Cardiovascular risk factor control is insufficient in young patients with coronary artery disease

Figures & data

Figure 1 Patient selection.

Table 1 Characteristics of the patients at study interview

Characteristics	Total (n=143)	Male (n=110)	Female (n=33)	P-value
Age, years	44 (41;47)	43 (41;47)	45(40;48)	0.40
Years since last coronary event	5.6 (2.1;8.9)	5.6 (2.4;8.7)	6.4 (1.9;10.5)	0.55
Diseased vessels				0.05
1VD	91 (63.6)	64 (58.2)	27 (81.8)
2VD	26 (18.2)	23 (20.9)	3 (9.1)
3VD	26 (18.2)	23 (20.9)	3 (9.1)
Last estimate of LVEF (%)	60 (50;60)	60 (50;60)	60 (50;60)	0.98
Vascular comorbidity
Prior MI	120 (83.9)	92 (83.6)	28 (84.9)	1.00
Prior stroke	11 (7.7)	7 (6.4)	4 (12.1)	0.28
PAD	3 (2.1)	2 (1.8)	1 (3.0)	0.55
Other comorbidity
Diabetes	29 (20.3)	18 (16.4)	11 (33.3)	0.03
FH	8 (5.6)	6 (5.5)	2 (6.1)	1.00
Systolic BP (mmHg)	122±14	122±14	123 (13)	0.49
Diastolic BP (mmHg)	82±9	83±10	81 (8)	0.41
BMI (kg/m^2)				0.01
<18.5	1 (0.7)	1 (0.9)	0 (0)
18.5–25	29 (20.3)	16 (14.6)	13 (39.4)
25–30	53 (37.1)	46 (41.8)	7 (21.2)
≥30	60 (42.0)	47 (42.7)	13 (39.4)
Waist (cm)	101.4 (92.1;112.2)	103.9 (93.2;114.3)	96.6 (82.3;103.2)	<0.01
Biochemistry
TC-C (mM)	4.1 (3.5;5.1)	4.1 (3.4;5.1)	4.0 (3.6;4.8)	0.81
HDL-C (mM)	1.1 (1.0;1.4)	1.1 (0.9;1.2)	1.3 (1.1;1.6)	<0.01
LDL-C (mM)a	2.2 (1.5;2.7)	2.2 (1.5;2.7)	2.0 (1.5;2.7)	0.40
Triglycerides (mM)	1.5 (1.0;2.2)	1.6 (1.0;2.2)	1.4 (1.0;2.2)	0.60
HbA1c (mmol/mol)	39 (36;42)	38 (36;40)	41 (38;50)	<0.01
Creatinine (μM)	78 (68;87)	79 (72;87)	66 (59;71)	<0.01

Notes: Values are expressed as median (interquartile range), n (%) or mean ± standard deviation.

a LDL-C was calculated in 133 patients.

Abbreviations: BMI, body mass index; BP, blood pressure; FH, familial hypercholesterolemia; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; LVEF, left ventricular ejection fraction; MI, myocardial infarction; PAD, peripheral artery disease; TC-C, total cholesterol concentration; VD, vessel disease.

Table 2 Patient medication at study interview

Medication	Total patients (n=143)
Platelet inhibitor or anticoagulant	138 (96.5)
Aspirin	126 (88.1)
ADP receptor blocker	30 (21.0)
Anticoagulant	7 (4.9)
Antihypertensive treatment	114 (79.7)
ACE-I/ARB	66 (46.2)
Beta-blocker	92 (64.3)
Calcium channel blocker	35 (24.5)
Diuretic	26 (18.2)
Lipid-lowering therapy	121 (84.6)
Statin	119 (83.2)
Ezetimibe	20 (14.0)
Fibrate	2 (1.4)
Other lipid-lowering drugs	4 (2.8)
Antidiabetic therapy (if known diabetes, n=23)	19 (82.6)
Metformin	8 (34.8)
Insulin	13 (56.5)
Other	4 (17.4)

Note: Values are expressed as n (%).

Abbreviations: ACE-I, angiotensin converting enzyme-inhibitor; ADP, adenosine diphosphate; ARB, angiotensin II receptor blocker.

Table 3 Risk factor control at study interview

Risk factor	Total (n=143)	Male (n=110)	Female (n=33)	P-value
Treatment goals
High BPa	37 (25.9)	29 (26.4)	8 (24.2)	0.81
Low HDL-Cb	48 (33.6)	38 (34.6)	10 (30.3)	0.65
High LDL-Cc	77 (57.9)	59 (58.4)	18 (56.3)	0.83
High triglyceridesd	67 (46.9)	52 (47.3)	15 (45.5)	0.85
Lifestyle goals
Elevated BMI^e	113 (79.0)	93 (84.6)	20 (60.6)	<0.01
Abd obesityf	76 (53.2)	57 (51.8)	19 (57.6)	0.56
Sedentary lifestyleg	78 (54.6)	58 (52.7)	20 (60.6)	0.43
Current smokingh	53 (37.1)	33 (30.0)	20 (60.6)	<0.01
Metabolic syndrome	68 (47.6)	51 (46.4)	17 (51.5)	0.60

Notes: Values are expressed as n (%).

a BP threshold is ≥140/90 mmHg except ≥140/80 mmHg in diagnosed diabetics.

b HDL-C <1.0/1.2 mM (M/F).

c LDL-C ≥1.8 mM and <50% of untreated value. Values were calculated in 133 patients and untreated values were only available in 75 patients.

d Triglycerides ≥1.7 mM. ^eBMI ≥25 kg/m².

f Waist circumference ≥102/88 cm (M/F).

g Exercising ≥30 minutes <3 times per week.

h Smoking within the last month.

Abbreviations: Abd, abdominal; BMI, body mass index; BP, blood pressure; F, female; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; M, male.

Figure 2 Blood pressure control and LDL-C control stratified by treatment in patients at study interview.

Notes: (A) Distribution of blood pressure levels and antihypertensive therapy within each category at study interview. Lower normal: <120/80 mmHg. Higher normal: <140/<90 mmHg. Grade 1 HTN: <160/100 mmHg. Grade 2 HTN: <180/110 mmHg. Grade 3 HTN: ≥180/110 mmHg. (B) Distribution of LDL-C levels and LLT within each category at study interview. LD statin: atorvastatin <40 mg/daily, rosuvastatin <20 mg/daily or another statin. HD statin: atorvastatin ≥ 40 mg/daily or rosuvastatin ≥20 mg/daily.
Abbreviations: HD, high-dose; HTN, hypertension; LD, low-dose; LDL-C, low-density lipoprotein cholesterol; LLT, lipid-lowering therapy.

Figure 3 Distribution of the number of uncontrolled risk factors among patients at study interview.

Table S1 Comparison between eligible patients and eligible nonparticipants based on the first registered coronary intervention between 2002 and 2013

Characteristics	Patients (n=143)	Eligible nonparticipants (n=140)	P-value
Agea, years	37 (35; 38)	37 (34; 38)	0.98
Male	110/143 (76.9)	104/140 (74.3)	0.61
			0.97
First registered procedure			0.97
PCI	137/143 (95.8)	134/140 (95.7)
CABG	6/143 (4.2)	6/140 (4.3)
PCI indication			0.78
STEMI	76/137 (55.5)	70/134 (52.2)
NSTEMI	30/137 (21.9)	31/134 (23.1)
UAP	1/137 (0.7)	1/134 (0.8)
SAP	29/137 (21.2)	28/134 (20.9)
Other	1/137 (0.7)	4/134 (3.0)
Diseased vessels (PCI-patients only)			0.72
1VD	84/106 (79.3)	83/104 (79.8)
2VD	12/106 (11.3)	14/104 (13.5)
3VD	10/106 (9.4)	7/104 (6.7)
Family history	86/134 (64.2)	63/127 (49.6)	0.02
Treatment of hypertension	21/139 (15.1)	18/135 (13.3)	0.67
Treatment of dyslipidemia	48/140 (34.3)	44/135 (32.6)	0.77
Diabetes	14/134 (10.5)	20/135 (14.8)	0.28
Current smoking	111/134 (82.8)	110/133 (82.7)	0.98
BMI (kg/m^2)b	27.7 (24.9; 31.1)	27.4 (24.8; 31.6)	0.98
Creatinine (μM)c	74 (65; 85)	75 (66; 85)	0.74

Notes: Values are expressed as median (IQR) or n/N (%).

a Data available for all patients and eligible nonparticipants.

b Data available for 99 patients and 101 eligible nonparticipants.

c Data available for 67 patients and 75 nonparticipants.

Abbreviations: BMI, body mass index; CABG, coronary artery bypass graft; IQR, interquartile range; NSTEMI, non-ST-elevation myocardial infarction; PCI, percutaneous coronary intervention; SAP, stable angina pectoris; STEMI, ST-elevation myocardial infarction; UAP, unstable angina pectoris; VD, vessel disease.