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World J Cardiol. Dec 26, 2016; 8(12): 728-734
Published online Dec 26, 2016. doi: 10.4330/wjc.v8.i12.728
Newer perspectives of coronary artery disease in young
Amitesh Aggarwal, Saurabh Srivastava, M Velmurugan
Amitesh Aggarwal, M Velmurugan, Department of Medicine, University College of Medical Sciences and GTB Hospital, Delhi 110095, India
Saurabh Srivastava, Department of Medicine, School of Medical Sciences and Research, Sharda University, Noida 201308, India
Author contributions: All authors contributed to this paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amitesh Aggarwal, MD, Associate Professor, Department of Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi 110095, India. dramitesh@gmail.com
Telephone: +91-11-22586262
Received: June 29, 2016
Peer-review started: July 1, 2016
First decision: September 5, 2016
Revised: October 14, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: December 26, 2016
Processing time: 173 Days and 14.1 Hours
Abstract

Coronary artery disease (CAD) occurring in less than 45 years of age is termed as young CAD. Recent studies show a prevalence of 1.2% of CAD cases in this age group. Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%. Conventional risk factors such as smoking, diabetes, hypertension, obesity and family history seems to be as important as in older CAD subjects. But the prevalence of these risk factors seems to vary in younger subjects. By far the most commonly associated risk factor is smoking in young CAD. Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein (CETP) gene, hepatic lipase gene, lipoprotein lipase gene, apo A1 gene, apo E gene and apo B. Biomarkers such as lipoprotein (a), fibrinogen, D-dimer, serum Wnt, gamma glutamyl transferase, vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies. In general CAD in young has better prognosis than older subjects. In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes. Angiographic studies shows predominance of single vessel disease in young CAD patients. Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.

Keywords: Young; Coronary artery disease; Risk factors; Epidemiological trends; Prognosis

Core tip: Coronary artery disease (CAD) in patients less than 45 years of age is termed young CAD. South Asians especially Indians are more vulnerable to have CAD in young age group. Although conventional risk factors, mainly smoking, are also important in young CAD but there are numerous other factors that are responsible for it. Several genes associated with lipoprotein metabolism are now found to be associated with young CAD. Gamma glutamyl transferase, vitamin D2 and osteocalcin seem to be associated with premature CAD in some studies. Angiographic studies shows predominance of single vessel disease in young CAD patients.