title: Gender differences in the prevalence, severity, and composition of coronary artery disease in the young: a study of 1635 individuals undergoing coronary CT angiography from the prospective, multinational confirm registry.
abstract: OBJECTIVE
  Prior studies examining coronary atherosclerosis in the young have been limited by retrospective analyses in small cohorts. We examined the relationship between cardiovascular risk factors (RFs) and prevalence and severity of coronary atherosclerosis in a large, prospective, multinational registry of consecutive young individuals undergoing coronary computerized tomographic angiography (CCTA).
  
  
  RESULTS
  Of 27 125 patients undergoing CCTA, 1635 young (<45 years) individuals without known coronary artery disease (CAD) or coronary anomalies were identified. Coronary plaque was assessed for any CAD, obstructive CAD (≥50% stenosis), and presence of calcified plaque (CP) and non-calcified plaque (NCP). Among 1635 subjects (70% men, age 38 ± 6 years), any CAD, obstructive CAD, CP, and NCP were observed in 19, 4, 5, and 8%, respectively. Compared with women, men demonstrated higher rates of any CAD (21 vs. 12%, P < 0.001), CP (6 vs. 3%, P = 0.01), and NCP (9 vs. 5%, P = 0.008), although no difference was observed for rates of obstructive CAD (5 vs. 4%, P = 0.46). Any CAD, obstructive CAD, and NCP were higher for young individuals with diabetes, hypertension, dyslipidaemia, current smoking, or family history of CAD; while only diabetes and dyslipidaemia were associated with CP. Increasing cardiovascular RFs was associated with a greater prevalence and extent and severity of CAD, with individuals with 0, 1, 2, ≥3 RFs manifesting a dose-response increase in any CAD (P < 0.001, for trend), obstructive CAD (P < 0.001, for trend), NCP (P < 0.001, for trend), and CP (P < 0.001, for trend). In multivariable analysis adjusting for sex and cardiovascular RFs, male sex was the strongest predictor for any CAD (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.43-2.66, P < 0.001), CP (OR = 1.46, 95% CI = 1.08-1.98, P = 0.01), and NCP (OR = 1.33, 95% CI = 1.06-1.67, P = 0.01); family history of CAD was the strongest predictor for obstructive CAD (OR = 2.71, 95% CI = 1.65-4.45, P < 0.001).
  
  
  CONCLUSIONS
  Any and obstructive CAD is present in 1 in 5 and 1 in 20 young individuals, respectively, with family history associated with the greatest risk of obstructive CAD.
authors.affiliation: Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Otaki
authors.affiliation: Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.affiliation: Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Cheng
authors.affiliation: Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.affiliation: Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Troy
authors.initials: T
authors.lastname: Labounty
authors.affiliation: Department of Medicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.affiliation: Department of Medicine, University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.affiliation: Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Chinnaiyan
authors.affiliation: Department of Medicine and Radiology, University of Ottawa, Ontario, Canada.
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
authors.affiliation: Capitol Cardiology Associates, Albany, NY, USA.
authors.forename: Augustin
authors.initials: A
authors.lastname: Delago
authors.affiliation: Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.affiliation: Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Hausleiter
authors.affiliation: University Hospital, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaufmann
authors.affiliation: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.affiliation: William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.affiliation: Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.affiliation: Baptist Cardiac and Vascular Institute, Miami, FL, USA.
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.affiliation: Seoul National University Hospital, Seoul, South Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Department of Medicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA Department of Radiology, Weill Cornell Medical College and the NewYork-Presbyterian Hospital, 413 E. 69th Street, New York, NY 10021, USA jkm2001@med.cornell.edu runone123@gmail.com.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed
keywords: coronary CT angiography; coronary artery disease; coronary risk factors; young adults