Age threshold for proper definition of premature coronary artery disease in males

Background: There is no universally accepted definition for the cut point age before which atherosclerosis is considered "premature." This is a retrospective study aimed to utilize the medico legal autopsy information for finding a proper definition of the age threshold of premature atherosclerosis in males. Objectives: This work aimed to utilize autopsy reports data that were issued at Jordan University Hospital to evaluate age-related differences in the distribution of coronary atherosclerotic and myocardial lesions and the determination of the age threshold at which such differences became apparent in male deaths. Such a threshold might provide a proper definition for premature atherosclerosis and premature sudden atherosclerotic cardiac death. At the same time, the meaning of a reference age for mature atherosclerotic death incidents could be elucidated. Methods: A total of 1139 male autopsy reports with sudden coronary atherosclerotic death were reviewed. Results: There is an overall decreasing trend in the prevalence of coronary thrombosis with age, where the prevalence of coronary thrombosis was more common in younger age groups and constitutes 59.9% of cases in the age groups less than 45 years in comparison to 42.7% of cases in the ages more than 65 years. The same trend was noticed for the prevalence of cases without evident myocardial fibrosis. On the other hand, the trend was increasing for stenosis without apparent thrombosis and for myocardial fibrosis. In spite of that, the detailed pattern of the prevalence of these pathologies with age did not show a steady, and a continuous change through the whole spanned age groups. Instead, two distinct phases were observed, the first phase represents the cases less than 49 years of age and the second phase represents the cases more than the age of 54 and the age group between 50/54 is what we called the "turn-interval." Conclusion: sThe "turn-interval"was considered as the scientific basis to define the age threshold that differentiates the premature atherosclerotic coronary diseases. Accordingly, it was proposed that male premature coronary artery diseases constituted the cases suffering from the heart attack, or died as a result of cardiac attacks below the age of 49, and the mature disease that affects people who is older than 54 years old.