A study on major cardiovascular risk factors in Acute Coronary Syndrome (ACS) patient 40 years and below admitted in CCU of Shahid Gangalal National Heart Center.

Abstract

Coronary artery disease (CAD), predominately manifest in older individuals, is a devastating disease precisely because an otherwise healthy person in the prime of life may die or become disabled without warning. When the afflicted individual is under the age of 40, the tragic consequences for family, friends, and occupation are particularly catastrophic and unexpected. Fortunately, the incidence of myocardial infarction (MI) and symptomatic CAD in young adults is low; most studies show that only about 3% of all CAD cases occur in this age range. Premature CAD is defined as cardiac events occurring before the age of 45 in men and 55 in women. In its severe form it is defined as CAD occurring below the age of 40 years. Prematurity and severity suggests that the disease starts at an early age and has a malignant course. In this study, we aim to investigate the major risk factor (smoking, Hypertension, Diabetes and dyslipidemia ) as defined by ACC-AHA pattern in ACS patient 40years or below admitted in Shahid Gangalal National Heart Centre (SGNHC) from April 2008 to April 2009. There were all together 54 ACS patients, male 44(81%) and female 10(19%). HTN is the risk factor which was more commonly diagnosed and treated, while Dyslipidemia, DM and IFG were not usually diagnosed in young patient before they were diagnosed CAD. Dyslipidemia was the most common comprising 83.3% followed by HTN 70%, smoking 70%, abnormal blood glucose level 50%, DM in 22.2% while IFG in 27.7 %. High total cholesterol (48%) is the common form of dyslipidemia followed by high LDL (44.4%), low HDL in 31.4%. When non modifiable risk factor family history is excluded, 85% of the patients have two or more risk factors of CAD. When smoking along with family history is excluded 94.5% of the patients have 1 or more risks factors for CAD.

An Autopsy Study of Atherosclerotic Changes in Coronary Arteries at B.P. Koirala Institute of Health Sciences

“…5,9 In a study done by Adhikari CM et al in a capital city heart center 70% patients were smokers who were brought for coronary heart disease in age group up to 40 years. 10 Study done in Central Nepal by Koju R et al showed that among the established cardiovascular risk factors, gender, diabetes mellitus and smoking are significantly associated with coronary stenosis among CAD patients which is in contrast to our study. 7 In our study, non-atherosclerotic lesions were seen in almost all cases except in one case where the right coronary artery showed atherosclerotic lesion.…”

Angiographic profile of young patients (≤ 40 years) in a tertiary care center of Nepal

“…14 Different studies conducted in different countries showed LAD was most frequently affected followed by RCA and LCX. [12][13][14] similarly in our study, 75% of CAD cases had LAD lesion.…”

“…10 The skewed gender distribution (males 81.65% versus females 18.35%) of the study population can be attributed to the gender bias and atypical presentation, which is also a feature in other South Asian studies. [10][11][12] This can be attributed to gender disparity and inequality in tertiary healthcare facility in Nepali society.…”

Acute Myocardial Infarction in Young Adults: Study of Risk factors, Angiographic Features and Clinical Outcome

“…Many other studies have also found high rates of tobacco use among young patients who have AMI, with percentages ranging from 70% to >90%. [10][11][12] Smoking is known to cause increased fibrinogen concentrations and platelet aggregability, along with impaired fibrinolytic activity, decreased coronary flow reserve, and increased vasospasm. [13][14][15] Recurrent exposure to cigarettes with subsequent catecholamine surges damage endothelial cells, leading to endothelial dysfunction and injury of the vascular intima.…”