Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease

Background: The effect of atherosclerotic cardiovascular disease (ASCVD) on cardiovascular death in adults with congenital heart disease (CHD) is not well understood. Objectives: The purpose of this study was to determine the prevalence and prognostic implications of ASCVD risk factors in adults with CHD. We hypothesized that ASCVD risk factors were associated with cardiovascular events defined as heart failure hospitalization, heart transplant, and cardiovascular death. Methods: This is a retrospective cohort study of adults with CHD at the Mayo Clinic (2003-2019). Patients with a history of coronary artery disease (CAD) were excluded. ASCVD risk factors were defined as hypertension, hyperlipidemia, diabetes, obesity, smoking, and family history of premature CAD. Results: There were 5,025 patients without a prior history of CAD. The mean age was 35 (23-45) years, and 2,558 (51%) were males. Of 5,025 patients, 2,382 (47%) had ≥1 ASCVD risk factors at baseline, and 16% developed additional ASCVD risk factors within 5 years (new-onset ASCVD risk). ASCVD risk factors at baseline (hazard ratio 1.27, 95% confidence interval 1.06-1.38) and new-onset ASCVD risk factors during follow-up (hazard ratio 1.06, 95% confidence interval 1.02-1.11) were associated with cardiovascular events. Conclusions: ASCVD factors were associated with cardiovascular events in adults with CHD. Since interventions that modify ASCVD risk have been shown to decrease cardiovascular death in the general population, it is logical to expect that such interventions would also improve clinical outcomes in the CHD population.