Risk Factors for Early-Onset Versus Late-Onset Coronary Heart Disease (CHD): Systematic Review and Meta-Analysis

Adeel Khoja, Prabha H. Andraweera, Zohra S. Lassi, Anna Ali, Mingyue Zheng, Maleesa M. Pathirana, Emily Aldridge, Melanie R. Wittwer, Debajyoti D. Chaudhuri, Rosanna Tavella, Margaret A. Arstall

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)


Aim: We aimed to systematically compare literature on prevalence of modifiable and non-modifiable risk factors for early compared to late-onset coronary heart disease (CHD). Methods: PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol registered in PROSPERO CRD42020173216). Study quality was assessed using the National Heart, Lung and Blood Institute tool for observational and case-control studies. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences (MD)/standardised MD (SMD) with 95% confidence intervals (CI) for categorical and continuous variables. Results: Individuals presenting with early-onset CHD (age <65 years) compared to late-onset CHD had higher mean body mass index (MD 1.07 kg/m2; 95% CI 0.31−1.83), total cholesterol (SMD 0.43; 95% CI 0.23−0.62), low-density lipoprotein (SMD 0.26; 95% CI 0.15−0.36) and triglycerides (SMD 0.50; 95% CI 0.22−0.68) with lower high-density lipoprotein-cholesterol (SMD 0.26; 95% CI -0.42−-0.11). They were more likely to be smokers (OR 1.76, 95% CI 1.39−2.22) and have a positive family history of CHD (OR 2.08, 95% CI 1.74−2.48). They had lower mean systolic blood pressure (MD 4.07 mmHg; 95% CI -7.36−-0.78) and were less likely to have hypertension (OR 0.47, 95% CI 0.39−0.57), diabetes mellitus (OR 0.56, 95% CI 0.51−0.61) or stroke (OR 0.31, 95% CI 0.24−0.42). Conclusion: A focus on weight management and smoking cessation and aggressive management of dyslipidaemia in young adults may reduce the risk of early-onset CHD.

Original languageEnglish
Pages (from-to)1277-1311
Number of pages35
JournalHeart Lung and Circulation
Issue number11
Publication statusPublished - Nov 2023
Externally publishedYes


  • Coronary heart disease
  • Early-onset
  • Geographical settings
  • Late-onset
  • Risk factors
  • Sex


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