Risk factors for CAD, stroke in adults with congenital heart disease
Among ageing adult congenital heart disease (ACHD) patients, traditional atherosclerotic risk factors are associated with coronary artery disease (CAD), while ischaemic stroke is related to factors suggesting a cardioembolic aetiology, a multicentre case–control study has found.
Using the national CONgenital CORvitia (CONCOR) registry, researchers identified 6,904 ACHD patients, among whom 55 had CAD (mean age 55.1 years; 80 percent male) and 56 had stroke (mean age 46.9 years; 46 percent male).
Patients with CAD were matched 1:2 with ACHD patients without CAD based on age, CHD defect group and gender. Patients with ischaemic stroke (or transient ischaemic attack) were similarly matched. The presence of risk factors was determined using medical charts and a standardized questionnaire.
Multivariable logistic regression analysis showed CAD to be associated with traditional atherosclerotic risk factors, such as hypertension (odds ratio [OR], 2.45; 95 percent CI, 1.15 to 5.23), hypercholesterolaemia (OR, 3.99; 1.62 to 9.83) and smoking (OR, 2.25; 1.09 to 4.66).
Stroke, on the other hand, was associated with previous shunt operations (OR, 4.20; 1.36 to 12.9), residual/unclosed septal defects (OR, 2.38; 1.03 to 5.51) and left-sided mechanical valves (OR, 2.67; 1.09 to 6.50). Risk factors for CAD were not associated with stroke.
In light of the present data, researchers called on physicians managing individuals with ACHD to recommend a heart-healthy lifestyle early on.
“Physicians should also be aware of the presence of risk factors such as hypertension and treat according to general guidelines,” researchers added.
Additional studies are needed to determine whether modification of the aforementioned risk factors may prevent acquired cardiovascular disease.