Introduction: Little is known about the prevalence or risk factors associated with “age advanced” CAD (defined as CAD in men < age 40 and women < age 50).
Hypothesis: The prevalence of CAD in this young cohort will be very low.
Methods: 1420 young patients were retrospectively analyzed for evidence of CAD on CCTA. The presence of any plaques or stenosis was recorded. The severity of CAD was determined using CAD RADS classification system. Clinical/Demographic information was also recorded.
Results:14.2% of patients in this study demonstrated evidence of CAD; 2.7% of patients demonstrated hemodynamically significant CAD. There was an exponential increase in CAD prevalence after age 36 among men and after age 40 among women (Figure). A majority of patients had soft plaque (p = 0.0441) with 72.5% having involvement of the proximal LAD. Risk factors for “age advanced” CAD included Framingham risk score (p<0.001), diabetes (p<0.001), hypertension (p<0.001), total cholesterol (p=0.002), triglycerides (p=0.002), and LDL (p=0.011). Cigarette smoking was not associated with “age advanced” CAD (p=0.381). Risk factors that showed significant correlation with “age advanced” CAD in multivariate analysis included age and Framingham risk score.
Conclusion: The prevalence of “age advanced” CAD was higher than expected. There is an exponential increase in the prevalence of CAD early in life, beginning in the late 30s. The expression of micro-RNAs have been shown to be different in young patients with CAD compared to controls, and alterations in gene expression may account for this exponential increase. Additional research is needed to identify the cause of these changes in this age group.