Cardiovascular risk factors and clinical pattern in young Nepalese population with acute coronary syndrome presenting to a tertiary care center of Nepal

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 identifi cation 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 fulfi lling 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.

Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review

“… 52 reported a 68.3% rate of SVD in their patients, the highest reported rate in Bangladeshi patients. The highest prevalences of SVD in Nepalese and Pakistani patients were 65.0% 41 and 63.4% 58 , respectively.…”

“…According to 43 studies, high BMI (≥23 kg/m 2 ) was observed in 1.7% 39 to 97.1% 40 of young South Asian patients with CAD. According to two studies, approximately 13.3% 41 and 25.0% 13 of Nepalese patients had a high BMI, respectively. Pakistani patients were reported to have high BMI that ranged from 15.6% 42 to 97.1% 40 , and up to 60.7% 11 of Bangladeshi patients had a high BMI.…”

“… 13 in Nepal reported coagulation abnormalities in 7.5% of patients. Two additional studies further investigated the presence of connective tissue disorders, which were observed in 0.8% 34 and 1.6% 41 of patients. A single South Asian study, one conducted in Nepal, reported vasculitis (5%) as a risk factor for young CAD.…”

Angiograhic profile and in-hospital outcome of young patients presenting with ST Elevation Myocardial Infarction (STEMI) in tertiary cardiac hospital

“…15 In a study done by Sahi et al From 2018-2019 among young (<45 years old) patients admitted in nearby hospital in Kathmandu for the first episode of Acute Coronary Syndrome (ACS); LAD was involved in 60%of cases and SVD was seen in majority (72%) of STEMI. 17 In another study from India undergoing CAG for either stable angina or CSA , SVD (65%) was the most common finding in CAG followed by normal/recanalised coronaries. LAD was the most common vessel involved (68%), followed by LCX (25%) and RCA (19%).…”

“…[13][14][15][16] As per different studies The involvement of LAD is seen in around 40-68% young patients with MI making it the most common artery involved in MI of young patients. 9,[17][18][19] However in a subgroup analysis of a study by Manjil et al Who studied angiographic profile of 200 patients of all age group Undergoing PCI, they have found that among young patients there is similar involvement of LAD with RCA 40% each among those undergoing PCI. 15 In a study done by Sahi et al From 2018-2019 among young (<45 years old) patients admitted in nearby hospital in Kathmandu for the first episode of Acute Coronary Syndrome (ACS); LAD was involved in 60%of cases and SVD was seen in majority (72%) of STEMI.…”