Premature Coronary Disease

Overview

Premature coronary disease refers to coronary artery disease that develops earlier in life than usual. Coronary artery disease occurs when the arteries that supply blood to the heart muscle become narrowed by a buildup of fatty plaque, a process called atherosclerosis. When this happens at a young age, generally before about 55 in men and 65 in women, it is considered premature.

Heart disease is often thought of as a problem of older age, but it can and does affect younger adults, sometimes with serious consequences such as a heart attack. Premature coronary disease frequently has a strong genetic component and is often driven by powerful risk factors such as inherited high cholesterol, smoking, diabetes, or a strong family history of early heart disease. Recognizing risk early is especially important in younger people, because identifying and treating these factors can prevent or delay heart attacks and protect long-term health.

Symptoms

Premature coronary disease can be silent until it causes a problem, but symptoms, when present, are similar to those of coronary artery disease at any age.

• Chest pain or pressure (angina), often brought on by exertion or stress and relieved by rest
• Shortness of breath, especially with activity
• Fatigue and reduced exercise tolerance
• Pain spreading to the arm, neck, jaw, shoulder, or back
• Sweating, nausea, or lightheadedness during an episode

In some younger people, the first sign is a heart attack. Because heart problems may be unexpected at a young age, symptoms are sometimes dismissed or attributed to other causes, which can delay vital treatment. Any chest pain or possible heart attack symptoms should be taken seriously at any age.

Causes

Premature coronary disease results from the same plaque buildup that causes heart disease later in life, but the process is accelerated, often by strong risk factors acting earlier.

• Inherited high cholesterol: conditions such as familial hypercholesterolemia cause very high cholesterol from birth and can lead to early heart disease.
• Family history: a strong genetic tendency to early heart disease.
• Smoking: a powerful accelerator of artery damage, especially harmful in younger people.
• Diabetes and high blood pressure: which speed up atherosclerosis.
• Obesity and physical inactivity: contribute to early disease.

Often several of these factors combine, and inherited cholesterol disorders are an especially important cause to identify because they are treatable.

Risk Factors

Many risk factors for premature coronary disease can be identified and treated.

• A strong family history of early heart disease
• Inherited high cholesterol (familial hypercholesterolemia)
• Smoking or tobacco use
• Diabetes
• High blood pressure
• High LDL ("bad") cholesterol
• Obesity and a sedentary lifestyle
• Chronic inflammatory conditions in some cases

Diagnosis

Diagnosing premature coronary disease involves assessing risk factors and testing the heart and arteries, often prompted by symptoms or a strong family history.

• Cholesterol and blood tests: including a full lipid panel and blood sugar, with attention to very high cholesterol that may signal an inherited disorder.
• Electrocardiogram (ECG): to look for signs of heart strain or a previous heart attack.
• Stress testing: to see how the heart performs under exertion.
• Imaging of the arteries: such as a coronary calcium scan, CT angiography, or coronary angiography to assess plaque and blockages.
• Family and genetic evaluation: when inherited cholesterol disorders are suspected.

Early and thorough evaluation is especially valuable in younger people with risk factors.

Treatment

Treatment aims to slow or halt the disease, relieve symptoms, and prevent heart attacks. Because the disease appears early, lifelong management is often needed.

• Aggressive risk-factor control: lowering cholesterol with statins and other medicines, controlling blood pressure and diabetes, and quitting smoking.
• Lifestyle changes: a heart-healthy diet, regular exercise, and weight management.
• Medications: such as aspirin or other drugs when appropriate to reduce the risk of clots and heart attack.
• Procedures: angioplasty with stenting or bypass surgery to restore blood flow in significant blockages.
• Treating inherited disorders: specialized treatment for familial hypercholesterolemia, sometimes including newer cholesterol-lowering therapies.

Identifying and treating affected family members is also an important part of care for inherited forms.

Prevention

• Do not smoke, and avoid tobacco entirely
• Have your cholesterol checked, especially with a family history of early heart disease
• Eat a heart-healthy diet and stay physically active
• Maintain a healthy weight
• Control blood pressure and manage diabetes
• Take prescribed cholesterol and other heart medicines consistently
• Encourage close relatives to be screened if an inherited cholesterol disorder is found

When to See a Doctor

See a clinician for a heart risk assessment if you have a strong family history of early heart disease, very high cholesterol, or other major risk factors, even when you feel well. Do not assume you are too young for heart problems.

Call emergency services right away if you have chest pain or pressure, especially with shortness of breath, sweating, nausea, lightheadedness, or pain spreading to the arm, neck, or jaw. These can be signs of a heart attack, which can occur even in younger people. Fast treatment saves heart muscle and lives.

Related Topics

Frequently Asked Questions

References

1. American Heart Association (AHA). Coronary artery disease.
2. National Heart, Lung, and Blood Institute (NHLBI). Coronary heart disease.
3. Mayo Clinic. Coronary artery disease — Symptoms and causes.
4. MedlinePlus, U.S. National Library of Medicine. Coronary artery disease.