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. Of 756 patients with
CoA who were alive in 2005, 37 had a history of CAD compared with 224 of 6481 patients with
ventricular septal defect (4.9% versus 3.5%; P=0.04). Male sex (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.62-2.80),
hypertension (OR, 1.95; 95% CI, 1.44-2.64),
diabetes mellitus (OR, 1.68; 95% CI, 1.09-2.58), age (OR per 10-year increase, 2.28; 95% CI, 2.09-2.48), and
hyperlipidemia (OR, 11.58; 95% CI, 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 for
CoA versus
ventricular septal defect, 1.44; 95% CI, 0.79-2.64) after adjustment for other factors.
CONCLUSIONS: Although 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.