Abstract
BackgroundThe prevalence of coronary artery disease (CAD) continues to increase among young Chinese adults. Current smoking has been recognized as a major risk factor for premature CAD, and hyperhomocysteinaemia (HHcy) has also been suggested to be associated with CAD progression. However, the combined effect of current smoking and HHcy on the severity of coronary artery stenosis in young adults is still uncertain.MethodsWe consecutively collected young patients (18–35 years of age), diagnosed with CAD and underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and May 2020. HHcy was defined as serum homocysteine (Hcy) level > 15 µmol/L. The severity of coronary artery stenosis was evaluated by Gensini Score. The co-effect of current smoking and HHcy on CAD severity as well as the relationship between plasma Hcy, pack-years of smoking and CAD severity were assessed by multivariate linear regression analysis.ResultsA total of 989 participants (mean age, 33 years; 96.2% male) fulfilling the criteria were enrolled in this study. Patients with both HHcy and current smoking accounted for 39.1% of all the subjects. Multivariate liner analysis indicated both serum Hcy levels (β 0.302; 95% CI 0.141–0.462; P < 0.001) and pack-years of smoking (β 0.523; 95% CI 0.265–0.781; P < 0.001) were independently associated with the severity of coronary artery stenosis after adjusting for other traditional confounders. In addition, serum Hcy levels were correlated with pack-years of smoking in young CAD patients (r = 0.116, P = 0.001). Moreover, combination of HHcy and current smoking was suggested to have higher risk for CAD severity (β 17.892; 95% CI 11.314–24.469; P < 0.001), compared with HHcy (β 7.471; 95% CI 0.009–14.934; P = 0.048) or current smoking (β 7.421; 95% CI 0.608–14.233; P = 0.033) alone.ConclusionCombination of HHcy and smoking is independently associated with the severity of CAD in young patients ≤ 35 years of age.
Highlights
Coronary artery disease (CAD), with a continuously rising prevalence and mortality, has become a significant public health problem in China [1]
Hypertriglyceridemia was defined as triglycerides (TG) ≥ 1.7 mmol/L, hypercholesterolemia was defined as total cholesterol (TC) ≥ 5.2 mmol/L, a high low-density lipoprotein cholesterol (LDL-C) level was defined as LDL-C ≥ 3.4 mmol/L, and a low high-density lipoprotein cholesterol (HDL-C) level was defined as HDL-C < 1.0 mmol/L [13]
The results indicated that diabetes mellitus (DM) (β 8.310; 95% Confidence intervals (CI) 2.656– 13.965; P = 0.004) and high LDL-C (β 9.022; 95% confidence intervals (95% CI) 1.876–16.168; P = 0.013) were the significant risk factors, while drinker was a protective factor for the severity of coronary artery disease (CAD) among young adults, after adjusting for confounding factors
Summary
Coronary artery disease (CAD), with a continuously rising prevalence and mortality, has become a significant public health problem in China [1]. Several traditional risk factors, such as age, current smoking status, diabetes mellitus (DM), and increased low-density lipoprotein cholesterol (LDL-C) level, have been identified to be correlated with the severity of CAD among young patients [4, 5]. Some studies indicated hyperhomocysteinemia (HHcy), as a non-traditional risk factor, was positively associated with severe CAD by increasing lesion counts in patients with premature CAD, which was due to the vascular endothelial damage and dysfunction [6]. Another study indicated pack-years of smoking were significantly positively correlated with serum Hcy levels, which may due to the effect of oxidative damage [8]. The combined effect of current smoking and HHcy on the severity of coronary artery stenosis in young adults is still uncertain
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