Prevalência de lesão aterosclerótica coronariana e fatores associados em pacientes jovens, abaixo de 45 anos

Abstract

Coronary artery disease (CAD) is the main cause of mortality in developed countries despite the great advances in the diagnosis and treatment in the last years. In Brazil, 30% of all-cause mortality is related to cardiovascular disease and 50% of these patients are adults between 30 and 69 years-old. The high morbity and mortality implies an important economic burden to the country. The most affected ages are between 50 to 65 years old, but an increasing number of younger patients have been noticed. We analized the data of patients under 45 years old that underwent coronary angiotomography evaluation due to chest pain or altered provocative tests. Objectives: estimate the prevalence of coronary artery disease, and its correlation to known cardiovascular risk-factors; discuss the use of coronary calcium scoring as a tool in the diagnosis of coronary artery disease in young patients. Methods: 181 patients were identified but 6 of them were excluded due to previous diagnosis of coronary disease. In our study, 175 patients we enrolled and analyzed for the presence of atheromatous plaques in the coronary arteries and quantification of calcium scoring. The plaques burdens were correlated to the known cardiovascular risk factors in bivariate and multivariate analyses. The prevalence of CAD was estimated and correlated to the different risk factors. Results: the mean age was 38 ± 7 years old, and 76% were men. The prevalence of CAD was estimated in 37.7%, and 109 patients had normal results at the coronary angiiotomography (p < 0.001). Obstructive plaques were identified in 3.4% of the cases. 60.6% of the patients had symptoms but the exam was normal in 70.8% of these cases (p < 0.001). The risk factors that had statistical significance were hypercholesterolemia, smoking and male sex. The calcium scoring was zero in 147 patients, but 38 of them had CAD. The sensitivity of calcium scoring was estimated in 42%, specificity 100%, positive predictive value 100% and negative predictive value 74%. Non-calcified plaques were the most common type of atheromatous plaque (p = 0.04). Conclusion: We conclude that the prevalence of CAD in young male individuals with coronary risk factors is not so low. Early diagnosis of risk factors and preventive actions are necessary, even before the recommended age by our health system. Also, the calcium scoring seems not to be an adequate diagnostic tool in young patients due its low sensitivity and negative predictive value.