# Premature Coronary Artery Disease and Familial Dyslipidemia in Patients Presenting With Acute Coronary Syndrome: A Tertiary Cardiac Center Registry

## TL;DR

This study finds that premature coronary artery disease in patients with heart attacks is strongly linked to smoking and family history of high cholesterol, not diabetes or high blood pressure.

## Contribution

The study identifies smoking and familial dyslipidemia as key predictors of premature coronary artery disease in acute coronary syndrome patients.

## Key findings

- Premature CAD patients were younger, more likely male, and had higher cholesterol and LDL levels.
- Smoking and family history of dyslipidemia were the strongest independent predictors of premature CAD.
- Diabetes and hypertension were less common in premature CAD cases compared to non-premature cases.

## Abstract

Background: Premature coronary artery disease (CAD) in patients presenting with acute coronary syndrome (ACS) is an increasing clinical concern driven by genetic predisposition and lifestyle factors. This study compared clinical and laboratory characteristics of premature versus non-premature CAD and identified predictors of early-onset disease.

Methods: This was a cross-sectional observational study of 2,000 patients admitted with confirmed ACS. Premature CAD was defined as males <55 years and females <65 years. Clinical, laboratory, and cardiological variables were compared between groups.

Results: From December 2021 to March 2025, 2,000 patients were enrolled. Premature CAD occurred in 637 patients (31.9%), who were younger (median age 49 years) and predominantly male (68.4%). Smoking (32.8% vs. 9.4%), family history of dyslipidemia (20.4% vs. 3.7%), higher total cholesterol (174.0 vs. 145.0 mg/dL, p<.001), higher low-density lipoprotein (LDL) cholesterol (108.3 vs. 85.1 mg/dL, p<.001), and higher corrected LDL (155.8 vs. 147.3 mg/dL, p<.001) were more common in premature CAD, whereas diabetes and hypertension were less frequent. Independent predictors included smoking (OR 4.71, 95% CI 3.68 6.03), family history of dyslipidemia (OR 6.73, 95% CI 4.78 9.48), cholesterol ≥200 mg/dL (OR 2.26, 95% CI 1.80 2.83), LDL ≥100 mg/dL (OR 2.10, 95% CI 1.74 2.54), and hypertriglyceridemia (OR 1.77, 95% CI 1.45 2.17).

Conclusions: Premature CAD in patients presenting with ACS demonstrates a risk profile dominated by smoking and familial dyslipidemia rather than metabolic comorbidities. Early lipid screening and aggressive modification of lifestyle risk factors are essential to reduce early atherosclerotic disease burden.