Association of Khat Chewing With Increased Risk of Stroke and Death in Patients Presenting With Acute Coronary Syndrome

Abstract

Objective: To evaluate the prevalence and significance of khat chewing in patients with acute coronary syndrome (ACS). From January 29, 2007, through July 29, 2007 consecutive patients presenting with ACS were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries. Patients and MethOds:Results: Of the 8176 study patients, 7242 (88.6%) were nonkhat chewers, and 934 (11.4%) were khat chewers, mainly of Yemeni origin. Khat chewers were older (57 vs 56 years; p=.01) and more likely to be men (85.7% vs 74.5%) compared with non-khat chewers. Non-khat chewers were more likely to have diabetes mellitus, hypertension, dyslipidemia, obesity, and prior history of coronary artery disease and revascularization. Cigarette smoking was more prevalent in khat chewers, and they were more likely to present greater than 12 hours after onset of symptoms compared with non-khat chewers. At admission, khat chewers had higher heart rate, Killip class, and Global Registry of Acute Coronary Events risk scores. Khat chewers had a significantly higher risk of cardiogenic shock, stroke, and mortality. After adjustment of baseline variables, khat chewing was an independent risk factor for in-hospital mortality (odds ratio, 1.9; 95% confidence interval, 1.3-2.7; p<.001) and stroke (odds ratio, 2.7; 95% confidence interval, 1.3-5.9; p=.01).cOnclusiOn: In this large cohort of patients with ACS, khat chewing was prevalent and was associated with increased risk of stroke and death. In the context of increasing global migration, a greater awareness of potential widespread practices is essential. Mayo

Acute Coronary Syndrome and Khat Herbal Amphetamine Use

“…10 The First Gulf Registry of Acute Coronary Events (Gulf RACE-1) has recently shown that khat chewing (confined mainly to patients in Yemen) was associated with increased in-hospital risk of stroke and death in patients with acute coronary syndrome (ACS) compared with non-khat chewers who were mainly from different Gulf populations. 11 Mateen and Casino 1 in an accompanying editorial suggested that this increased risk of complications may be attributed in part to variations in income and access to health care between the different Gulf populations studied. Here, we review the clinical characteristics and 1-year outcome of khat chewers presenting with ACS and compare them with non-khat chewers using Gulf RACE-2 registry data.…”

Khat Chewing: A Smokeless Gun?

“…Khat chewers were less likely to be treated with coronary reperfusion therapy, probably because they presented late to the hospital (defined as >12 hours after symptom onset). 5 The strengths of the study include the high number of khat chewers, the clarity with which the outcomes are reported, and the duration of follow-up of the patients (including both chewers and nonchewers). The results are supported by those from other studies, including casecontrol and case reports, that suggest that khat may be a risk factor for myocardial infarction, ischemic stroke, and increased blood pressure and heart rate in both humans and laboratory animals.…”

“…1,4 Although khat chewing has been a social custom for centuries in that part of the world, it has largely escaped medical attention. Before the inclusion of khat as a risk factor for acute coronary syndrome (ACS) and early post-ACS death, reported in this issue of Mayo Clinic Proceedings, 5 khat chewing had been the subject of few robust clinical studies. In Canada and parts of the European Union, khat possession is illegal.…”

La toxicité du khat impose-t-elle une modification de la réglementation de son usage en Europe?

“…[51] observent également que la consommation de khat est associée à une augmentation du risque d'infarctus et de décès. Ils soulignent, comme Apps et coll.…”