818 ATHEROSCLEROTIC HEART DISEASE IN EAST EUROPEAN POPULATION IN ROME METROPOLITAN AREA: RISK FACTORS AND ANGIOGRAPHIC FINDINGS
Authors: Tamburro Claudia , Russo Massimo , Oro Pietro , Porzio Federica , Rosenfeld Roberto , Andreadi Aikaterini , Lauro Davide , Barone Lucy , Muscoli Saverio , Barilla´ Francesco 
Published: December 2022

Abstract

Introduction
Coronary artery disease (CAD) is a major cause of morbidity and mortality in the world and its prevalence varies considerably by ethnicity, as shown by the SCORE2 and SCORE2- OP risk tables calibrated to four country groups (low, moderate, high and very high risk). High risk and very high risk regions include Eastern European countries. Previous studies have shown that risk factors such as smoking, excessive alcohol consumption, obesity, hypercholesterolaemia and type 2 diabetes are more prevalent in this population. However, mortality in Eastern European countries is higher than wealth levels would suggest, implying that Eastern European ethnicity may be an independent risk factor.

Methods
In this retrospective observational study at a single centre, we selected patients from Eastern Europe who underwent coronary angiography. We compared 106 Eastern European patients with 100 Italian patients as a control group. All Eastern European patients were consecutively selected from our registry from 2016 to 2021. Patients who had not undergone coronary angiography in our centre were excluded from the study. We recorded medicalÂ history, age, sex, cardiovascular risk factors, number of previous cardiovascular events (STEMI, NSTEMI and UA) and age of first cardiovascular event. Using the coronary angiography reports, we analysed the site of the lesions (RCA, LAD, LCX and LMA). We then used Ï‡ square test to compare the two populations.

Results
We observed a lower mean age at first cardiovascular event in Eastern European patients (p value &lt; 0.0001) with a relative reduction of 30.5% in the general population (ReR 30.5%, t167 = 10.6, p &lt; 0.0001, 95% CI 12.8 - 18.6).
The incidence of STEMI events was twice as high in Eastern Europe (OR 2.73, CI 1.3-5.98, p-value 0.006). Regarding coronary anatomy, Eastern Europeans had a higher incidence of significant lesions on the artery LAD with an increase of 31.1% (OR 2.73, p-value 0.0006). When comparing the number of risk factors in the two ethnic groups, the prevalence of multiple risk factors was significantly lower in Eastern Europe than in Italy, with the population with two or fewer risk factors being twice as high as the Italian population (OR 2.26, CI 1.2- 4.3, p-value 0.01).

Discussion
Our study showed an early and more aggressive CAD in Eastern European patients while adding previously unknown data on coronary anatomy, with Eastern Europeans having 30% more significant stenoses on LAD than Italians. Surprisingly, the Eastern European population had a lower incidence of multiple risk factors compared to Italian patients, refuting the findings of previous studies on this topic and the common misconception that the incidence of CAD in Eastern Europe is due to an unhealthy lifestyle.

Conclusion
The present study confirms that Eastern European ethnicity is an independent risk factor for CAD and, in accordance with the principles of personalised cardiovascular medicine, elaborates on the coronary lesions associated with it.