Juan-Salvadores Pablo, Olivas-Medina Dahyr, de la Torre Fonseca Luis Mariano, Veiga Cesar, Campanioni Silvia, Caamaño Isorna Francisco, Iñiguez Romo Andrés, Alfonso Jiménez Díaz Víctor
Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Vigo, Pontevedra, Spain; Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain.
Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Vigo, Pontevedra, Spain; Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain.
Rev Port Cardiol. 2025 Jan;44(1):13-21. doi: 10.1016/j.repc.2024.06.004. Epub 2024 Sep 1.
Coronary artery disease (CAD) is a globally significant cardiovascular condition, ranking among the leading causes of morbidity and mortality. CAD has been predominantly associated with advanced age and classic cardiovascular risk factors. However, over the past decades, there has been a concerning rise in its occurrence among young adults, including patients under 35 years old. The present study analyzes the clinical features and outcomes of patients aged ≤35 years with CAD, compared to two age-matched control groups.
A nested case-control study of ≤35-year-old patients referred for coronary angiography due to clinical suspicion of CAD. Patients were divided into three groups: patients ≤35 years with CAD, subjects ≤35 years without CAD, and young patients ≥36-40 years with CAD.
Of the 19321 coronary angiographies performed at our center over 10 years, 408 (2.1%) patients were ≤40 years old, 109 patients aged ≤35 years. Risk factors that showed a relationship with the presence of CAD were smoking (OR 2.49; 95% CI 1.03-6.03; p=0.042) and family history of coronary disease (OR 6.70; 95% CI 1.46-30.65; p=0.014). The group aged ≤35 years with CAD exhibited a risk of major cardiovascular adverse events (MACE) (HR 13.3; 95% CI 1.75-100; p<0.001) than subjects ≤35 years without CAD. The probability of major adverse cardiovascular events was associated with being ≤35 years old, diabetes, dyslipidemia, and depression.
Patients aged ≤35 exhibited a poor long-term prognosis, with a high risk of new revascularization and acute myocardial infarction during the follow-up period. Focusing on preventive measures can have a significant impact on overall prognosis.
冠状动脉疾病（CAD）是一种在全球范围内具有重要意义的心血管疾病，是发病和死亡的主要原因之一。CAD主要与高龄和经典的心血管危险因素相关。然而，在过去几十年中，其在年轻人（包括35岁以下患者）中的发病率令人担忧地上升。本研究分析了年龄≤35岁的CAD患者的临床特征和预后，并与两个年龄匹配的对照组进行比较。
对因临床怀疑CAD而接受冠状动脉造影的≤35岁患者进行巢式病例对照研究。患者分为三组：年龄≤35岁的CAD患者、年龄≤35岁无CAD的受试者以及年龄≥36 - 40岁的年轻CAD患者。
在我们中心10年间进行的19321例冠状动脉造影中，408例（2.1%）患者年龄≤40岁，其中109例年龄≤35岁。与CAD存在相关的危险因素包括吸烟（OR 2.49；95% CI 1.03 - 6.03；p = 0.042）和冠心病家族史（OR 6.70；95% CI 1.46 - 30.65；p = 0.014）。年龄≤35岁的CAD患者发生主要心血管不良事件（MACE）的风险（HR 13.3；95% CI 1.75 - 100；p < 0.001）高于年龄≤35岁无CAD的受试者。主要不良心血管事件的概率与年龄≤35岁、糖尿病、血脂异常和抑郁症有关。
年龄≤35岁的患者长期预后较差，在随访期间有较高的再次血管重建和急性心肌梗死风险。关注预防措施对总体预后可能有重大影响。
