Acute Coronary Syndrome in the Young - Risk Factors and Angiographic Pattern

Abstract

Background: Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. There is documented evidence that South Asian people develop CAD at a higher rate and also at an early age. If the affected individual is 40 yrs old or below, the tragic consequences are catastrophic. Methods: It was a retrospective observational study to find out the pattern of acute coronary syndrome in the young (40 years old or less) in a military hospital (CMH Dhaka) from July 2007 to July 2008 and to analyze the risk factors and the angiographic characteristics of coronary vessels. Consecutive 64 young patients including both male and female admitted into this hospital were the study subjects. Out of these patients 53 were males and 11 were females. Among these patients coronary risk factors and angiographic pattern were studied. 64 older patients with Acute coronary syndrome (age more than 40 years) were also studied. Results: Out of 64 young patients 15.6% patients presented to this hospital as UA, 9.37% presented as Non-Q MI, 28.12% Acute Anterior MI, 14.06% Acute Anteroseptal MI, 26.56% Acute Inferior MI, 6.25% Acute Infero-posterior MI. Smoking was the most common risk factor among these young patients. 64.06% patients were smoker. Dyslipidaemia was present among 50% patients, 37.55% were hypertensive, 15.62% were diabetic, and 15.62% were obese. SVCAD was the most common lesion and it was 53.12%. 26.56% patients had DVCAD and TVCAD was present among 20.31% patients. In the older group (more than 40 years) most common risk factor was dyslipidaemia (71.88%) and smoking was present among 48.43% patients. Conclusion: Young patients have a different risk factor profile in comparison with older patients. Smoking is a strong and quite common coronary risk factor in the young ACS patients who are 40 years or less. Risk factor identification and control is very crucial in the primary and secondary prevention in young patients with CAD. Keywords: Acute coronary syndrome; Risk factors; Coronary Angiography DOI: 10.3329/cardio.v2i2.6635Cardiovasc. j. 2010; 2(2) : 175-178

AGE-Related Differences of Novel Atherosclerotic Risk Factors and Angiographic Profile Among Gujarati Acute Coronary Syndrome Patients

“…Obesity is an alarming concern among young adults [2]. The present study also showed that the mean BMI in younger patients with ACS was comparable to that in older patients with ACS.…”

“…In this study, we determined the differences in the characteristics of class I-IV risk factors and angiographic profile between younger and older patients with ACS. We selected an age cut-off of 40 y to define a premature CAD, based on previous Indian [1,11] and Indian subcontinent studies [2,[5][6][7].…”

“…Although numerous risk factors have been established to predict the development of ACS, these risk factor profile, severity of disease and its prognosis may be different between the young and older age groups [5]. Clinical studies have shown that as compared with older patients, patients with early-onset of cardiovascular disease may have preponderance of risk factors such as dyslipidaemia, positive family history, cigarette smoking, with lesser extent and less severe occurrence of CAD [2,6,7]. However, conventional risk-factors may not clearly explain the predisposition to ACS in younger patients.…”

“…Onset of CAD before 40 y of age is considered as premature CAD [1,5].Although majority of studies reported that only about 3% of all CAD cases occur in <40 y of age, it should be considered as the 'tip of the iceberg' as young, asymptomatic patients usually do not undergo medical investigations. The incidence of CAD is reported to be 12-16% among young Indian patients, with more than half of death related to cardiovascular disease occurring in patients below the age of 50 y and one-fourth of acute myocardial infarction cases being reported in patients under the age of 40 y [2]. Although numerous risk factors have been established to predict the development of ACS, these risk factor profile, severity of disease and its prognosis may be different between the young and older age groups [5].…”

“…It may lead to death or disability, without warning, in an otherwise healthy individual in the prime of life [1,2]. The disease is posing a major public health hazard and clinical problem particularly in South Asia.…”