Behavioral habits and familial tendency; Case-Control study among premature and non-premature coronary artery disease
Keywords:
Premature CAD, Risk Factors, Lifestyle, Coronary Artery Disease
Abstract
https://doi.org/10.31386/dmj.2026.20.2.4
Abstract
Background and Aim: Premature Coronary artery disease (CAD) represent a riding global health concern. CAD is the most common form of heart disease and the leading cause of morbidity and mortality worldwide. This study aims to identify the modifiable risk factors besides genetic predisposition that contributes to high prevalence of premature coronary artery disease and correlate it to non-premature coronary artery disease.
Methods: Data were collected inform of a case (Premature CAD) – control (non-premature CAD) with a total of 350 cases were enrolled from both genders. The study was conducted during a period of one-year interval. Patients under the classification of premature CAD; male patients less than 45 years and female patients less than 55 years of age presenting as Acute coronary syndrome. Data were analyzed using SPSS version 26 to analyze descriptive statistics, test for normality using Kolmogorov-Smirnov (KS) and Shapiro-Wilk, The Mann-Whitney U test and Chi-square test (Fisher's Exact once), P value < 0.05 indicated statistical significance.
Results: Younger females, those with a family history, Non ST Segment elevation Myocardial Infarction, diabetes, hypertension, obesity, and former smokers are more likely to develop premature CAD, P < 0.05. additionally, other factors were assessed.
Conclusion: Despite the direct correlation of Premature and Non-premature coronary artery disease to risk factors; they showed significant differences in terms of Family history, gender, Hypertension, Diabetes, Smoking, Obesity, lifestyle, habits and Occupation in Premature CAD group.
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References
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37. Lichtman, J. H., Bigger, J. T., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., LespéRance, F., . . . Froelicher, E. S. (2008). Depression and coronary heart disease. Circulation, 118(17), 1768–1775. https://doi.org/10.1161/circulationaha.108.190769.
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2. Stark, B., Johnson, C., & Roth, G. A. (2024). GLOBAL PREVALENCE OF CORONARY ARTERY DISEASE: AN UPDATE FROM THE GLOBAL BURDEN OF DISEASE STUDY. Journal of the American College of Cardiology, 83(13), 2320. https://doi.org/10.1016/s0735-1097(24)04310-9.
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4. Sharma, S. K., Makkar, J. S., Bana, A., Sharma, K., Kasliwal, A., Sidana, S. K., Degawat, P. R., Bhagat, K. K., Chaurasia, A. K., Natani, V., Sharma, S. K., & Gupta, R. (2022). Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry. Indian heart journal, 74(5), 391–397. https://doi.org/10.1016/j.ihj.2022.08.003.
5. Vaduganathan, M, Mensah, G, Turco, J. et al. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. JACC. 2022 Dec, 80 (25) 2361–2371. https://doi.org/10.1016/j.jacc.2022.11.005
6. Khoja, A., Andraweera, P. H., Lassi, Z. S., Zheng, M., Pathirana, M. M., Ali, A., Aldridge, E., Wittwer, M. R., Chaudhuri, D. D., Tavella, R., & Arstall, M. A. (2021). Risk factors for premature coronary artery disease (PCAD) in adults: a systematic review protocol. F1000Research, 10, 1228. https://doi.org/10.12688/f1000research.74926.1.
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8. Dai, X., Wiernek, S., Evans, J. P., & Runge, M. S. (2016). Genetics of coronary artery disease and myocardial infarction. World journal of cardiology, 8(1), 1–23. https://doi.org/10.4330/wjc.v8.i1.1.
9. Ram, R. V., & Trivedi, A. V. (2012). Behavioral risk factors of coronary artery disease: A paired matched case control study. Journal of cardiovascular disease research, 3(3), 212–217. https://doi.org/10.4103/0975-3583.98896.
10. Mohammad, A.M., Jehangeer, H.I. & Shaikhow, S.K. Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq. BMC Cardiovasc Disord 15, 155 (2015). https://doi.org/10.1186/s12872-015-0145-7.
11. Mohammad, A. M., Rashad, H. H., Habeeb, Q. S., Rashad, B. H., & Saeed, S. Y. (2021). Demographic, clinical and angiographic profile of coronary artery disease in kurdistan region of Iraq. Am J Cardiovasc Dis, 11(1), 39-45 .
12. Mohammad, A. M., Mohammed, M., Rasul, M. T., & Sgery, A. S. (2023). Silent Coronary Artery Disease in Patients with Rheumatoid Arthritis in Kurdistan, Iraq: A Cross-sectional Study. Journal of Contemporary Medical Sciences, 9(2).
13. Güldaval, F., Polat, G., Doruk, S., Karadeniz, G., Ayranci, A., Türk, M., Gayaf, M., Yavuz, M. Y., Büyükşirin, M., & Anar, C. (2021). What are the Differences Between Smoker and Non-smoker COPD Cases? Is it a Different Phenotype?. Turkish thoracic journal, 22(4), 284–288. https://doi.org/10.5152/TurkThoracJ.2021.20147.
14. NCI Dictionary of Cancer Terms. (n.d.). Cancer.gov. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pack-year.
15. Dariusz Nowak, Artur Jasionowski. Analysis of the Consumption of Caffeinated Energy Drinks among Polish Adolescents. Int. J. Environ. Res. Public Health 2015, 12, 7910-7921.
16. Gateway Foundation. (2023, October 11). Social Drinking vs. Problem Drinking: What’s the Difference? https://www.gatewayfoundation.org/addiction-blog/social-drinking.
17. Amanda L et al. COMING OF AGE: CONSIDERATIONS IN THE PRESCRIPTION OF EXERCISE FOR OLDER ADULTS. MDCVJ XII (2) 2016.
18. Arja Erkkilä 1, Vanessa D F de Mello, Ulf Risérus, David E Laaksonen. Dietary fatty acids and cardiovascular disease: an epidemiological approach. Prog Lipid Res. 2008 May;47(3):172-87
19. BMI. (2024, May 20). BMI. https://www.cdc.gov/healthyweight/assessing/index.html#:~:text=If%20your%20BMI%20.
20. M E Lean 1, T S Han, C E Morrison. Waist circumference as a measure for indicating need for weight management. BMJ 1995 Jul 15;311(6998):158-61.
21. Lloyd-Jones, D. M., Nam, B. H., D'Agostino, R. B., Sr, Levy, D., Murabito, J. M., Wang, T. J., Wilson, P. W., & O'Donnell, C. J. (2004). Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA, 291(18), 2204–2211. https://doi.org/10.1001/jama.291.18.2204.
22. Bachmann, J. M., Willis, B. L., Ayers, C. R., Khera, A., & Berry, J. D. (2012). Association between family history and coronary heart disease death across long-term follow-up in men: the Cooper Center Longitudinal Study. Circulation, 125(25), 3092–3098. https://doi.org/10.1161/CIRCULATIONAHA.111.065490.
23. Bertuzzi, M., Negri, E., Tavani, A., & La Vecchia, C. (2003). Family history of ischemic heart disease and risk of acute myocardial infarction. Preventive medicine, 37(3), 183–187. https://doi.org/10.1016/s0091-7435(03)00094-x.
24. Chacko, M., Sarma, P. S., Harikrishnan, S., Zachariah, G., & Jeemon, P. (2020). Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study. Wellcome open research, 5, 70. https://doi.org/10.12688/wellcomeopenres.15829.2.
25. Di Lenarda F, Balestrucci A, Terzi R, Lopes P, Ciliberti G, Marchetti D, Schillaci M, Doldi M, Melotti E, Ratti A, et al. Coronary Artery Disease, Family History, and Screening Perspectives: An Up-to-Date Review. Journal of Clinical Medicine. 2024; 13(19):5833. https://doi.org/10.3390/jcm13195833.
26. Li, Y., Wang, C., Feng, Z., Tian, L., Yao, S., Wang, M., Zhao, M., Lan, L., & Xue, H. (2024). Premature coronary heart disease complicated with hypertension in hospitalized patients: Incidence, risk factors, cardiovascular-related comorbidities and prognosis, 2008–2018. International Journal of Cardiology. Cardiovascular Risk and Prevention, 21, 200253. https://doi.org/10.1016/j.ijcrp.2024.200253.
27. Salehi, N., Janjani, P., Tadbiri, H., Rozbahani, M., & Jalilian, M. (2021). Effect of cigarette smoking on coronary arteries and pattern and severity of coronary artery disease: A review. The Journal of International Medical Research, 49(12), 03000605211059893. https://doi.org/10.1177/03000605211059893.
28. Yang, Y., Peng, N., Chen, G. et al. Interaction between smoking and diabetes in relation to subsequent risk of cardiovascular events. Cardiovasc Diabetol 21, 14 (2022). https://doi.org/10.1186/s12933-022-01447-2.
29. Manoharan, M. P., Raja, R., Jamil, A., Csendes, D., Gutlapalli, S. D., Prakash, K., Swarnakari, K. M., Bai, M., Desai, D. M., Desai, A., & Penumetcha, S. S. (2022). Obesity and Coronary Artery Disease: An Updated Systematic Review 2022. Cureus, 14(9), e29480. https://doi.org/10.7759/cureus.29480.
30. Panwar, R. B., Gupta, R., Gupta, B. K., Raja, S., Vaishnav, J., Khatri, M., & Agrawal, A. (2011). Atherothrombotic risk factors & premature coronary heart disease in India: a case-control study. The Indian journal of medical research, 134(1), 26–32.
31. Rämö, J. T., Ripatti, P., Tabassum, R., Söderlund, S., Matikainen, N., Gerl, M. J., . . . Ripatti, S. (2019). Coronary artery disease risk and lipidomic profiles are similar in hyperlipidemias with family history and Population‐Ascertained hyperlipidemias. Journal of the American Heart Association, 8(13). https://doi.org/10.1161/jaha.119.012415.
32. Vikulova, D, Pinheiro-Muller, D, Rojas-Fernandez, C. et al. Longitudinal Control of Lipid Levels in Patients With Premature Coronary Artery Disease. JACC Adv. 2023 Dec, 2 (10) .
33. Larsson, S. C., Burgess, S., Mason, A. M., & Michaëlsson, K. (2020). Alcohol consumption and cardiovascular disease. Circulation Genomic and Precision Medicine, 13(3). https://doi.org/10.1161/circgen.119.002814.
34. Lavie, C. J., Ozemek, C., Carbone, S., Katzmarzyk, P. T., & Blair, S. N. (2019). Sedentary behavior, exercise, and cardiovascular health. Circulation Research, 124(5), 799–815. https://doi.org/10.1161/circresaha.118.312669.
35. Elendu, C., Amaechi, D. C., Elendu, T. C., Jingwa, K. A., Okoye, O. K., Chirinos, G. A., Agada, D., Okah, M. J., Adebayo, O. D., Dang, K., Egbunu, E., Alabi, O. S., Nasre, V. S., Yadav, C. P., & Badru, M. D. (2023). Relationship between stress and coronary artery disease: A comprehensive review. Medicine, 103(5), e37066. https://doi.org/10.1097/MD.0000000000037066.
36. Nakada, S., Ward, J., Strawbridge, R.J. et al. Anxiety disorder, depression and coronary artery disease: associations and modification by genetic susceptibility. BMC Med 23, 73 (2025). https://doi.org/10.1186/s12916-025-03915-4.
37. Lichtman, J. H., Bigger, J. T., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., LespéRance, F., . . . Froelicher, E. S. (2008). Depression and coronary heart disease. Circulation, 118(17), 1768–1775. https://doi.org/10.1161/circulationaha.108.190769.
38. Wang, Y. J., Yeh, T. L., Shih, M. C., Tu, Y. K., & Chien, K. L. (2020). Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. Nutrients, 12(10), 2934. https://doi.org/10.3390/nu12102934.
39. Hunter, R. W., Dhaun, N., & Bailey, M. A. (2022). The impact of excessive salt intake on human health. Nature reviews. Nephrology, 18(5), 321–335. https://doi.org/10.1038/s41581-021-00533-0.
Published
2026-07-20
How to Cite
1.
HUSSEIN MUSTAFA M. Behavioral habits and familial tendency; Case-Control study among premature and non-premature coronary artery disease. Duhok Medical Journal [Internet]. 20Jul.2026 [cited 23Jul.2026];20(2):36-9. Available from: https://dmj.uod.ac/index.php/dmj/article/view/359
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College of Medicine, University of Duhok
Duhok, Iraq
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