Coarctation of the Aorta and Coronary Artery Disease: Fact or Fiction?
Background—Aortic coarctation (CoA) is reported to predispose to coronary artery disease (CAD). However, our clinical observations do not support this premise. Our objectives were to describe the prevalence of CAD among adults with CoA and to determine if CoA is an independent predictor of CAD or premature CAD.
Methods and Results—The study population was derived from the Quebec Congenital Heart Disease Database. We compared patients with CoA to those with a ventricular septal defect (VSD), who are not known to be at increased risk of CAD. Prevalence of CAD in patients with CoA vs. VSD was determined. We then employed a nested case-control design in order to determine if CoA independently predicted for the development of CAD. Of 756 patients with CoA alive in 2005, there were 37 with a history of CAD vs. 224 out of 6,481 VSD patients (4.9% vs. 3.5%, p = 0.04). Male sex (OR 2.13, 1.62-2.80), hypertension (OR 1.95, 1.44-2.64), diabetes (OR 1.68, 1.09-2.58), age (OR per 10 year increase 2.28, 2.09-2.48) and hyperlipidemia (OR 11.58, 5.75-23.3) all independently predicted for the development of CAD. CoA did not independently predict for the development of CAD (OR 1.04, 95% CI 0.68-1.57) or premature CAD (OR CoA vs. VSD 1.44, 0.79-2.64) after adjusting for other factors.
Conclusions—While traditional cardiovascular risk factors independently predicted for the development of CAD, the diagnosis of CoA alone did not. Our findings suggest that cardiovascular outcomes of these patients may be improved with tight risk factor control.
- Received December 20, 2011.
- Accepted May 1, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited