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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