Risk Estimates for Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease

Abstract

The adult with congenital heart disease (CHD) is at risk of developing atherosclerotic cardiovascular disease (ASCVD). We performed a cross-sectional study to describe established ASCVD risk factors and estimate 10-year and lifetime risk of ASCVD in adults over age 18 with CHD of moderate or great complexity using three validated risk assessment tools—the Framingham Study Cardiovascular Disease Risk Assessment, the Reynolds Risk Score, and the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator. We obtained extensive clinical and survey data on 178 enrolled patients, with average age 37.1±12.6 years, 51% men. At least one modifiable ASCVD risk factor was present in 70%; the two most common were overweight/obesity (53%) and systemic hypertension (24%). Laboratory data was available in 103 of the 178 patients. Abnormal levels of glycated hemoglobin, high-sensitivity C-reactive protein, and high-density lipoprotein (HDL) were each found in around 30% of patients. The 10-year ASCVD predicted risk using all three tools was relatively low (i.e., at least 90% of patients <10% risk), yet the median estimated lifetime risk was 36%. In conclusion, ASCVD risk factors are prevalent in adults with CHD. The risk estimation tools suggest that this population is particularly vulnerable to ASCVD with aging and should undergo guideline-based screening and management of modifiable risk factors.

Cardiovascular risk factors and arterial thrombotic events in congenital heart disease patients

“…In relation to dyslipidemia, our CHD patients had lower total, LDL and HDL cholesterol than patients in the control group what is consistent with previously published data . Similarly, the number of smoking patients was lower than in other European countries and similar to what is found in the United States . This low number of smoking patients may be in relation to the awareness of the need for healthy habits.…”

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…4,289,305,307 Lipoprotein(a) levels were found to be similar to those in the general cohort. 308 A Korean study found low-density lipoprotein to be higher and high-density lipoprotein lower in patients with CHD than in a control group.…”

“…Impaired glucose tolerance and prediabetes have been demonstrated in almost 40% of adults with CHD. 304,305 Patients with Down, Turner, and Williams-Beuren syndromes have markedly increased risk of DM ( Table 5). The causes of these important differences from the general population are hard to determine from available data but may relate to increased rates of obesity and reduced physical exercise.…”

Substantial Cardiovascular Morbidity in Adults With Lower-Complexity Congenital Heart Disease

“…While the long-term risks of HF and arrhythmia associated with ACHD are well described 8,30,31 , morbidity from ACS and stroke in the ACHD population is a more recently recognized phenomenon due to increasing life expectancy 32,33 . In this study, the elevated risk of ACS and ischemic stroke associated with ACHD despite adjustment for atherosclerotic risk factors suggests a non-atherosclerotic etiology of cardiovascular disease.…”