Age-stratified Prevalence and Relative Prognostic Significance of Traditional Atherosclerotic Risk Factors: A Report from the Nationwide Registry of Percutaneous Coronary Interventions in Japan
Authors: Kanenawa Kenji , Yamaji Kyohei , Kohsaka Shun , Ishii Hideki , Amano Tetsuya , Andò Kenji , Kozuma Ken 
Published: May 2023

AbstractBackgroundThe prevalence of traditional atherosclerotic risk factors (TARFs) and their association with clinical profiles or mortality in percutaneous coronary intervention (PCI) remain unclear.MethodsThe study analyzed 559,452 patients who underwent initial PCI between 2012 and 2019 in Japan. TARFs were defined male, hypertension, dyslipidemia, diabetes, smoking, and chronic kidney disease (CKD). We evaluated the age-specific prevalence of TARFs, and calculated the relative importance (RI) according to R2, machine learning to assess the impact of TARFs on clinical profile (age, the presentation of acute myocardial infarction, cardiogenic shock, and multivessel disease) and in-hospital mortality. The average percentage of the RI calculated from these models was defined as the relative contribution (RC) of each TARF.ResultsThe age-specific prevalence of TARFs, except for CKD, formed an inverted U-shape with significantly different peaks and percentages. Smoking was more prevalent in patients with ST-elevation myocardial infarction than in patients with stable angina (odds ratio [OR], 1.75, 95% confidence interval [CI], 1.73-1.77). In logistic regression model and relative risk model, smoking was most strongly associated with acute myocardial infarction (AMI) (adjusted OR, 1.62, 95% CI, 1.60-1.64; RC, 47.1%) and premature coronary artery disease (adjusted unstandardized beta coefficient [UC], 2.68, 95% CI, 2.65-2.71, RC, 42.2%). Diabetes was most strongly associated with multivessel disease (adjusted UC, 0.068; 95% CI, 0.066-0.070, RC, 59.4%) and the presentation of non-AMI (adjusted OR, 0.77, 95% CI, 0.76-0.78, RI, 21.9%). The absence of dyslipidemia was most strongly associated with presentation of cardiogenic shock (adjusted OR, 0.62; 95% CI, 0.61-0.64, RC, 34.2%) and in-hospital mortality (adjusted OR, 0.44, 95% CI, 0.41-0.46, RC, 39.8%). These specific associations were consistently observed regardless of adjustment or stratification by age.ConclusionsOur analysis showed a significant variation in the age-specific prevalence of TARFs. Further, their contribution to clinical profiles and mortality also varied widely.What is knownTraditional atherosclerotic risk factors (TARFs) are well-established targets for the prevention of adverse cardiovascular events.The impact of TARFs on clinical profiles in the patients with percutaneous coronary intervention remain unclear.What the Study AddsDue to the prevalence of TARF, which varies by age group, the TARFs that should be actively intervened and educated on will differ for each age groupThe relative importance of TARF differed significantly by clinical profile (age, the presentation of acute myocardial infarction, cardiogenic shock, and multivessel disease) and in-hospital mortality.Understanding the differences in the impact of TARFs on CAD is an important step in improving population-based strategies for CAD prevention.