title: Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq.
abstract: BACKGROUND
  Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. Given the lack of such studies in the country, this study examines the prevalence, associated cardiovascular risk factors, and coronary angiographic profile of the disease in Iraq.
  
  
  METHODS
  Data was collected from a total of 445 adult patients undergoing coronary angiography at Duhok Heart Center, Kurdistan in a period between March and September 2014. Patients were divided into PCAD (male <45 years and female < 55 years) and mature coronary artery disease (MCAD).
  
  
  RESULTS
  The prevalence of the angiographically documented PCAD was 31 %. The PCAD had higher rates of hyperlipidemia (p = 0.04), positive family history of coronary artery disease (p = 0.002), type A lesions (p = 0.02), single vessel disease (p = 0.01) and medical treatment (p = 0.01) than the MCAD. Logistic regression model indicated that male sex (OR 3.38, C.I 1.96-7.22), smoking (OR 2.08, C.I 1.05-4.12), hypertension (OR 1.58, C.I 1.25-2.03), hyperlipidemia (OR 1.89, C.I 1.17-2.42) and positive family history of coronary artery disease (OR 2.62, C.I 1.38-9.54) were associated with the PCAD. Sensitivity analysis showed highest specificity (94.2 %) and positive predictive value (96.5 %) in patients with coronary stenosis >70 % compared to lesser obstruction.
  
  
  CONCLUSIONS
  Premature coronary artery disease is alarming  in the country. Cardiovascular risk factors are clustered among them. But the angiographic profile and therapeutic options of PCAD are close to those reported from previous studies.
authors.affiliation: Division of Cardiology, Department of Medicine, Medical School, Faculty of Medical Sciences, University of Duhok, Duhok, Kurdistan, Iraq. doctoramb@yahoo.com.
authors.forename: Ameen Mosa
authors.initials: AM
authors.lastname: Mohammad
authors.affiliation: Duhok Heart Center, Duhok, Kurdistan, Iraq. hekmatizzat@yahoo.com.
authors.forename: Hekmat Izzat
authors.initials: HI
authors.lastname: Jehangeer
authors.affiliation: Division of Cardiology, Department of Medicine, Medical School, Faculty of Medical Sciences, University of Duhok, Duhok, Kurdistan, Iraq. shaikhow@yahoo.uk.com.
authors.forename: Sabri Khalif
authors.initials: SK
authors.lastname: Shaikhow
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index