Risk factor comparison in young patients presenting with acute coronary syndrome with atherosclerotic coronary artery disease vs. angiographically normal coronaries

Abstract

Background: Acute myocardial infarction is a relatively rare phenomenon in the young population. The incidence has nevertheless increased from years past, likely due to the presence of multiple risk factors from an increasingly younger age. Regardless of whether they have atherosclerotic coronary artery disease or normal coronary angiogram, young patients with risk factors for coronary artery disease (CAD), chest pain, and positive troponin, are initially treated in a similar fashion. Our goal was to shed light on whether risk factors between these two groups differ to help guide physicians in clinically determining whether or not an atherosclerotic cardiovascular event has occurred, as well as to potentially identify young patients at risk of acute coronary syndrome (ACS) despite normal coronary arteries. Methods: A retrospective cross sectional study was undertaken over an 8 year period at Tawam Hospital. 576 patients aged 50 or under who underwent coronary angiography were selected for the study. Medical records were analyzed for the patient's demographics and CAD risk factor profile, including the following variables: family history of CAD, smoking status, Body Mass Index category, lipid profile, and diagnosis of hyperlipidemia, diabetes, or hypertension. Details of the coronary angiogram were also reviewed. Results: Statistically significant outcomes included a higher prevalence of diabetes, hyperlipidemia, and smoking history in patients with CAD compared to the patients with normal coronary angiogram. Diabetes was one of the strongest risk factors in CAD patients, with an odds ratio of 1.98 (p= 0.011), followed by hyperlipidemia at 1.85 (p= 0.021). Smoking history had an odds ratio of 2.93 (p <0.001). Conclusion: Risk factors were present in both groups, but significantly more in the CAD group. No particular risk factor stood out for the development of ACS in those with normal coronary arteries, other than mean BMI being slightly higher in this group. Based on our analysis, no single variable can accurately predict the risk for ACS in normal coronaries. To our knowledge, few studies have been done in the young population with angiographically normal coronary arteries to determine possible risk factors for development of ACS. Further research needs to be done to determine whether the risk factors that were common amongst both groups are coincidental, or a cause of ACS in those with normal coronary arteries.

Effects of Serum LDL-C, CysC, and D-D in Patients with Coronary Atherosclerotic Heart Disease

“…Most of the cholesterol in the human body exists and is transported in the form of binding to lipoproteins and then transported to various parts of the body to play corresponding roles [ 3 ]. Studies have shown that the elevated contents of total cholesterol and LDL-C in the blood circulation are related to coronary atherosclerosis [ 9 ].…”

“…Therefore, it is of great significance to accurately diagnose and evaluate the degree of coronary artery disease in cases with CHD. Although coronary angiography is the gold standard for evaluating the severity of CHD, it has inevitable limitations as a high-cost, invasive procedure [ 3 ]. Studies have found that dyslipidemia is closely connected with CHD, and low-density lipoprotein cholesterol (LDL-C) is a crucial hazardous factor for CHD [ 4 ].…”

ST-Elevation Acute Myocardial Infarction in a Young Man

“…Among previous reports, current age of onset was 19 years old [ 3 , 6 - 9 ]. Age range between 19 and 29 years, and female sex were the only categories in which the number of patients with angiographically normal coronary arteries was higher than those with atherosclerotic CAD [ 3 ]. This could mean that patients with normal coronary anatomy may not be having an acute coronary syndrome (ACS) and could be presenting with symptoms due to other conditions, or out of fear that they may be experiencing an ACS [ 3 ].…”

“…Acute myocardial infarction (AMI) is the leading worldwide cause of cardiovascular events, and angina is commonly seen before AMI [1,2]. AMI is extremely rare in young patients: in one study in Poland, individuals under age 40 represented only 1-6% of all AMI patients [2][3][4][5]. The rate of incidence has increased over years past in younger patients (< 35 years old) compared to older patients, and the age of onset is gradually falling, likely due to the following multiple risk factors such as smoking, obese, hypertension, diabetes, hyperlipidemia (higher level of low-density lipoprotein-cholesterol (LDL-C)), higher level of uric acid, history of coronary artery disease, family history of premature AMI, non-obstructive coronary artery disease (CAD), and genetic polymorphisms related to blood coagulation, fibrinogen, homocysteine, being present [3,[6][7][8][9].…”

“…The rate of incidence has increased over years past in younger patients (< 35 years old) compared to older patients, and the age of onset is gradually falling, likely due to the following multiple risk factors such as smoking, obese, hypertension, diabetes, hyperlipidemia (higher level of low-density lipoprotein-cholesterol (LDL-C)), higher level of uric acid, history of coronary artery disease, family history of premature AMI, non-obstructive coronary artery disease (CAD), and genetic polymorphisms related to blood coagulation, fibrinogen, homocysteine, being present [3,[6][7][8][9]. Among previous reports, current age of onset was 19 years old [3,[6][7][8][9]. Age range between 19 and 29 years, and female sex were the only categories in which the number of patients with angiographically normal coronary arteries was higher than those with atherosclerotic CAD [3].…”