Coarctation of the Aorta and Coronary Artery Disease

Abstract

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 whether 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 and those with a ventricular septal defect, who are not known to be at increased risk of CAD. The prevalence of CAD in patients with CoA compared with those with ventricular septal defect was determined. We then used a nested case-control design to determine whether CoA independently predicted for the development of CAD.

Almanac 2014: Congenital Heart Disease.

“…Now, in a large sample of adult patients with CoA from Canada (n=756), the diagnosis of CoA was not found to be an independent predictor for CAD development after adjustment for traditional CAD risk factors 52 and this fi nding is supported by recent evidence of no clinically signifi cant dif- Prevalence of pulmonary valve replacement (PVR) stratifi ed by quality of follow-up. Data from a UK cohort study demonstrates that the prevalence of PVRs in patients that are followed up under specialised care (A) is signifi cantly higher than in patients without such care.…”

“…arterijske abnormalnosti u prirođenim srčanim greškama Istraživanja tijekom ovoga desetljeća pokazala su da pacijenti s korigiranom koarktacijom aorte imaju veći rizik od smrti nego opća populacija ili pacijenti s drugim vrstama koronarne bolesti srca (KBS), 52 što se pripisuje prije svega višoj prevalenciji KBS u toj skupini. U nedavnome velikom uzorku odraslih pacijenata s koartktacijom aorte iz Kanade (n = 756) nije potvrđeno da je ta dijagnoza neovisni prediktivni čimbenik za razvoj KBS-a nakon korekcije za tradicionalne čimbenike rizika.…”

“…U nedavnome velikom uzorku odraslih pacijenata s koartktacijom aorte iz Kanade (n = 756) nije potvrđeno da je ta dijagnoza neovisni prediktivni čimbenik za razvoj KBS-a nakon korekcije za tradicionalne čimbenike rizika. 52 Te podatke potkrepljuju nedavni dokazi da nema klinički značajne razlike u endotelnoj funkciji između odraslih pacijenata s KBS-om i zdrave kontrolne skupine.…”

“…Research in the last decade has demonstrated that patients with repaired Coarctation of the Aorta (CoA) have a higher risk of mortality than the general population or patients with other forms of coronary artery disease (CAD), 52 which has been attributed predominantly to an increased prevalence of CAD in this cohort. Now, in a large sample of adult patients with CoA from Canada (n=756), the diagnosis of CoA was not found to be an independent predictor for CAD development after adjustment for traditional CAD risk factors 52 and this fi nding is supported by recent evidence of no clinically signifi cant dif- Prevalence of pulmonary valve replacement (PVR) stratifi ed by quality of follow-up.…”

Management of Cardiovascular Risk Factors in Adults With Congenital Heart Disease

“…44 Roifman et al demonstrated higher rates of HTN, heart failure, and stroke in COA patients. 45 It is less clear whether COA alone versus the groups' increased prevalence of HTN or hyperlipidemia is associated with premature CVD. There have been suggestions of persistent endothelial dysfunction and impaired arterial reactivity, suggesting a primary vascular abnormality in COA.…”