Coronary artery disease in young diabetics (under 40 years): Are they Different?

Aims: The aim is to study the clinical, social, biochemical, and angiographic profiles of Indian diabetic youth presenting with premature coronary artery disease (PCAD). Subjects and Methods: Of 3450 patients registered in PCAD registry till date, 375 (10.86%) satisfied the entry criteria. The data were analyzed by statistical software R version 3.5.0. Further, a subgroup analysis based on age was made, and comparisons were drawn. Results: The study had 375 patients. The average age was 35.94 years; there were 228 (60.8%) patients between 36 and 40 years, 104 (27.7%) between 31 and 35 years, and 43 (11.5%) between 26 and 30 years. There were 291 (77.6%) males and 84 (22.4%) females. There were 152 (42.10%) smokers, 102 (27.2%) hypertensives and 68 (18.1%) with family history of CAD in the group. Around 285 (75.9%) had abnormal body mass index (BMI) and 290 (77.3%) had abdominal obesity. The most common index presentation was ST-elevation myocardial infarction (STEMI), 275 (73.34%). Single-vessel disease was the most common presentation in 265 (79.1%). A subgroup analysis by age showed that younger diabetics more often presented with STEMI and triple-vessel disease was less common, whereas the older diabetics presented more often with dyslipidemia and non-STEMI. Conclusions: Patients with diabetes have a high cardiovascular risk. Diabetes negates the cardiovascular protection seen in premenopausal women. High BMI and abdominal obesity are the most common risk factors for diabetes in the young. Diabetics with premature CAD present more often with STEMI and have single-vessel disease, unlike older diabetics. Hence, aggressive lifestyle modifications that begin in childhood are very important to tackle this growing epidemic.