Conventional risk factors and arterial bed parameters in patients with coronary artery disease younger and older than 50 years

Aim. To study conventional risk factors and arterial stiffness parameters to identify non-invasive markers of coronary atherosclerosis in patients with and without history of cardiovascular disease, with premature and physiological vascular aging.

Material and methods. The study included 198 patients with coronary artery disease (CAD) and 57 healthy people. The subjects were divided into two cohorts: younger and older than 50 years. Each group included patients with newly diagnosed acute coronary syndrome with/without history of cardiovascular disease (CAD and/or hypertension). Conventional risk factors were analyzed in all subjects. Ultrasound radiofrequency of common carotid arteries (CCA), applanation tonometry, volume sphygmography were performed.

Results. Analysis of arterial parameters in individuals <50 years old revealed differences between healthy people and patients with CAD. In the

 subgroup of patients without a history of cardiovascular disease compared with healthy people, CCA were damaged in  77%  (p<0,05), aorta — in 13%, muscular arteries — in 29% (p<0,05); in patients with a history of cardiovascular disease, in 71% (p<0,05), 5% and 34% (p<0,05), respectively. In the older age group of patients with and without history of cardiovascular disease, CCA were damaged in 84% and 94% (p<0,05), aorta — in 92% and 87% (p<0,05), muscular arteries — in 42-44% (p<0,05), respectively. According to the ROC analysis, in patients <50 years old, the area under the curve (AUC) for the intima-media thickness (IMT) was 0,830, the threshold — 622,3 (p=0,000); for the  beta  stiffness index — 0,850, threshold — 7,01 (p=0,002); for L-/CAVI₁ — 0,742, threshold — 7,3 (p=0,000). In patients >50 years of age, AUC for the IMT was 0,948, threshold — 607,5 (p=0,000); for the beta stiffness index — 0,740, threshold — 8,84 (p=0,000); for L-/CAVI₁ — 0,861, threshold — 8,4 (p=0,000).

Conclusion. Timely identification of atherosclerotic markers using noninvasive techniques can improve the prediction of cardiovascular events. A comprehensive non-invasive examination of the arteries with determination of IMT, beta stiffness index, and L-/CAVI₁ will probably identify young people with an unfavorable absolute cardiovascular risk. .

1. Drapkina OM, Samorodskaya IV, Vaysman DSh. Opportunities and Problems of Analysis of Mortality from Myocardial Infarction According to Medical Certificates of Death (on the Example of the Tula Region). Kardiologiia. 2019;59(7):5-10. (In Russ.). doi:10.18087/cardio.2019.7.n417.

2. Zdravookhranenie v Rossii. 2019: Stat.sb. M.: Rosstat, 2019. p. 170. (In Russ.). ISBN: 978-5-89476-470-2.

3. Egiziano G, Akhtari S, Pilote L, et al. Sex differences in young patients with acute myocardial infarction. Diabet Med. 2013;30(3):e108-14. doi:10.1111/dme.12084.

4. Shalnova SA, Oganov RG, Deev AD, et al. on behalf of the ESSERF study work team. Comorbidities of ischemic heart disease with other non-communicable diseases in adult population: age and risk factors association. Cardiovascular Therapy and Prevention. 2015;14(4):44-51. (In Russ.). doi:10.15829/1728-8800-2015-4-44-51.

5. Canto JG, Kiefe CI, Rogers WJ, et al. Number of Coronary Heart Disease Risk Factors and Mortality in Patients With First Myocardial Infarction. JAMA. 2011;306(19):2120-7. doi:10.1001/jama.2011.1654.

6. Koshelskaya OA, Suslova TE, Kologrivova IV, et al. Metabolic, Inflammatory and Imaging Biomarkers in Evaluation of Coronary Arteries Anatomical Stenosis in Patients with Stable Coronary Artery Disease. Rational Pharmacotherapy in Cardiology. 2020;16(1):4-9. (In Russ.). doi:10.20996/1819-6446-2020-01-01.

7. Metelskaya VA, Gavrilova NE, Yarovaya EA, Boytsov SA. An integrative boimarker: opportunities for non-invasive diagnostics of coronary atherosclerosis. Russian Journal of Cardiology. 2017;(6):132-8. (In Russ.). doi:10.15829/1560-4071-2017-6-132-138.

8. Oleynikov VE, Salyamova LI, Burko NV et al. Ultrasound Evaluation of the Great Arteries Based on the Analysis of Radio-Frequency Signal. J Biomedical Engineering. 2017;50(5):48-51. doi:10.1007/s10527-017-9654-2.

9. Cardiovascular prevention 2017. National guidelines. Russian Journal of Cardiology. 2018;(6):7-122. (In Russ.). doi:10.15829/1560-4071-2018-6-7-122.

10. Andreenko EY, Yavelov IS, Loukianov MM, et al. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Prevalence and Cardio-Vascular Risk Factors. Kardiologiia. 2018;58(10):53-8. (In Russ.). doi:10.18087/cardio.2018.10.10184.

11. Nilsson P. Early Vascular Ageing — A Concept in Development. European Endocrinology. 2015;11(1):26-31. doi:10.17925/EE.2015.11.01.26.