Risk Factor Patterns for Premature Versus Late-Onset Coronary Artery Disease in Iran: A Systematic Review and Meta-Analysis

Negar Morovatdar1, Yones Bondarsahebi2, Nastaran Khorrampazhouh2, Seyyed Amin Hozhabrossadati2, Konstantinos Tsarouhas3, Ramin Rezaee1, Reza Jafarzadeh Esfehani4, Hoorak Poorzand5, Amirhossein Sahebkar6, 7, 8, *
1 Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Students research committee, Faculty of medicine, Mashhad University of medical sciences, Mashhad, Iran
3 Department of Cardiology, University Hospital of Larissa, Larissa, Greece
4 Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5 Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
6 Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
7 Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
8 School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran



There are few data regarding the risk factors of premature vs late-onset coronary artery disease (CAD). This study systematically reviews these risk factors in Iranian people.


Medline, Web of Science, Embase and SID (Scientific Information database; www.sid.ir) databases were searched for studies comparing CAD risk factors in young and older patients in Iran. Data extracted and pooled odds ratio (OR) with 95% confidence interval (CI) for each risk factor were calculated. Publication bias was evaluated by Egger’s test.


Seven studies (9080 participants) were included in the meta-analysis; analysis was carried out independently for each risk factor. Smoking (Odds Ratio (OR): 2.57, 95% CI: 1.96-3.37; p=<0.001), family history of CAD (OR: 2.45: 95% CI, 1.44-4.15, p<0.001), opium abuse (OR: 2.44: 95% CI, 1.22-4.88; p=0.001) and hyperlipidaemia (OR: 1.4: 95% CI, 1.13-1.73; p=0.001) were more common in premature CAD compared with older CAD patients. In contrast, diabetes mellitus (OR: 0.54: 95% CI, 0.39-0.73; p=0.0001) and hypertension (OR: 0.36, 95% CI: 0.21-0.59; p<0.001) were less prevalent.


Risk factors were significantly different between premature and late-onset CAD. Policies regarding smoking and opium cessation and controlling hyperlipidaemia may be useful for the prevention of premature CAD in Iran.

Keywords: Coronary artery disease, Premature, Cardiovascular risk factors.

Abstract Information

Identifiers and Pagination:

Year: 2019
Volume: 13
Publisher Item Identifier: EA-TOCMJ-2018-27

Article History:

Received Date: 29/11/2018
Revision Received Date: 07/01/2019
Acceptance Date: 28/01/2019
Electronic publication date: 07/02/2019
Collection year: 2019

© 2019 Morovatdar et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Neurogenic Inflammation Research Center Mashhad University of Medical Sciences, Mashhad, Iran; Tel: 985118002288; Fax: 985118002287; E-mail: sahebkara@mums.ac.ir