title: Acute coronary syndrome in the young: clinical characteristics, risk factors and prognosis.
abstract: BACKGROUND
  To describe the characteristics of patients ≤40 years of age hospitalized for acute coronary syndrome, analyze the risk factors and identify the variables associated with prognosis.
  
  
  METHODS
  Case series of patients admitted between 2003 and 2012 inclusive in a tertiary hospital (123 consecutive cases admitted between 2003 and 2012), and case-control study (369 controls selected from the general population matched for sex and age with cases, at a ratio of 3:1).
  
  
  METHODS
  Mortality, likelihood of survival without readmission for heart-related problems, extent of coronary disease as determined by coronary angiography and cardiovascular risk factors.
  
  
  RESULTS
  Mean age was 35.4±4.8 years and 83.7% of the participants were men. Myocardial infarction with abnormal Q wave (48%) and single-vessel involvement (44.7%) predominated. Intrahospital mortality was 1.6%. For the 108 patients eventually included in the follow-up, likelihood of readmission-free survival after 60 months was 69.3±4.8%. In the case group 36% of the patients admitted to using cocaine. Compared to controls, the prevalence in patients was higher for smoking (74.8 vs 33.1%, p<0001), diabetes (14.6% vs 5.1%, p=0.001), low HDL-cholesterol (82.9 vs 34.1%, p<0.001) and obesity (30.0 vs 20.3%, p=0.029). Decreased left ventricular ejection fraction (odds ratio=2.2, p=0.033) and smoking (odds ratio=7.8, p=0.045) were associated with readmission for coronary syndrome.
  
  
  CONCLUSIONS
  Acute coronary syndrome in people younger than 40 years is associated with diabetes and unhealthy lifestyle: smoking, sedentary behavior (low HDL-cholesterol), cocaine use and obesity. The readmission rate is high, and readmission is associated with smoking and decreased ejection fraction.
authors.affiliation: Servicio de Cardiología.
authors.forename: Marcos R
authors.initials: MR
authors.lastname: Esteban
authors.affiliation: Unidad de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Montero
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: José J A
authors.initials: JJ
authors.lastname: Sánchez
authors.affiliation: Servicio de Cardiología.
authors.forename: Horacio P
authors.initials: HP
authors.lastname: Hernández
authors.affiliation: Servicio de Cardiología.
authors.forename: José J G
authors.initials: JJ
authors.lastname: Pérez
authors.affiliation: Servicio de Cardiología.
authors.forename: Julio H
authors.initials: JH
authors.lastname: Afonso
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Del C R
authors.initials: del CR
authors.lastname: Pérez
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Buenaventura B
authors.initials: BB
authors.lastname: Díaz
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain ; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: de León
keywords: Acute coronary syndrome; prognosis; risk factors; young age.