Out of 11986 patients, 9083 (75.8%) had more than 50% coronary artery obstruction. They were classified as CAD, and 2903 (24.2%) patients had normal angiography or obstruction of less than 50% (non-CAD group). In total, 7910 (65.9%) patients were male; also, 6441 (70.9%) patients in the CAD group were male. In the non-CAD group, the number of males and females was almost equal, so being male had a statistically significant relationship with the frequency of CAD (P-value < 0.05). The mean age of the patients was 58.9 ± 10.7 years. The mean age of patients in the CAD group was approximately 3.2 years lower than those in the non-CAD group, which was statistically significant (P-value = < 0.05). The most common risk factor in patients undergoing angiography was HTN at 57.8%, followed by DLP at 50.7%. All traditional risk factors in the CAD group were significantly higher than the non-CAD group (Table 1).
Table 1
Correlation of demographic features and cardiovascular risk factors with coronary artery disease in patients undergoing coronary angiography.
Variable | All patients (n = 11986) | CAD (n = 9083) | Non CAD (n = 2903) | Invariable | Multivariable |
OR (95% CI) | P- Value | Adjusted OR (95% CI) | P- Value |
Age | 58.9 ± 10.7 | 59.8 ± 10.6 | 56.5 ± 11 | 1.44 (1.25–1.72) | < 0.001 | 1.33 (1.11–1.58) | < 0.001 |
Sex (Male) | 7910 (65.9%) | 6441 (70.9%) | 1469 (50.4%) | 1.51 (1.34–1.68) | < 0.001 | 1.42 (1.29–1.57) | < 0.001 |
BMI | 31.9 ± 10.2 | 32.1 ± 10.2 | 31.1 ± 10.4 | 1.16 (1.11–1.27) | < 0.001 | 1.09 (1.05–1.19) | 0.014 |
Waistline | 100.1 ± 12.3 | 100.9 ± 12.4 | 99.9 ± 11.8 | 1.09 (1.02–1.23) | < 0.001 | 1.01 (0.89–1.14) | 0.128 |
Smoking | 2915 (24.3%) | 2386 (26.3%) | 529 (18.2%) | 1.31 (1.15–1.52) | < 0.001 | 1.11 (1.04–1.24) | < 0.001 |
DLP | 6080 (50.7%) | 5051 (55.6%) | 1029 (35.4%) | 1.83 (1.46–2.32) | < 0.001 | 1.57 (1.33–1.83) | < 0.001 |
DM | 4796 (40%) | 3957 (43.6%) | 839 (28.9%) | 1.68 (1.43–2.06) | < 0.001 | 1.46 (1.27–1.72) | < 0.001 |
HTN | 6937 (57.8%) | 5475 (60.3%) | 1462 (50.4%) | 1.45 (1.29–1.66) | < 0.001 | 1.28 (1.14–1.47) | < 0.001 |
FH | 2208 (18.4%) | 1746 (19.2%) | 462 (15.9%) | 1.23 (1.15–1.32) | < 0.001 | 1.07 (1.01–1.18) | 0.003 |
CAD, Coronary artery disease; BMI, Body mass index; DLP, Dyslipidemia; DM; Diabetes mellitus; HTN, Hypertension; FH, Familial history
Of 11,986 patients who underwent angiography, 1515 patients (12.7%) had parental CM, of which 1190 (78.5%) had CAD. Out of 10471 (87.3%) patients with a non-relative marriage of parents, 7893 (75.3%) had CAD. This study showed that the frequency of CAD in patients with parental CM is about 3.2% higher, which is statistically significant (P-value < 0.001) (Fig. 2).
Also, the mean age of patients with CAD in patients with parental CM was 1.9 years less than in patients without parental CM (P-value < 0.001) (Table 2).
Table 2
Correlation of demographic features and cardiovascular risk factors with the consanguineous marriage of parents in patients with confirmed coronary artery disease.
Variable | Total CAD (n = 9083) | With parental CM (n = 1090) | Non parental CM (n = 7993) | Invariable | Multivariable |
OR (95% CI) | P- Value | Adjusted OR (95% CI) | P- Value |
Age | 59.8 ± 10.6 | 58.1 ± 10.8 | 60.2 ± 10.6 | 1.23 (1.11–1.44) | < 0.001 | 1.14 (1.09–1.25) | < 0.001 |
Sex (Male) | 6441 (70.9%) | 753 (69.1%) | 5688 (71.2%) | 1.02 (0.72–1.28) | 0.284 | 1.08 (0.79–1.34) | 0.126 |
BMI | 32.1 ± 10.2 | 31.7 ± 11.3 | 32.1 ± 10.1 | 1.17 (0.96–1.37) | 0.096 | 1.08 (0.84–1.18) | 0.351 |
Waistline | 100.1 ± 12.3 | 100.2 ± 11.3 | 99.9 ± 12.8 | 1.06 (0.84–1.21) | 0.520 | 1.01 (0.86–1.14) | 0.741 |
Smoking | 2386 (26.2%) | 269 (24.7%) | 2117 (26.5%) | 1.11 (0.85–1.42) | 0.477 | 1.16 (0.94–1.39) | 0.214 |
DLP | 7052 (77.6%) | 851 (78.1%) | 6201 (77.6%) | 1.13 (0.78–1.46) | 0.727 | 1.24 (0.92–1.36) | 0.154 |
DM | 3957 (43.5%) | 476 (43.7%) | 3481 (43.6%) | 1.01 (0.95–1.04) | 0.948 | 1.07 (0.86–1.24) | 0.756 |
HTN | 5475 (60.2%) | 610 (56%) | 4865 (60.9%) | 0.85 (0.74–0.96) | 0.020 | 0.73 (0.59–0.87) | < 0.001 |
FH | 1746 (19.2%) | 234 (21.5%) | 1512 (18.9%) | 1.16 (1.02–1.34) | 0.045 | 1.14 (0.94–1.28) | 0.227 |
CAD, Coronary artery disease; CM, Consanguineous marriage; BMI, Body mass index; DLP, Dyslipidemia; DM; Diabetes mellitus; HTN, Hypertension; FH, Familial history.
Of the 11986 patients who underwent angiography, 9083 (75.7%) had CAD according to coronary angiography during this study or in the past; the mean age of the first coronary angiography of the patients was 58.6 years. Also, the patient's mean age for the first CAD, first percutaneous coronary intervention (PCI), and first coronary artery bypass graft (CABG) were 59 years, 59.9 years, and 60.6 years, respectively. In all four variables, the mean age of patients with parental CM was about two years less than that of patients whose parents were not consanguineous (P-Value < 0.001) (Table 3).
Table 3
Correlation of parental consanguineous marriage with the age of first coronary angiography, age of onset of coronary artery disease, age of percutaneous coronary intervention, and coronary artery bypass graft.
Variable | All patients (n = 11986) | With parental CM (n = 1515) | Non parental CM (n = 10471) | Invariable | Multivariable |
OR (95% CI) | P- Value | Adjusted OR (95% CI) | P- Value |
Age of first CAG | 58.6 ± 10.8 | 56.7 ± 10.8 | 58.8 ± 10.7 | 1.47 (1.14–1.84) | < 0.001 | 1.24 (1.11–1.43) | < 0.001 |
Age of first CAD | 59 ± 10.8 | 57.2 ± 10.8 | 59.3 ± 10.7 | 1.34 (1.21–1.68) | < 0.001 | 1.31 (1.16–1.47) | < 0.001 |
Age of first PCI | 59.9 ± 10.6 | 58.4 ± 11.1 | 60.1 ± 10.5 | 1.58 (1.18 2.06) | < 0.001 | 1.27 (1.21–1.44) | < 0.001 |
Age of first CABG | 60.6 ± 10.4 | 58.7 ± 10.4 | 60.9 ± 10.38 | 1.41 (1.09–1.83) | < 0.001 | 1.37 (1.18–1.62) | < 0.001 |
Procedure of PCI | 5302 (44.2%) | 670 (44.3%) | 4632 (44.2%) | 1.07 (0.87–1.31) | 0.503 | 1.16 (0.74–1.41) | 0.628 |
Procedure of CABG | 2772 (23.1%) | 315 (20.8%) | 2457 (23.3%) | 1.14 (0.76–1.53) | 0.246 | 1.28 (0.94–1.57) | 0.124 |
CAG, Coronary angiography; PCI, Percutaneous coronary intervention; CABG, coronary artery bypass graft; CM, consanguineous marriage; CAD, coronary artery disease
The mean age of CAD incidence was 59.8 ± 10.6 years in our study, which was 63.1 ± 10.3 after adjusting for CAD risk factors. After adjusting for CAD risk factors, the results showed that parental CM independently reduces the onset of CAD by 2.4 years. Among the risk factors, positive FH has the most significant effect on decreasing the onset of CAD, with a reduction of 4.9 years. Also, smoking, DLP, and male gender reduce the onset of CAD occurrence by 3.5 years, 3 years, and 2.6 years, respectively. The incidence age of CAD in hypertensive patients was subsequently two years higher than the mean age of CAD in all patients (P-Value < 0.001) (Fig. 3).
After adjusting for all variables, the mean age of CAD was 63.1 years. This study showed that the age of CAD would decrease from 63.1 years old to 60.7 years old if we consider only CM as one of the risk factors for CAD, and if the above patient is also male (male with parental CM), the onset of the age of CAD decreases to 58.1 years old. Finally, if the patient is "male, smoker, with DLP, with FH positive for CAD and was with parental CM," the age of occurrence of CAD decreases by a total of 16.4 years, and these patients will develop CAD at the age of 46.7 years (Fig. 4).