diseases, Rüdersdorf, Germany. rona.reibis@hotmail.de
authors.forename: Rona
authors.initials: R
authors.lastname: Reibis
authors.forename: Andras
authors.initials: A
authors.lastname: Treszl
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Kurt
authors.initials: K
authors.lastname: Bestehorn
authors.forename: Barbara
authors.initials: B
authors.lastname: Karmann
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000235:genetics / Q000628:therapy; D005260:Female; D020022:Genetic Predisposition to Disease; D005858:Germany / Q000453:epidemiology; D044882:Glucose Metabolism Disorders / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010375:Pedigree; D011314:Preventive Health Services; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology