Risk factors and clinical presentation of coronary artery disease in young patients: a decade-long single-center experience

BACKGROUND: Coronary artery disease (CAD) is a major health concern that also affects younger individuals, yet data on this population remain limited. We aimed to analyze trends, clinical features, and risk factors in patients aged ≤ 40 years undergoing invasive coronary angiography (ICA) at a high-volume Italian center. METHODS: We retrospectively analyzed all patients aged ≤ 40 years who underwent ICA from January 2010 to March 2024, assessing demographics, cardiovascular risk factors (CVRFs), and clinical presentations. We compared patients with significant CAD requiring revascularization and those without, exploring gender and ethnic differences. RESULTS: Of 38,304 ICA procedures, 441 (1.2%) involved young patients, with a decreasing trend over time. Males comprised 74.1% of the cohort. CAD requiring intervention was found in 100 procedures (22.7%), while 341 (77.3%) had no significant disease. The most prevalent CVRFs were hypertension (30.6%), active smoking (28.8%), family history of ischemic heart disease (26.8%), and hypercholesterolemia (24.9%). Diabetes prevalence was lower (8.6%). CAD patients had a higher CVRF burden, except for diabetes, which showed no significant difference. Notably, 10.0% of CAD patients lacked traditional CVRFs, while peripheral artery disease was more prevalent in patients with CAD. In particular, non-Caucasian patients had higher rates of hypertension, hypercholesterolemia, diabetes, and CAD. Males had higher rates of ST-segment elevation acute coronary syndrome and CAD, whereas nearly half of females had no CVRFs. Results were consistent in a sensitivity analysis restricted to the first procedure per patient. CONCLUSIONS: In very young patients undergoing ICA, age and hypercholesterolemia were the only independent predictors of angiographic CAD, while ethnicity was not independently associated after multivariable adjustment. Clinical presentation—particularly acute coronary syndromes and typical angina— were strongly associated with obstructive disease.