Determination of risk factors for acute coronary syndrome in a young population using survival analysis and Cox regression methods

ABSTRACT Determining Risk Factors for Acute Coronary Syndrome in a Young Population using Survival Analysis and Cox Regression Methods Objective: The aim of this study was to determine the incidence of acute coronary syndrome and its risk factors affecting survival time in young adults aged 18-40 years, and to statistically evaluate the relative effects of these factors. Method: In this retrospectively designed study, data from a total of 722 patients aged 0-40 years were analyzed. First, descriptive statistics were used to summarize the basic characteristics of the variables. For comparisons between two groups, independent sample t-tests or Mann-Whitney U tests were applied, while for comparisons of three or more groups, ANOVA or Kruskal-Wallis tests were used. The effects of risk factors on acute coronary syndrome development and survival were evaluated using Kaplan-Meier survival analysis and a multivariate Cox regression model. Model fit was tested with the -2 Log Likelihood value and the Chi-square test. Results: According to the Cox regression results, obesity (Expβ=3.663; p<0.001), smoking (Expβ=2.296; p=0.017), hyperlipidemia (Expβ=2.119; p=0.025), and age (Expβ=1.081; p=0.022) were identified as statistically significant risk factors for the development of ACS. Kaplan-Meier analysis showed that obesity significantly reduced survival time (Log-Rank p=0.009). Other variables, including gender, hypertension, diabetes, alcohol use, and family history, were not significantly associated with survival time. Discussion: These findings highlight that obesity, smoking, hyperlipidemia, and increasing age are major risk factors for ACS among young adults. In contrast, classical cardiovascular risk factors such as hypertension and diabetes did not show the expected effect size in this age group, suggesting the influence of age-specific pathophysiological mechanisms. The results underscore the critical importance of early intervention and preventive health policies focused on modifiable lifestyle factors in young populations. Weight management, smoking cessation, and lipid control should be prioritized strategies to reduce ACS risk at an early stage of life. Keywords: Acute Coronary Syndrome, Risk Factors, Cox Regression, Survival Analysis, Young Adults