Coronary artery disease in adults with congenital heart disease

The increasing population of adult patients with congenital heart disease (ACHD) is at risk of developing coronary artery disease (CAD) and other atherosclerotic cardiovascular diseases due to exposure to cardiovascular risk factors. The impact of this exposure is growing larger as life expectancy of these subjects increases with the progressive improvement in management of congenital heart disease. Studies have shown that ACHD patients have a higher risk for CAD than their non-ACHD matches, highlighting the need for awareness and prevention efforts among congenital heart disease specialists and non-ACHD cardiologists. At the same time, ACHD patients with CAD often present specific characteristics all practicing cardiologists should be aware of. While further research is needed to fully understand the mechanisms underlying the higher CAD risk in this population, this article summarizes key evidence on CAD in ACHD and emphasizes on one hand the importance of early screening and management of known cardiovascular risk factors in ACHD patients, particularly those who are younger, female, or have more complex/severe CHD. On the other hand, it calls for a broader knowledge of ACHD risk for CAD and its peculiarities among all cardiologists.