Risk Factors for Early-Onset Versus Late-Onset Coronary Heart Disease (CHD): Systematic Review and Meta-Analysis

Adeel Khoja; Prabha H Andraweera; Zohra S Lassi; Anna Ali; Mingyue Zheng; Maleesa M Pathirana; Emily Aldridge; Melanie R Wittwer; Debajyoti D Chaudhuri; Rosanna Tavella; Margaret A Arstall

doi:10.1016/j.hlc.2023.07.010

Risk Factors for Early-Onset Versus Late-Onset Coronary Heart Disease (CHD): Systematic Review and Meta-Analysis

Heart Lung Circ. 2023 Nov;32(11):1277-1311. doi: 10.1016/j.hlc.2023.07.010. Epub 2023 Sep 28.

Authors

Affiliations

¹ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia. Electronic address: adeel.khoja@adelaide.edu.au.
² Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia.
³ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
⁴ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
⁵ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia.
⁶ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
⁷ Cardiology Unit, Northern Adelaide Local Health Network, South Australia, Australia; Medical Specialties, Faculty of Health Sciences, The University of Adelaide, SA, Australia.

PMID: 37777398
DOI: 10.1016/j.hlc.2023.07.010

Abstract

Aim: We aimed to systematically compare literature on prevalence of modifiable and non-modifiable risk factors for early compared to late-onset coronary heart disease (CHD).

Methods: PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol registered in PROSPERO CRD42020173216). Study quality was assessed using the National Heart, Lung and Blood Institute tool for observational and case-control studies. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences (MD)/standardised MD (SMD) with 95% confidence intervals (CI) for categorical and continuous variables.

Results: Individuals presenting with early-onset CHD (age <65 years) compared to late-onset CHD had higher mean body mass index (MD 1.07 kg/m²; 95% CI 0.31-1.83), total cholesterol (SMD 0.43; 95% CI 0.23-0.62), low-density lipoprotein (SMD 0.26; 95% CI 0.15-0.36) and triglycerides (SMD 0.50; 95% CI 0.22-0.68) with lower high-density lipoprotein-cholesterol (SMD 0.26; 95% CI -0.42--0.11). They were more likely to be smokers (OR 1.76, 95% CI 1.39-2.22) and have a positive family history of CHD (OR 2.08, 95% CI 1.74-2.48). They had lower mean systolic blood pressure (MD 4.07 mmHg; 95% CI -7.36--0.78) and were less likely to have hypertension (OR 0.47, 95% CI 0.39-0.57), diabetes mellitus (OR 0.56, 95% CI 0.51-0.61) or stroke (OR 0.31, 95% CI 0.24-0.42).

Conclusion: A focus on weight management and smoking cessation and aggressive management of dyslipidaemia in young adults may reduce the risk of early-onset CHD.

Keywords: Coronary heart disease; Early-onset; Geographical settings; Late-onset; Risk factors; Sex.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Aged
Cholesterol
Coronary Disease* / epidemiology
Coronary Disease* / etiology
Humans
Hypertension*
Risk Factors
Smoking Cessation*

Substances

Cholesterol