Epicardial Coronary Arteries in Khat Chewers Presenting with Myocardial Infarction

Abstract

Background. Khat chewing is a common habit in Yemen despite increased evidence of its negative impact on the cardiovascular system. Aims. We aimed to study the epicardial coronary arteries in khat chewers presenting with myocardial infarction (AMI). Materials and Methods. A descriptive, cross-sectional study was conducted between November 2008 and May 2009 in Yemen. AMI patients who underwent coronary angiogram were enrolled and divided into groups (gp): gp1 (diabetic and khat chewers), gp2 (khat chewers and nondiabetic), and gp3 (diabetic and non-khat users). Results. Of 347 AMI patients 63%, 21%, and 16% were in gp 2, 3, and 1, respectively. Khat chewers were younger in comparison to non-khat users. Group 3 patients were more likely to have multivessel disease, severe left anterior descending (LAD), right coronary artery (RCA) stenosis and total RCA, and left circumflex (Lcx) occlusion compared to other groups. Group 1 patients were more likely to have total LAD occlusion and severe Lcx lesions. In multivariate analysis, age, diabetes mellitus, and smoking were significant independent predictors for significant coronary artery lesions; however, khat chewing did not show such association. Conclusions. Coronary spasm is the main mechanism of AMI in khat chewers. The impact of our finding for risk stratification and management warrants further studies.

Khat (Catha Edulis) as a Risk Factor for Cardiovascular Disorders: Systematic Review and Meta-Analysis

“…There were also similar findings from Yemen [ 28 ]. In addition to elevation of BP and HR, khat chewers were at higher risk of developing AMI and stroke [ 4 , 10 , 16 - 19 , 22 ]. We did not include some of the above studies in to the meta-analysis because they did not quantify the intended outcome.…”

“…In addition to its effects on BP, khat has also been associated with the increased incidence of acute coronary vasospasm and myocardial infarction (MI) [ 15 ]. As one of the constituents of khat, cathinone is reported to be associated with severe coronary vasoconstriction and a severe negative inotropic effect on the cardiac muscle, suggesting that coronary spasm contributes to the development of acute MI [ 10 , 16 ]. Furthermore, Al-Shami and Al-Motarreb, evaluated the effect of khat chewing on the coronary arteries in patients with history of heart failure.…”

Khat Use: History and Heart Failure

“…In a study of 347 AMI patients, Al-Motarreb et al, 32 confirmed coronary spasm as the main mechanism of AMI in khat users. Of the total AMI cases, 79% were Yemenis.…”

Psychostimulant use disorder and the heart

“…The typical clinical presentation is one of an acute coronary syndrome with sudden‐onset chest pain, which can be the result of progression of atheromatous narrowing, vasospasm, plaque instability with thrombus formation, increased myocardial oxygen demand and direct myocyte toxicity . It is likely that the majority of cases are the result of sympathomimetic‐induced vasospasm of coronary arteries , but acute myocardial infarction as a result of plaque rupture and thrombus formation is the cause of angina symptoms in a significant minority of cases, and this is more likely to be the case following cocaine consumption, given its prothrombotic action .…”