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

Background: Clinical, angiographic, and biochemical features may diffe r in young patients with coronary heart disease compared with older pa tients. 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 patie nt groups were compared in terms of the pattern of angina at disease o nset, angiographic features, and coronary risk factors. Results: Seven ty-six patients in group 1 and 49 patients in group 2 presented with a cute coronary syndromes (unstable angina or myocardial infarction) at clinical disease onset (p<0.001). Compared with patients in group 2, y ounger patients (group 1) showed a preponderance of single-vessel dise ase (54 vs 36%; p<0.001) and complex stenosis morphologic features (59 vs 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 m mol/L in group 1 and 6.1+/-1.2 mmol/L in group 2 (p=NS). Younger patie nts, 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 triglyc eride 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 coron ary 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 lev els are associated with premature coronary artery disease.