In African-American Patients, Nontraditional Risk Factors Track With Early CAD

African-American men and women who develop coronary artery disease prematurely are significantly more likely to have nontraditional cardiovascular risk factors when compared with older patients who have CAD, according to a new study. 

Among more than 7,000 African Americans with premature disease, defined as those aged 45 years and younger with CAD, investigators observed a higher incidence of drug and alcohol abuse, psychiatric illnesses, and HIV than among African-American CAD patients > 45 years. Interestingly, there was no significant difference in the prevalence of hypertension, diabetes, congestive heart failure, or obstructive sleep apnea between the younger and older African-American patients with coronary disease, report investigators.

“Once they already have the disease and come to us with MI or coronary artery disease, it can be too late,” said lead investigator Ahmad Awan, MD (Howard University Hospital, Washington, DC). “We still have a lot of things to offer, but the earlier we can start to target these risk factors, [the better] the chance that we can delay or prevent the onset of coronary disease. That’s the aim for us.”   

To TCTMD, Awan said a higher prevalence of smoking and obesity has previously been seen in patients with premature CAD, but the prevalence of CAD-related risk factors is understudied in African Americans with early-onset disease. Since at their center they primarily take care of African-American patients, the researchers sought to identify the prevalence of traditional and nontraditional risk factors in those with premature CAD and to learn how these might differ from older patients.

The study, which was presented this week at the Society for Cardiovascular Angiography and Interventions (SCAI) 2021 Scientific Sessions, is a retrospective analysis of the National Inpatient Sample from the Agency for Healthcare Research and Quality. It included 139,657 African-American patients with CAD, of whom 7,093 were 45 years and younger.

Compared with older patients, obesity was more common in African Americans with premature CAD (31.2% vs 19.4%; P < 0.001), who also were more likely to be smokers (49.8% vs 46.6%; P < 0.001). These younger patients had a higher prevalence of drug abuse (17.8% vs 6.7%), alcohol abuse (5.2% vs 4.3%), and HIV diagnosis (1.88% vs 0.88%). End-stage renal disease was more frequently diagnosed in younger patients (20.7% vs 14.7%; P < 0.001). Depression and psychiatric illnesses, such as anxiety, were also more common in the younger people. For example, 13.8% of those aged 45 years and younger had a diagnosis of depression compared with 10.4% of older patients (P < 0.001).

While the study is observational, several of the measurements, such as alcohol and drug abuse, have been previously linked with CVD, while patients with HIV are known to be at higher risk for cardiovascular events, said Awan. Similarly, CAD is highly prevalent, and CVD the leading cause of death, in patients with end-stage renal disease.

Awan said the study suggests physicians should be aggressive in targeting these nontraditional risk factors in their younger patients.

“If we see them in clinic, we need to provide them with support structures, to help them quit smoking, to help them with their drug and alcohol abuse,” Awan advised. These patients, including those with HIV, depression, or anxiety, require specialized care that is often not the domain of primary care physicians, he added, noting that depressed patients can struggle to take of their health, generally speaking, or may not be compliant with medications. “We need to make sure they receive the appropriate care and that there is no stigma [attached to mental illness],” he stressed.

The researchers next plan to compare the prevalence of these nontraditional risk factors with other race/ethnicities, but that analysis is not yet completed, said Awan.