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What Causes Premature Coronary Artery Disease?

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Abstract

Purpose of Review

This review provides an overview of genetic and non-genetic causes of premature coronary artery disease (pCAD).

Recent Findings

pCAD refers to coronary artery disease (CAD) occurring before the age of 65 years in women and 55 years in men. Both genetic and non-genetic risk factors may contribute to the onset of pCAD. Recent advances in the genetic epidemiology of pCAD have revealed the importance of both monogenic and polygenic contributions to pCAD. Familial hypercholesterolemia (FH) is the most common monogenic disorder associated with atherosclerotic pCAD. However, clinical overreliance on monogenic genes can result in overlooked genetic causes of pCAD, especially polygenic contributions. Non-genetic factors, notably smoking and drug use, are also important contributors to pCAD. Cigarette smoking has been observed in 25.5% of pCAD patients relative to 12.2% of non-pCAD patients. Finally, myocardial infarction (MI) associated with spontaneous coronary artery dissection (SCAD) may result in similar clinical presentations as atherosclerotic pCAD.

Summary

Recognizing the genetic and non-genetic causes underlying pCAD is important for appropriate prevention and treatment. Despite recent progress, pCAD remains incompletely understood, highlighting the need for both awareness and research.

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Data Availability

No datasets were generated or analyzed during the current study.

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Authors and Affiliations

  1. Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada

    Ann Le, Helen Peng, Danielle Golinsky, Matteo Di Scipio, Ricky Lali & Guillaume Paré

  2. Department of Medical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Ann Le, Matteo Di Scipio & Guillaume Paré

  3. Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Guillaume Paré

  4. Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada

    Guillaume Paré

  5. Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Guillaume Paré

  6. Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada

    Ricky Lali & Guillaume Paré

  7. Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada

    Matteo Di Scipio

  8. Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada

    Helen Peng

  9. School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada

    Danielle Golinsky

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  1. Ann Le
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  2. Helen Peng
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Contributions

A. L. wrote the following sections: Introduction, Genetics of pCAD, Polygenic Causes of pCAD, Clinical Risk Factors and Clinical Risk Scores, and Conclusion as well as revised writing for all sections. H. P. wrote the following sections: Smoking, Alcohol, Amphetamines, Stress and Exercise, and Spontaneous Coronary Artery Dissection (SCAD). D. G. wrote the following sections: Opioid Usage and collaborated for research on sections written by H. P. M. D. prepared Fig. 1 and aided with research on clinical aspects. R. L. revised genetics section and provided expertise regarding overall topic. G. P. assigned topics related to pCAD and is the principal investigator of the project. All authors reviewed the manuscript.

Corresponding author

Correspondence to Guillaume Paré.

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Le, A., Peng, H., Golinsky, D. et al. What Causes Premature Coronary Artery Disease?. Curr Atheroscler Rep (2024). https://doi.org/10.1007/s11883-024-01200-y

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