Relation between severe coronary stenosis lesion distribution and risk factors in young and middle-aged adults

AIM: To evaluate the classical and novel risk factors in young and middle-aged patients with coronary artery disease (CAD), and to analyze the relation between coronary risk factors and coronary lesion distribution. METHODS: A group of one hundred and eighty-nine patients, aged not more than 60 years with severe coronary stenosis on coronary angiography, and the other group of age-matched one hundred and sixty-one patients having normal or non-severe stenosis on coronary angiography were comprised in the study. Conventional factors (such as smoking, diabetes, hypertension, lipid spectrum and fasting plasma glucose) and novel risk factor (homocysteine) were compared between the groups. Moreover, the relation between the risk factors, and coronary lesion distribution including left main artery (LMA) or proximal or mid-left anterior descending (LAD) artery and remaining coronary lesions were investigated. Logistic regression analysis was used to define confounding factors for predicting severe CAD and coronary lesion distribution. RESULTS: Male and smoking were more prevalent in the group with severe coronary stenosis compared to the other group. The levels of homocysteine, triglyceride and apolipoprotein B were also higher in the group with severe coronary stenosis than those in the other group. From the perspective of gender analysis, homocysteine and apolipoprotein B significantly increased regardless of gender in severe coronary stenosis group. In men, the prevalence of diabetes rates and fasting plasma glucose were higher in severe coronary stenosis group. In women, the prevalence of triglyceride is obviously increased in severe coronary stenosis group. Male, smoking, homocysteine and apolipoprotein B were independent predictors of severe CAD in young and middle-aged patients according to logistic regression analysis with odds ratios of 2.798 (95% CI: 1.520~5.152; P<0.01), 3.570 (95% CI: 2.125~5.996; P<0.01), 1.079 (95% CI: 1.028~1.133; P<0.01), and 2.883 (95% CI: 1.427~5.825; P<0.01). Group analysis in the severe coronary stenosis patients revealed that only homocysteine was an independent predictor of LMA or proximal or mid-LAD lesion presence with an odds ratio of 0.911 (95% CI: 0.831~0.998; P<0.05). CONCLUSION: In our study, young and middle-aged patients with severe CAD have different risk profiles with higher frequency of male, smoking and increased levels of apolipoprotein B and homocysteine. Only homocysteine predicts coronary lesion distribution in LMA and proximal or mid-LAD.