CLINICAL FACTORS AND ANGIOGRAPHIC FEATURES ASSOCIATED WITH PREMATURE CORONARY-ARTERY DISEASE

Background: Clinical, angiographic, and biochemical features may differ in you Methods: We compared clinical and angiographic characteristics in 100 male patients with clinical onset of disease at age less than or equal to 45 years (group 1) with those of 100 older male patients (clinical onset of disease at greater than or equal to 60 years) (group 2). Ah 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 (59vs 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<0.001) 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.