Cardiovascular risk factors and clinical pattern in young Nepalese population with acute coronary syndrome presenting to a tertiary care center of Nepal
Main Article Content
Abstract
Background and objectives: Cardiovascular disease is a major health problem reaching epidemic proportions. Although Acute Coronary Syndrome (ACS) is an uncommon entity in the young, it constitutes a rising burden in the socioeconomic status of the country because of its impact on the economically productive age group. Early identification and control of the cardiovascular risk factors helps to prevent cases of Myocardial Infarction (MI) in young resulting in reduced health burden. Therefore, we aimed to assess clinical pattern and the prevalence of cardiovascular risk factors in the young and economically productive population of an underdeveloped country to lower the socioeconomic burden.
Methods: A total of 60 patients presenting at the cardiology department of Manmohan Cardiothoracic Vascular and Transplant Center were included in our study after fulfilling the inclusion criteria. ACS was diagnosed by cardiac enzymes, electrocardiography, and echocardiography and coronary intervention was done in the cardiac catheterization room. Patients were followed up at 1 and 3-months and reassessed clinically and by echocardiography.
Results: Mean age of presentation was 38.55 + 4.98 (SD) years. Over three-fourth of the patients were male (80%) and nearly three-quarter experienced ST-elevated MI (73%). Smoking was the most prevalent risk factor (67%), followed by dyslipidemia (40%), diabetes (32%), hypertension (30%), and obesity (13%). Most of the patients presented with single-vessel disease (65%), followed by double-vessel disease (18%), triple-vessel disease (12%), left main disease (3%), and minor coronary artery disease (2%).
Conclusions: ACS in underdeveloped country is more common in male and single-vessel disease is the most common clinical pattern of ACS and smoking the most prevalent risk factor.
Downloads
Article Details
Copyright (c) 2020 Sahi R, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing and protecting the author rights is the central aim and core of the publishing business. Peertechz dedicates itself in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. Peertechz licensing terms are formulated to facilitate reuse of the manuscripts published in journals to take maximum advantage of Open Access publication and for the purpose of disseminating knowledge.
We support 'libre' open access, which defines Open Access in true terms as free of charge online access along with usage rights. The usage rights are granted through the use of specific Creative Commons license.
Peertechz accomplice with- [CC BY 4.0]
Explanation
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
With this license, the authors are allowed that after publishing with Peertechz, they can share their research by posting a free draft copy of their article to any repository or website.
'CC BY' license observance:
License Name |
Permission to read and download |
Permission to display in a repository |
Permission to translate |
Commercial uses of manuscript |
CC BY 4.0 |
Yes |
Yes |
Yes |
Yes |
The authors please note that Creative Commons license is focused on making creative works available for discovery and reuse. Creative Commons licenses provide an alternative to standard copyrights, allowing authors to specify ways that their works can be used without having to grant permission for each individual request. Others who want to reserve all of their rights under copyright law should not use CC licenses.
Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLos Med 3: e442. Link: https://bit.ly/3idEMLF
Joshi P, Islam S, Pais P, Reddy S (2007) Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 297: 286-294. Link: https://bit.ly/3iavika
Yusuf S, Reddy S, Ôunpuu S, Anand S (2001) Global burden of cardiovascular diseases part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 104: 2746-2753. Link: https://bit.ly/30A1gjV
World Health Rankings 2018. World Health Organization. Link: https://bit.ly/2DISzL0
Doughty M, Mehta R, Bruckman D, Das S, Karavite D, et al. (2002) Acute myocardial infarction in the young - the University of Michigan experience. Am Heart J 143: 56-62. Link: https://bit.ly/2XF3Ymu
Choudhury L, Marsh JD (1999) Myocardial infarction in young patients. Am J Med 107: 254-261. Link: https://bit.ly/33BZmBo
Zimmerman FH, Cameron A, Fisher LD (1995) Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis.(Coronary Artery Surgery Registry). J Am Col Cardiol 26: 654-661. Link: https://bit.ly/3fIZUrD
Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, et al. (2005) Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 149: 67-73. Link: https://bit.ly/3fAoydU
Feeman WE (2001) Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Expert Panel of Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Journal of the American Medical Association. 285: 2486-2497. Link: https://bit.ly/31GQV5h
Chobanian AV, Bakris GL, Black HR, Cushman WC, et al. (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289: 2560-2571. Link: https://bit.ly/30BLyEZ
American Diabetes Association (2018) 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes care 41: S13- S27. Link: https://bit.ly/30AVS04
WHO/IASO/IOTF (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia; Melbourne. Link: https://bit.ly/3igmCc1
Incalcaterra E, Caruso M, Lo Presti R, Caimi G (2013) Myocardial infarction in young adults: risk factors, clinical characteristics and prognosis according to our experience Clin Ter 164: e77-e82. Link: https://bit.ly/33Bwbyo
Haque AF, Siddiqui AR, Rahman SM, Iqbal SA, Fatema NN, et al. (2010) Acute coronary syndrome in the young-risk factors and angiographic pattern. Cardiovascular Journal 2: 175-178.Link: https://bit.ly/3keYoAV
Ismail J, Jafar TH, Jafary FH, White F, Faruqui AM, et al. (2004) Risk factors for non-fatal myocardial infarction in young South Asian adults. Heart 90: 259-263. Link: https://bit.ly/30A28Fd
Egred M, Vishwanath G, Davis GK (2005) Myocardial infarction in young adults. Postgrad Med J 81: 741-745. Link: https://bit.ly/30A29ZN
Moccetti T, Malacrida R, Pasotti E, Sessa F, Genoni M, et al. (1997) Epidemiologic Variables and Outcome of 1972 Young Patients with Acute Myocardial Infarction: Data from the GISSI-2 Database. ArchInternMed 157: 865-869. Link: https://bit.ly/3a3AOlI
Dwiwedi S, Dwiwedi G, Sharma S (2000) Coronary artery disease in young: Heredofemilial or Faculty Life Style or both. JIACM 1: 245-251.
Dani SI, Ghosh SB, Prajapati JS, Jain S (2003) Clinical and coronary Angiographic profile of Coronary Artery Disease in a young Gujarati population. IHJ.
Jit Singh P (2001) Myocardial infarction in young- A Study of 42 cases. JAPI 49: 32.
Siwach SB, Singh H, Sharma D, Katyal VK (1998) Profile of young Acute Myocardial Infarction in Haryana. JAPI 46: 424-426. Link: https://bit.ly/31txwoc
Enas EA, Mehta JL (1995) Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention and treatment. Clin Cardiol 18: 131-135. Link: https://bit.ly/31GSosj
Herrmann SM, Ricard S, Nicaud V, Mallet C, Arveiler D, et al. (1998) Polymorphisms of the tumour necrosis factor-alpha gene, coronary heart disease and obesity. Eur J Clin Invest 28: 59-66. Link: https://bit.ly/2C9xZ6k
Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW (1999) C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler thromb vasc biol 19: 972-978. Link: https://bit.ly/3gC7q8O
Alexander JK (2001) Obesity and coronary heart disease. Am J Med Sci 321: 215-224. Link: https://bit.ly/3aaWtc0
Paudel N, Alurkar VM, Jha GS, Kafle R, et al. (2018) Profile of Acute Coronary Syndrome In Young People: A Hospital Based Observational Study in Western Nepal. BJHS 3: 361-365. Link: https://bit.ly/3fyMzSA
Yagi H, Komukai K, Hashimoto K, Kawai M, Ogawa T, et al. (2010) Difference in risk factors between acute coronary syndrome and stable angina pectoris in the Japanese: Smoking as a crucial risk factor of acute coronary syndrome. J Cardiol 55: 345-353. Link: https://bit.ly/30yfCBi
Gotto AM (1986) Interac ons of the major risk factors for coronary heart disease. Am J Med 80: 48-55.
Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, et al. (2006) ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management. Circulation 113: e463-654. Link: https://bit.ly/3kohzbl
Desai N, Cortes A, Kita K, Rad N (2013) Young patients with acute myocardial infarction: How are thy different? JACC CV Interven 6: S9.
Dar MA, Mufti AA, Beshir Y, Khalaf H, Soomro TI, et al. (2013) ST elevation myocardial infarction in young adults: demographics, risk factor profile and early outcome after primary percutaneous coronary intervention. J Saudi Heart Assoc 25: 145. Link: https://bit.ly/2PyInYu
Mente A, Yusuf S, Islam S, McQueen MJ, Tanomsup S, et al. (2010). Metabolic syndrome and risk of acute myocardial infarction a case-control study of 26,903 subjects from 52 countries. J Am Coll Cardiol 55: 2390-2398. Link: https://bit.ly/3gwARsO
Harpaz D, Behar S, Rozenman Y, Boyko V, Gottlieb S, et al. (2003) Family history of coronary artery disease and prognosis after first acute myocardial infarction in a national survey. Cardiology 102: 140-146. Link: https://bit.ly/3a3GiwP
Harrap SB, Zammit KS, Wong ZYH, Williams FM, Bahlo M, et al. (2002) Genome-wide linkage analysis of the acute coronary syndrome suggests a locus on chromosome 2. Arterioscler Thromb Vasc Biol. Am Heart Assoc 22: 874-878. Link: https://bit.ly/31rl5ZX
Laudari S, Dhungel S, Dubey L, Panjiyar R, Gupta M, et al. (2017) Acute coronary syndrome in the young Nepalese popula on with their angiographic characteristics. Journal of College of Medical Sciences Nepal 13: 235-240. Link: https://bit.ly/31tsOqh
Tambyah PA, Lim YT, Choo MH (1996) Premature Myocardial Infarction in Singapore - Risk Factor Analysis and Clinical Features. 37: 31-33. Link: https://bit.ly/33NbShB
Colkesen AY, Acil T, Demircan S, Sezgin AT, Muderrisoglu H (2008) Coronary lesion type, location, and characteristics of acute ST elevation myocardial infarction in young adults under 35 years of age. Coronary Artery Dis 19: 345-347. Link: https://bit.ly/31px1eU
Alappatt N (2016) Acute coronary syndrome in young adults. Journal of Medical Sciences and Health 2.
Stone PH (1996) Prognostic significance of location of MI. American J of Cardiology 78: 19-25.
Sarr M, Ba DM, Ndiaye MB, Bodian M, Jobe M, et al. (2013) Acute coronary syndrome in young Sub- Saharan Africans: A prospective study of 21 cases. BMC Cardiovasc Disord13: 118. Link: https://bit.ly/3ilwBwV
Al-Khadra AH (2003) Clinical profile of young patients with acute myocardial infarction in Saudi Arabia. Int J Cardiol 91: 9-13. Link: https://bit.ly/30A4J1V
Kanitz MG, Giovannucci SJ, Jones JS, Mott M (1996) Myocardial infarction in young adults: Risk factors and clinical features. Emerg Med J 13: 139-145. Link: https://bit.ly/3gw4nyV
Magid DJ, Masoudi FA, Vinson DR, van der Vlugt TM, Padgett TG, et al. (2005) Older emergency departement patients with acute myocardial infarction receive lower quality of care than younger patients. Ann Emerg Med 13: 14-21. Link: https://bit.ly/3a29dS9