Young Coronary Artery Disease Research Articles

A case control study on lipoprotein (a) levels in young coronary artery disease patients and their first degree relatives

A case control study on lipoprotein (a) levels in young coronary artery disease patients and their first degree relatives

Serum Trimethylamine N-Oxide, Choline, Betaine, and Carnitine levels among Coronary Artery Disease patients

Background and aimRecent studies have linked Trimethylamine N-oxide (TMAO) to cardiovascular diseases; our study aimed to analyze the association between coronary artery disease (CAD) and TMAO. MethodsPubMed, Scopus, Embase, and Web of Science were searched using terms; such as “CAD” and “TMAO”. Only observational controlled studies were included. RevMan software version 5.4 was used for the analysis. ResultsA significant association was found between the CAD group and increased serum TMAO levels compared with the control group (MD = 1.16, 95% CI = 0.54 to 1.78, p-value =0.0003). This association remained significant among acute coronary syndrome (ACS) patients (MD=0.98, 95% CI =0.73 to 1.23, p-value <0.00001) and was also detected among young and old CAD patients (MD = 0.35, 95% CI = 0.06 to 0.64, p-value = 0.02 and MD = 1.36, 95% CI = 0.71 to 2.01, p-value <0.0001, respectively). On further analysis of intestinal metabolites, we detected an insignificant association between choline, betaine, carnitine, and CAD. According to our sensitivity analysis, TMAO is an acceptable discriminatory marker for CAD (0.721, SE was 0.0816, 95% CI 0.561 to 0.881). ConclusionTMAO is an acceptable discriminatory marker for CAD, with significantly higher levels among these patients regardless of their age. Other metabolites didn't show such an association. The role of serum level TMAO in the early diagnosis of CAD should be further explored.

Very young coronary artery disease: Case series of 11 patients ≤35 years old undergoing CABG over 10 years from Hospital Serdang, Malaysia

Very young coronary artery disease: Case series of 11 patients ≤35 years old undergoing CABG over 10 years from Hospital Serdang, Malaysia

Serum trimethylamine N-oxide levels among coronary artery disease and acute coronary syndrome patients: a systematic review and meta-analysis

Background and Aim: Recent studies have linked trimethylamine N-oxide (TMAO) to cardiovascular diseases; our study aimed to analyze the association between coronary artery disease (CAD), acute coronary syndrome (ACS), and TMAO. Methods: PubMed, Scopus, Embase, and Web of Science were searched using terms such as ʻCADʼ and ʻTMAOʼ. Only observational controlled studies were included. RevMan software version 5.4 was used for the analysis. Results: A significant association was found between the CAD group and increased serum TMAO levels compared with the control group (MD=1.16, 95% CI=0.54–1.78, P=0.0003). This association remained significant among acute coronary syndrome patients (MD=0.98, 95% CI=0.73–1.23, P&lt;0.00001) and was also detected among young and old CAD patients (MD=0.35, 95% CI=0.06–0.64, P=0.02 and MD=1.36, 95% CI=0.71–2.01, P&lt;0.0001, respectively). On further analysis of intestinal metabolites, the authors detected an insignificant association between choline, betaine, carnitine, and CAD. According to our sensitivity analysis, TMAO is an acceptable diagnostic marker for CAD (0.721, SE was 0.0816, 95% CI: 0.561–0.881). Conclusion: TMAO is an acceptable diagnostic marker for CAD, with significantly higher levels among these patients regardless of their age. Other metabolites did not show such an association. The role of serum level TMAO in the early diagnosis of CAD should be further explored.

CORONARY ARTERY BYPASS SURGERY IN YOUNG ADULT A INSTITUTIONAL RETROSPECTIVE STUDY

Objective: To study the overall causes, perioperative mortality, post operative complications, prognosis, outcome and follow up in a young adult present with coronary artery disease under going coronary artery bypass in our institute. Methods: Asum of 56 patient who are 40 years and less then 40 years who underwent coronary artery bypass surgery between January 2017 to December 2022 who's clinical case history, coronary angiography, pre operative and post operative echo cardiography, operative notes, post operative notes, outpatient follow up are collected from our computer stored data and from medical record department in our college and from Tamilnadu chief minister comprehensive health insurance scheme institutional Web site data base Results: Out of 56 patient,8 Female(14.3%) and 48 Male(85.7%),mean age 37.1 years (range 32 – 40 years),Diabetic 39 Patient (62.5%),Hypertensive 21 patient (37.5%) 7 / 8 women(87.5%) diabetic ,3/8 women both diabetic and hypertensive. Out of 48 male 47(97.9%) chronic smoker, 45 (93.8%) chronic alcoholic,44 (91.6%) both alcoholic and smoke , no women in this study neither alcoholic or smoker, 3patient (5.35%) hyperlipidaemia, 2 patient (3.57%) hypothyroidism all 2/8 (25%) are female,2 patient on haemodialysis for kidney disease, 1patient with bilateral renal artery stenosis, 1 patient with right innominate, right subclavian, bilateral carotid stenosis. Left ventricular function was impaired with ejection fraction average 46% (range 30% - 55%). 1 patient with ventricular septal rupture.2 patient with post coronary stent, The indication for surgery was triple vessel disease in 30 patient(53.57%) ,double vessel disease in 20 patient(35.7%),single vessel disease in 1 patient, single vessel disease with ventricular septal rupture in 1 patient, left main coronary artery stenosis in 4 patient(7%). Surgical procedure Off pump coronary artery bypass surgery in 51 patient(91%), On pump beating heart coronary artery bypass surgery in 2 patient (3.57%),On pump arrested heart coronary artery bypass surgery in 3 patient(5.35%). A total of 132 grafts were constructed(mean 2.4 grafts per patient),35 (27%) of them being arterial only left internal mammary artery harvested and other grafts were great saphenous vein. Post operative average ventilation time18hrs (range 18hrs to 24hrs), There were 5(8.9%)hospital death and 5(8.9%) late death in follow up, total 10 (17.8%) death till now. Conclusion: Most common cause for young coronary artery disease from our clinical history is found to be early onset diabetic mellitus and from our personal history chronic smoking and chronic alcoholism, intra operative mortality and morbidity is high in patient present with severe left ventricular dysfunction, coronary artery diseases induced complication and additional comorbidity, however most of patient recovered from post operative cardiovascular lethal or morbid event and on regular clinical follow up

Comparison of clinical profiles and associated factors for acute myocardial infarction among young and very young patients with coronary artery disease.

This study aimed to compare the profiles of young and very young patients with coronary artery disease (CAD) and explore the factors associated with acute myocardial infarction (AMI) based on age. Young CAD patients aged between 18 and 44 years diagnosed by angiography were enrolled retrospectively. They were divided into two groups according to age: young CAD was defined as patients aged between 36 and 44 years, and very young CAD was defined as patients aged between 18 and 35 years. Demographic and clinical characteristics of the patients were collected. In total, 9286 patients were included in the final database. Most were assigned to the young CAD group (86.5%), and 1250 (13.5%) had very young CAD. Most demographic and clinical characteristics of the young and very young patients with CAD differed significantly. The proportion of patients with CAD in the total population increased with age, whereas the incidence of AMI showed a decreasing trend. A previous percutaneous coronary intervention (PCI) was negatively associated with AMI. Dyslipidemia, current smoking, and hyperhomocysteinemia were positively associated with AMI in the overall and young population with CAD. The clinical profiles and factors associated with AMI in CAD patients of different ages were significantly different. Lifestyle-related factors were significantly associated with AMI in young patients with CAD.

Type 2 diabetes significantly modulates the power of lipoprotein(a) to predict cardiovascular events and mortality in young coronary artery disease patients

Background and Aims : Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals. The power of Lp(a) to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM) however is unclear and is addressed in the present study.

Changing trends of patients undergoing thrombolysis for acute ST-elevated myocardial infarction in tertiary care hospital in Maharashtra, India

Background: Coronary artery disease (CAD) is becoming a major cause of morbidity and mortality burden in the developing world. Indians have been associated with a more severe form of CAD that has its onset at a younger age group with a male predominance. Reperfusion of the occluded coronary artery at the earliest is the most important aim of management of acute ST-elevation myocardial infarction (STEMI). Aim: The aims of this work were to (1) study the changing trends in patients presenting with STEMI, (2) the outcomes of patients undergoing thrombolysis in a tertiary care hospital, and (3) the increasing trend of CAD in young (CADY). Materials and Methods: A total of 500 patients undergoing thrombolysis between January 2017 and December 2019 were studied retrospectively. We studied the age of presentation, sex, agents used for thrombolysis, their angiography findings, and their management and outcome. Results: CADY in less than 45 years of age was noted in 26.2% in our study. It was more common in men. Left anterior descending coronary artery (LAD) was the most common artery to be involved in single-vessel coronary artery disease (SVCAD) patients followed by the right coronary artery (RCA). Door to needle time in our study was 28 min. Conclusion: The prevalence of CADY Indians in our study was significantly high. The most common age group of men presenting with STEMI was 51–55 years, followed by 45–50 years. The most common age group of women presenting with CAD was 61–65 years.

Abstract 8937: Type 2 Diabetes Significantly Modulates the Power of Lipoprotein(a) to Predict Cardiovascular Events and Mortality in Young Coronary Artery Disease Patients

Introduction: Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals. Hypothesis: We hypothesize that Lp(a) has the power to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM). Methods: Lp(a) was measured in a cohort of 731 patients with angiographically proven CAD who were aged &lt;65 years. Vascular events were recorded over a mean follow-up of 6.6±3.2 years. At baseline, 216 patients had T2DM, and 515 did not have diabetes. Results: During follow-up, 30.2% of our patients suffered cardiovascular events. Lp(a) proved to be a strong and independent predictor of vascular events in the total study cohort (standardized adjusted HR=1.30 [1.07-1.56]; p=0.007). In subgroup analyses by diabetes status, Lp(a) significantly predicted vascular events in non-diabetic patients (standardized adjusted HR= 1.39 [1.12-1.74]; p=0.003) but not in diabetic patients (standardized adjusted HR=0.93 [0.63-1.38]; p=0.731). An interaction term Lp(a)xT2DM was significant (p=0.002), indicating that T2DM significantly modulated the power of Lp(a) to predict cardiovascular events. Conclusions: We conclude that Lp(a) significantly modulates the power of Lp(a) to predict cardiovascular events in CAD patients &lt;65 years.

Type 2 diabetes significantly modulates the power of lipoprotein(a) to predict cardiovascular events and mortality in young coronary artery disease patients

Abstract   Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals. The purpose of this study was to investigate whether Lp(a) has the power to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM). Lp(a) was measured in a cohort of 731 patients with angiographically proven CAD who were aged &amp;lt;65 years. Vascular events were recorded over a mean follow-up of 6.6±3.2 years. At baseline, 216 patients had T2DM, and 515 did not have diabetes. During follow-up, 30.2% of our patients suffered cardiovascular events. Lp(a) proved to be a strong and independent predictor of vascular events in the total study cohort (standardized adjusted HR=1.30 [1.07–1.56]; p=0.007). In subgroup analyses by diabetes status, Lp(a) significantly predicted vascular events in non-diabetic patients (standardized adjusted HR= 1.39 [1.12–1.74]; p=0.003) but not in diabetic patients (standardized adjusted HR=0.93 [0.63–1.38]; p=0.731). An interaction term Lp(a) x T2DM was significant (p=0.002), indicating that T2DM significantly modulated the power of Lp(a) to predict cardiovascular events. We conclude that Lp(a) significantly modulates the power of Lp(a) to predict cardiovascular events in CAD patients &amp;lt;65 years. Funding Acknowledgement Type of funding sources: None.

Combined effect of hyperhomocysteinemia and smoking on the severity of coronary artery disease in young adults\u2009\u2264\u200935\xa0years of age: a hospital-based observational study

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.

Lipoprotein (a) in young coronary artery disease and its association with severity of coronary artery disease

Background and Aims: Numerous studies have suggested the causal association of high serum Lp(a) and elevated CVD risk. The aim of this study is to evaluate Lp(a) as risk factor for young coronary artery disease (CAD) and to find the association between elevated Lp(a) levels and severity of CAD.

Screening for Premature Coronary Artery Disease (CAD) using Coronary Artery Calcium (CAC) Score: A Primary Prevention Pilot Study

Acute Coronary Syndrome (ACS) events can be accelerated by positive family history of young coronary artery disease (CAD). Risk factors assessment sometimes fail to predict ACS occurrence. Additional investigations with coronary artery calcium (CAC) score can be used independently in screening for primary prevention in some population. This was a cross-sectional study in asymptomatic population with first degree relatives (FDR) having premature CAD compared with a matched population with no family history of CAD from September 2017 to March 2018 at the Cardiology Clinic of Univeristi Kebangsaan Malaysia Medical Centre. A total of 36 subjects were recruited with equal number in each group. Female were the majority in each group (66.7%). The FDR group were slightly younger compared to the control group [mean (SD) age 36.9 (4.9) against 38 (3.8), respectively). Both groups represent high risk factors including overweight and obesity, abdominal obesity as well as dyslipidemia. Newly diagnosed dyslipidemia was significant in the group with family history (83.3% versus 44.4%, P&lt;0.01). Both groups were screened either into the low or moderate risk Framingham Risk Score group. CAC score was higher in family history group (11.1% vs 0%, P&gt;0.05). In conclusion, CAC may be irrelevant for screening in younger population. However, the yield of other risk factor is still alarming.

381-P: Type 2 Diabetes Significantly Modulates the Power of Lipoprotein(a) to Predict Cardiovascular Events and Mortality in Young Coronary Artery Disease Patients

Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals. The power of Lp(a) to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM) however is unclear and is addressed in the present study. Lp(a) was measured in a cohort of 731 patients with angiographically proven CAD who were aged &amp;lt;65 years. Vascular events were recorded over a mean follow-up of 6.6±3.2 years. At baseline, 216 patients had T2DM, and 515 did not have diabetes. During follow-up, 30.2% of our patients suffered cardiovascular events. Lp(a) proved to be a strong and independent predictor of vascular events in the total study cohort (standardized adjusted HR=1.30 [1.07-1.56]; p=0.007). In subgroup analyses by diabetes status, Lp(a) significantly predicted vascular events in nondiabetic patients (standardized adjusted HR= 1.39 [1.12-1.74]; p=0.003) but not in diabetic patients (standardized adjusted HR=0.93 [0.63-1.38]; p=0.731). An interaction term Lp(a)xT2DM was significant (p=0.002), indicating that T2DM significantly modulated the power of Lp(a) to predict cardiovascular events. We conclude that Lp(a) significantly modulates the power of Lp(a) to predict cardiovascular events in CAD patients &amp;lt;65 years. Disclosure A. Mader: None. C. H. Saely: None. M. Maechler: None. B. Larcher: None. L. Sprenger: None. B. Mutschlechner: None. A. Leiherer: None. A. Muendlein: None. A. Vonbank: None. H. Drexel: None.

Association of MTHFR C677T (rs1801133) and A1298C (rs1801131) Polymorphisms with Serum Homocysteine, Folate and Vitamin B12 in Patients with Young Coronary Artery Disease.

C677T (rs1801133) and A1298C (rs1801131) MTHFR gene polymorphisms and/or nutritional deficiency of folate/vitamin B12 leading to hyperhomocysteinemia is an established risk factor for CAD. The objective of this study was to evaluate the clinical usefulness of association between MTHFR C677T (rs1801133) and A1298C (rs1801131) polymorphisms with serum homocysteine, folate and vitamin B12 in addition to conventional cardiovascular risk factors in patients with young CAD. Genomic DNA was isolated from the whole blood. Genotyping of MTHFR C677T (rs1801133) and MTHFR A1298C (rs1801131) polymorphisms in young CAD patients and healthy controls was performed by ARMS-PCR method. Serum homocysteine, vitamin B12 and folate were estimated by CMIA and lipid profile parameters were measured by automated chemistry analyzers. Serum homocysteine levels were significantly higher but serum folate and vitamin B12 levels were not significantly different among young CAD group as compared to control group. Statistically significant hyperhomocysteinemia was observed in carriers of T allele for MTHFR 677C/T (rs1801133) genotype in young CAD group but this association was not significant for MTHFR 1298A/C (rs1801131) polymorphism. The association between hyperhomocysteinemia and CAD in young group was not independent of conventional cardiovascular risk factors. Risk of hyperhomocysteinemia and young CAD could be monitored by MTHFR polymorphism detection followed by serum homocysteine, folate and vitamin B12 measurements. The findings could help to prevent or delay the occurrence of young CAD through appropriate measures.

FH CatScreen: computer-based familial hypercholesterolemia (FH) screening and categorisation application based on various FH diagnostic criteria

Background and Aims: Familial hypercholesterolemia (FH) is the most common autosomal dominant inherited dyslipidaemia. FH is treatable with low-cost lipid lowering therapies, leading to a substantial reduction in premature coronary artery disease (CAD) if detected and treated early. Hence, screening for FH in young CAD is of utmost importance. Currently, the diagnostic scoring and categorisation of FH patients is primarily done manually using paper-based. The goal of this study is to develop a computer-based FH screening application (FH CatScreen) to facilitate the diagnostic scoring and categorisation of patients by medical practitioners based on Dutch Lipid Clinic Network Criteria, Simon Broome, US-MEDPED and Japanese FH Management Criteria.

Profile of acute coronary syndrome in young diabetics: a review

The clinical presentation and angiographic findings of coronary artery disease (CAD) varies from diabetic and non-diabetic patients and varies with the age of presentation. Coronary artery disease in patients below the age of 45 is a special subset. The objective of this study is to compare the clinical and angiographic profile in patients with the acute coronary syndrome (ACS) with diabetes mellitus (DM) and without DM below the age of 45 years. Clinical Presentation of coronary artery disease in young patients with various risk factors differs, which plays an important role in management strategies. This was conducted through internet search on PubMed and ProQuest database from 2000 to until 2019. Key words used for searching are acute coronary syndrome, young diabetics, and clinical, angiographic profile. An important exclusion criterion is studies which included type one diabetic patients. Totally 35 papers were reviewed. Pattern of involvement of coronary arteries as assessed by the coronary angiographic study is found to be different in younger CAD patients. Atypical clinical presentation and distinct angiographic finding are common in diabetics below the age of 45. In most of the studies single vessel disease (SVD) is the most common angiographic finding in young CAD and non-diabetics. While the diabetics showed the more diffuse pattern of double vessel disease (DVD).

Young adults Undergoing Coronary Artery Bypass Grafting (CABG)

Background: Coronary artery bypass grafting (CABG) is referred to as the gold standard therapeutic modality for treating coronary artery disease (CAD) among both old or young patients. hypertension, diabetes, Increased BMI and obesity, etc. are among the major risk factors for the development of cardiovascular diseases. The aim of the current study was to highlight the increasing rate of CAD and associated CABG surgery among young adults and to identify the potential risk factors associated with it.&#x0D; Methodology: In this hospital based observational study, CAD patients ≤40 years of age admitted to the cardiac surgery department of a leading cardiac center for CABG surgery were included in the study. The study continued from 5th January 2018 to 21st August 2019 and the data of 184 patients who underwent CABG was collected during this time period. The details regarding patients' age, weight, height and body mass index (BMI) were obtained at the time of initial examination. Moreover, medical records, familial history and risk profile were also monitored. The collected data was analyzed using SPSS Version 22.0.&#x0D; Results: A total of 184 CAD patients who underwent CABG surgery were included in the study and 114(62%) of them were males and 70(38%) were females. The age range was 25 to 40 years with the mean age of 36.5±3.17 years. The risk profile displayed that increased BMI was the major contributor for cardiovascular disease i.e. 38% patients were overweight, 10.9% were in Obese I category and 5.97% were in obese II category. Following obesity, hypertension (49.5%), diabetes (29.9%) and dysfunctional lipids (14.7%) were common comorbid conditions. While smoking and positive familial history also contributed to the risk ratio. It was observed that hypertension, diabetic history was more among overweight and obese individuals (p=0.029 &amp; 0.666).&#x0D; Conclusion: Young CAD patients ≤40 years of age display decreased risk and adverse outcomes as compared to the older counterparts but the clinical pattern of presentation is different and hence require different strategic attention.

Prevalence of risk factors in young coronary artery disease patients diagnosed with and without familial hypercholestrolemia

Prevalence of risk factors in young coronary artery disease patients diagnosed with and without familial hypercholestrolemia

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