The
poor prognosis for people diagnosed with coronary artery disease before
age 40 years emphasizes need to control risk factors early in life
The
largest long-term study of people diagnosed with coronary artery
disease before age 40 years shows that almost 1 of 3 died within
15 years, according to an article in the February 19th issue of
the Journal of the American College of Cardiology. The prognosis
was even worse for people with diabetes: The mortality rate was
almost 2 out of every 3 patients.
"If you take the average person, they
had a 30-percent mortality over 15 years. The mean age at diagnosis
was 35 for women, 36 for men, so by the age of 50 almost a third
of them had died. It's a tremendous mortality," said Joseph
Miller III, M.D., lead author.
Miller and his American colleagues identified
843 patients with at least 1 documented coronary artery blockage
who were treated at a university hospital between 1975 and 1985.
The highest death rates occurred among patients who had diabetes,
smoked, had suffered a myocardial infarction prior to the study
period, or had heart failure.
"It's a little shocking," Miller
said. "If I saw somebody who had an infarct at age 35, I'd
think, since they are younger, they are going to do better. They
may not live to be 100, but their outcome is going to be better
than someone who is 70 or 75. But our data from that time period
says very differently, that they are more likely to have recurrent
events and a third of our group did not live to age 50. And that's
a young age for people to die."
Miller also said the results highlight the
urgent need to prevent or stop smoking. Nearly two thirds of the
patients studied were current or former smokers. Although patients
who continued to smoke had higher than average death rates, the
long-term mortality of former smokers was not significantly different
from that of patients who had never smoked. The medical records
did not include information on diet or physical activity levels
of the patients.
Among the patients in this study, those who
had either angioplasty or bypass surgery to treat coronary artery
blockages fared better than those treated with drugs. However, the
researchers noted that this study was a retrospective review of
patient records and not a randomized trial, and it was not designed
to compare the effectiveness of treatments.
Miller believes the high mortality rate seen in their data should
alert doctors to be more concerned about younger adults with coronary
artery disease. "I think so. Be more aggressive and really
push the lifestyle changes, smoking cessation, lipid management.
I think these are patients you really want to make sure reach goals,"
he said.
Lloyd Klein, M.D., who wrote an editorial
comment in the journal, agreed that the observed mortality rates
are indeed a call to physicians to be more aggressive in addressing
risk factors in younger patients. He said the analysis helps puncture
the myth that heart disease is a disease of older people, not younger
adults. "It can happen, and the people who do get it are those
who smoke and those who are diabetic," Klein said. He added
that many of these patients are aware of a family history of heart
disease at a young age, and he urged such individuals to seek medical
evaluation and make lifestyle improvements.
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