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Chen S, Li Z, Li H, Zeng X, Yuan H, Li Y. RNA Sequencing of Whole Blood in Premature Coronary Artery Disease: Identification of Novel Biomarkers and Involvement of T Cell Imbalance. J Cardiovasc Transl Res 2024; 17:638-647. [PMID: 38038868 DOI: 10.1007/s12265-023-10465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
Serum biomarkers were explored based on the peripheral blood gene expression profiles of premature coronary artery disease (PCAD). RNA sequencing (RNA-Seq) was used to detect PCAD-specific differentially expressed genes (DEGs). Quantitative real-time polymerase chain reaction (RT-PCR) was used to validate the most significant DEGs, and enzyme-linked immunosorbent assay (ELISA) was utilized to quantify the effect on corresponding serum proteins. Fifty-nine PCAD-specific DEGs were identified. Functional analysis showed positive regulation of T cell-mediated cytotoxicity, regulation of T cell-mediated immunity, and the regulation of alpha-beta T cell proliferation which were enriched in PCAD. RT-PCR validated the significant difference in the expression of BAG6, MUC5B, and APOA2 between PCAD and late-onset coronary artery disease (LCAD) patients. ELISA validation showed serum MUC5B increased dramatically in PCAD when compared to LCAD. Our study found T cells contribute to the occurrence of PCAD, and the inflammatory factor MUC5B may be a novel serum marker in PCAD patients.
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Affiliation(s)
- Si Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhan Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Haolong Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoli Zeng
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Yuan
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongzhe Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
- State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Goulden CJ. Percutaneous coronary intervention versus coronary artery by-pass grafting in premature coronary artery disease: What is the evidence? -A narrative review. Perfusion 2023:2676591231223356. [PMID: 38108274 DOI: 10.1177/02676591231223356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Coronary artery disease (CAD) remains one of the leading causes of death globally. In the United States of America, in 2016, 19% of all patients under the age of 65 died of cardiovascular disease despite improvements in primary prevention. The premature clinical onset of symptoms in the young population (<60 years) is much more aggressive than in the older population, and the overall long-term prognosis is poor. CAD appears to have a rapidly progressive form in those under the age of 60 due to genetic predisposition, smoking, and substance abuse, however, the ideal management strategy is still yet to be established. The two primary methods of establishing coronary revascularization are percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Despite the increasing prevalence of CAD in the young population, they are consistently underrepresented in major randomized clinical trials of each revascularization strategy. Both CABG and PCI are known to have similar survival rates, but PCI is associated with higher repeat revascularization rate. Many argue this may be due to the progressive nature of CAD combined with the vessel patency time required in a patient under 60 with potentially another 20-30 years of life. There is little in literature regarding the outcomes of these various revascularization strategies in populations under 60 years with CAD. This review summarises the current evidence for each revascularisation strategy in patients under the age of 60 and suggests future avenues of research for this unique age group.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Muhammad AS, Ashraf T, Mir A, Alishan S, Farooq F, Ammar A, Karim M, Rizvi SNH, Saghir T, Sial JA, Khan NU. Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single vs multivessel disease. World J Cardiol 2020; 12:136-143. [PMID: 32431784 PMCID: PMC7215964 DOI: 10.4330/wjc.v12.i4.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/10/2019] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Even though percutaneous coronary intervention (PCI) improved the survival of patients with acute myocardial infarction, still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease (SVD).
AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease (MVD).
METHODS The retrospective cohort of patients were divided into two groups: SVD and MVD group. The study population consisted of both male and female young (≤ 45 years) patients presented with ST-elevation myocardial infarction (STEMI) at the National Institute of Cardiovascular Disease, Karachi, Pakistan and undergone primary PCI from 1st July 2017 to 31st March 2018. Pre and post-procedure management of the patients was as per the guidelines and institutional protocols.
RESULTS A total of 571 patients with STEMI, ≤ 45 years were stratified into two groups by the number of vessels involved, 342 (59.9%) with SVD and 229 (40.1%) with MVD. The average age of these patients was 39.04 ± 4.86 years. A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group (25.1% vs 38%, P < 0.01; 11.7% vs 27.5%, P < 0.001) respectively. While, smoking was more prevalent among the SVD group as compare to MVD group (36.3% vs 28.4%, P = 0.05). The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group (48.8% vs 39.2%, P = 0.021). Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98% vs 96.5% of the patients is SVD vs MVD group.
CONCLUSION The MVD comprised of around 40% of the young patients presented with STEMI. Also, this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases, therefore, preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.
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Affiliation(s)
- Atif Sher Muhammad
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Tariq Ashraf
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Ayaz Mir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Syed Alishan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Faiza Farooq
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Ali Ammar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Musa Karim
- Department of Clinical Research, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Syed Nadeem Hassan Rizvi
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Naveed Ullah Khan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
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Mean Platelet Volume Predicts Short-term Prognosis in Young Patients with St-segment Elevation Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background: Acute ST-elevation myocardial infarction (STEMI) is an uncommon diagnosis in patients less than 40 years of age. Over the last two decades, there is an increase in the frequency of cardiovascular events among young adults. However, at present there is only limited clinical data on the clinical characteristics and outcomes of STEMI in young patients who were treated with primary percutaneous coronary intervention (pPCI). Plaque erosion is the underlying pathological mechanism leading to STEMI in the vast majority of young adults. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. Mean platelet volume (MPV) is recognized as a marker of the platelet activation process and may be a better indicator of short-term prognosis than the inflammatory markers in young patients with STEMI. Therefore, we aimed to investigate clinical and angiographic characteristics, risk factors and the independent value of MPV on predicting short-term major adverse cardiovascular events (MACEs) in young adults with STEMI. Methods: A total of 349 patients aged 40 years or younger who underwent pPCI at our center between 2010–2015 with the diagnosis of STEMI were retrospectively analyzed. Results: The mean age of the patients was 36.4 ± 3.6 years and 90% of them were men. Smoking was by far the most frequent cardiovascular risk factor. MACEs were observed in 23 patients (6.6%), and according to the multivariate regression analysis, Killip IIIIV (OR 7.52, 95% CI 1.25–45.24, p = 0.03), lower admission SBP (OR 0.94, 95% CI 0.90–0.98, p <0.01) and increased MPV (OR 1.67, 95% CI 1.05–2.67, p = 0.03) were found to be independently correlated with MACE in the study population. Conclusion: Our results indicate that MPV is an independent predictor of MACEs at the short-term follow-up in young patients with STEMI undergoing pPCI. Accordingly, we suggested that MPV, a marker of platelet activation, could play a significant role in predicting clinical evolution in young patients with STEMI.
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Hirode G, Vittinghoff E, Bharmal NH, Kandula NR, Kanaya AM. The association of religious affiliation with cholesterol levels among South Asians: the Mediators of Atherosclerosis in South Asians Living in America study. BMC Cardiovasc Disord 2019; 19:75. [PMID: 30925868 PMCID: PMC6441170 DOI: 10.1186/s12872-019-1045-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 01/04/2023] Open
Abstract
Background South Asians have disproportionately high rates of cardiovascular disease. Dyslipidemia, a contributing factor, may be influenced by lifestyle, which can vary by religious beliefs. Little is known about South Asian religions and associations with dyslipidemia. Methods Cross-sectional analyses of the MASALA study (n = 889). We examined the associations between religious affiliation and cholesterol levels using multivariate linear regression models. We determined whether smoking, alcohol use, physical activity, and dietary pattern mediated these associations. Results Mean LDL was 112 ± 32 mg/dL, median HDL was 48 mg/dL (IQR:40–57), and median triglycerides was 118 mg/dL (IQR:88–157). Muslims had higher LDL and triglycerides, and lower HDL, while participants with no religious affiliation had lower LDL and higher HDL. The difference in HDL between Muslims and those with no religious affiliation was partly explained by alcohol consumption. Conclusions Religion-specific tailoring of interventions designed to promote healthy lifestyle to reduce cholesterol among South Asians may be useful.
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Affiliation(s)
- Grishma Hirode
- OakCare Medical Group, Highland Hospital, 1411 E 31st St, Oakland, CA, 94602, USA
| | - Eric Vittinghoff
- UCSF Department of Epidemiology and Biostatistics, 550 16th St, San Francisco, CA, 94158, USA
| | - Nazleen H Bharmal
- U.S. Department of Health and Human Services, 200 Independence Avenue, Washington DC, 20201, USA
| | - Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 6th Floor, Chicago, IL, 60611, USA
| | - Alka M Kanaya
- UCSF Department of Epidemiology and Biostatistics, 550 16th St, San Francisco, CA, 94158, USA. .,UCSF Division of General Internal Medicine, 1545 Divisadero Street, Suite 311, San Francisco, CA, 94115, USA.
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Andreenko EY, Yavelov IS, Loukianov ММ, Vernohaeva AN, Drapkina OM, Boytsov SA. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis. ACTA ACUST UNITED AC 2018; 58:24-34. [PMID: 30625075 DOI: 10.18087/cardio.2018.11.10195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022]
Abstract
In addition to conventional risk factors in young patients with ischemic heart disease (IHD) numerous other risk factors including genetics play an important role in its causation. Molecular genetic testing is recommended for the detection of monogenic diseases with a high risk of developing IHD, such as familial hypercholesterolemia. In majority ofyoung patients, the first manifestation of IHD is an acute coronary syndrome. Young patients with IHD more often have normal coronary arteries or single-vessel coronary disease, and in up to 20% of them cause of myocardial ischemia is not related to atherosclerosis. In general, young patients with IHD have better prognosis. However, there are sex differences in IHD outcomes the prognosis of patients with premature IHD and reason for this is still unclear.
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Affiliation(s)
- E Yu Andreenko
- National Medical Research Center for Preventive Medicine.
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Illness Perceptions in Patients with Premature Coronary Artery Disease: A Sex-Based Analysis 8 Years After the Diagnosis. J Clin Psychol Med Settings 2018; 26:158-165. [PMID: 30043245 DOI: 10.1007/s10880-018-9575-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To assess illness perceptions in patients with premature atherosclerotic coronary artery disease (CAD), 717 adults with premature CAD (diagnosis of CAD in men age < 45 years and women age < 55 years) completed sociodemographic indices, the Beck's Depression Inventory-II, Beck Anxiety Inventory and the Brief Illness Perceptions 8 years after the diagnosis. Mean age was 49.59 ± 3.57 years for men and 57.72 ± 4.90 years for women at the time of study. Both sexes were treated through coronary artery bypass graft surgery, percutaneous coronary intervention, or medical treatment. Depressive and anxiety symptoms were significantly more prevalent among women. Generally, the patients believed that their disease was chronic and well controlled and that it had no considerable negative impact on their routine life. Overall, patients had a low concern about their illness. Women had a more negative perception of their disease than did men which may indicate their need for higher psychological support.
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Li Y, Dong R, Hua K, Liu TS, Zhou SY, Zhou N, Zhang HJ. Outcomes of Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention in Patients Aged 18-45 Years with Diabetes Mellitus. Chin Med J (Engl) 2017; 130:2906-2915. [PMID: 29237922 PMCID: PMC5742917 DOI: 10.4103/0366-6999.220305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Debate on treatment for young patients with coronary artery disease still exists. This study aimed to investigate the intermediate- and long-term outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients aged 18-45 years with diabetes mellitus (DM). METHODS Between January 2006 and March 2016, a total of 2018 DM patients aged 18-45 years including 517 cases of CABG and 1501 cases of PCI were enrolled in the study. Using propensity score matching (PSM), 406 patients were matched from each group. The intermediate- and long-term data were collected. The primary end point of this study was long-term death. The secondary end points included long-term major adverse cardiovascular and cerebrovascular events (MACCEs), stroke, angina, myocardial infarction (MI), and repeat revascularization. RESULTS Before PSM, the in-hospital mortality was 1.2% in the CABG group and 0.1% in the PCI group, with statistically significant difference (P < 0.0001). The 10-year follow-up outcomes including long-term survival rate and freedom from MACCEs were better in the CABG group than those in the PCI group (97.3% vs. 94.5%, P = 0.0072; 93.2% vs. 86.3%, P < 0.0001), but CABG group was associated with lower freedom from stoke compared to PCI group (94.2% vs. 97.5%, P = 0.0059). After propensity score-matched analysis, these findings at 10-year follow-up were also confirmed. Freedom from MACCEs was higher in CABG group compared to PCI group, but no significant difference was observed (93.1% vs. 89.2%, P = 0.0720). The freedom from recurrent MI was significantly higher in CABG patients compared with PCI patients (95.6% vs. 92.5%, P = 0.0260). Furthermore, CABG was associated with a higher rate of long-term survival rate than PCI (97.5% vs. 94.6%, P = 0.0403). There was no significant difference in the freedom from stroke between CABG and PCI groups (95.3% vs. 97.3%, P = 0.9385). The hospital cost was greater for CABG (13,936 ± 4480 US dollars vs. 10,926 ± 7376 US dollars, P < 0.0001). CONCLUSIONS In DM patients aged 18-45 years, the cumulative survival rate, and freedom from MI and repeat revascularization for CABG were superior to those of PCI. However, a better trend to avoid stroke was observed with PCI.
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Affiliation(s)
- Yang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Kun Hua
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tao-Shuai Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shao-You Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ning Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hong-Jia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol 2016; 8:728-734. [PMID: 28070240 PMCID: PMC5183972 DOI: 10.4330/wjc.v8.i12.728] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/03/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease (CAD) occurring in less than 45 years of age is termed as young CAD. Recent studies show a prevalence of 1.2% of CAD cases in this age group. Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%. Conventional risk factors such as smoking, diabetes, hypertension, obesity and family history seems to be as important as in older CAD subjects. But the prevalence of these risk factors seems to vary in younger subjects. By far the most commonly associated risk factor is smoking in young CAD. Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein (CETP) gene, hepatic lipase gene, lipoprotein lipase gene, apo A1 gene, apo E gene and apo B. Biomarkers such as lipoprotein (a), fibrinogen, D-dimer, serum Wnt, gamma glutamyl transferase, vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies. In general CAD in young has better prognosis than older subjects. In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes. Angiographic studies shows predominance of single vessel disease in young CAD patients. Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.
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