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 Table of Contents  
ORIGINAL ARTICLE
Year : 2023  |  Volume : 16  |  Issue : 1  |  Page : 125-129

Epidemiological profile among young patients (≤45 years) suffering from acute myocardial infarction in a tertiary care center in Goa


1 Department of General Medicine, Goa Medical College, Goa, India
2 Department of Community Medicine, Goa Medical College, Goa, India

Date of Submission17-May-2022
Date of Acceptance27-Jun-2022
Date of Web Publication21-Jan-2023

Correspondence Address:
Dr. Bhargav Pandurang Sawant Dessai
Sawant Dessai, H. No. 2575, Sasanmoddi, Kakoda, Goa - 403 706
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_413_22

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  Abstract 


INTRODUCTION: The incidence of myocardial infarction (MI) is increasing among the young population in India. Change in lifestyle is the main reason for such an increase in prevalence. Although MI in young is less severe than in old patients, it causes a significant morbidity to the individual. Young MI has the potential of being a major public health problem in our country and its complications can cause major morbidity and mortality. Hence, it is necessary to understand the prevalence of risk factors in order to improve our strategies for the prevention and management of young MI.
AIM: To study profile of young patients (≤45 years) suffering from acute myocardial infarction in a tertiary care centre in Goa.
MATERIALS AND METHODS: A retrospective record-based study was conducted on patients aged ≤45 years who suffered from ST-elevation MI and were admitted in Goa Medical College, Bambolim, from January 1, 2019, to December 31, 2021. Data on anthropometric measurements, demographic characteristics, clinical profile, hospital stay, complications, and other details were extracted from these records.
RESULTS: Among the 176 patients, 73 (42%) patients consumed alcohol, 116 (66%) were current smokers, 48 (28%) were diagnosed with hypertension (HTN), 92 (48%) were diagnosed with dyslipidemia, and 34 (20%) were diagnosed with diabetes. Among the patients, 36 (21%) had a history of coronary artery disease and 56 (32%) had a history of HTN. Fifty-three (30%) had a history of diabetes mellitus (DM) in the family; among them, 27 had diabetes and 10 were prediabetic. Fifty-six (31%) participants were admitted for >7 days following MI. Forty-eight (27%) had complications post-MI. Trend analysis showed a significant association of complications and increased hospital stay with type 2 DM (T2DM), HTN, smoking, and dyslipidemia (P < 0.05). Most of the patients 91% of T2DM, 90% of hypertensives, and 83% of patients suffering from dyslipidemia were diagnosed after they were admitted with MI.
CONCLUSION: As we already know that the incidence of ischemic heart disease (IHD) is already rising in the general population, there is also an alarming rising trend of IHD in young people too. This study provides the prevalence of assorted risk factors in young MI. The rising trend of complications with an increase in risk factors studied in our group makes early diagnosis imperative for better management and prevention of complications. Increased burden of IHD in young people will lead to decreased quality of life, increased morbidity, and mortality and also have an increased economic burden for the society. This underscores the importance of building capacity of the primary health-care system for early detection of diabetes, HTN, and dyslipidemia and making people aware of unwarranted effects of smoking and alcohol consumption. Proper management and prevention of the above said risk factors would go a long way in preventing young MI as described in this study.

Keywords: Body mass index, lifestyle risk reduction, myocardial infarction, risk factors, young


How to cite this article:
Kumar S, Dessai BP. Epidemiological profile among young patients (≤45 years) suffering from acute myocardial infarction in a tertiary care center in Goa. Indian J Health Sci Biomed Res 2023;16:125-9

How to cite this URL:
Kumar S, Dessai BP. Epidemiological profile among young patients (≤45 years) suffering from acute myocardial infarction in a tertiary care center in Goa. Indian J Health Sci Biomed Res [serial online] 2023 [cited 2023 Jan 28];16:125-9. Available from: https://www.ijournalhs.org/text.asp?2023/16/1/125/368324




  Introduction Top


The incidence of myocardial infarction (MI) is increasing in young adults;[1] the disease at younger age carries a high burden in terms of psychosocial effects and economical loss for patients and their families.[2] The increasing incidence of coronary artery disease (CAD) in the younger age group can be attributed to factors such as smoking, sedentary lifestyles, and childhood obesity.[3]

Type 2 diabetes mellitus (T2DM) and hypertension (HTN) have independent adverse cardiac effects, including increased left ventricular mass and wall thicknesses, reduced LV systolic chamber and myocardial function, and increased arterial stiffness.[4] These findings identify adverse cardiovascular effects of DM, HTN, and dyslipidemia independent of associated increases in body mass index (BMI).[5]

According to the World Health Organization, the results of the Global Burden of Disease Study state an age-standardized cardio vascular diseases (CVD) death rate of 272/100,000 population in India which is much higher than that of the global average of 235. CVDs strike Indians a decade earlier than the Western population.[6],[7],[8],[9]


  Methods Top


Study design

A retrospective record-based study was undertaken. The duration of this study was 2 months on patients aged under 45 years who suffered from ST-elevation MI (STEMI) and were admitted in Goa Medical College, Bambolim, from January 1, 2019, to December 31, 2021. The details were obtained from admission papers from Medical Records Department, Goa Medical College, being the only government tertiary care center in the state, which provides health care to its 1.458 million population.

All patients ≤45 years of age who had suffered from acute coronary syndrome (ACS) were included in the study, and patients with a history of ACS in the past were excluded from the study.

Data collection and study tools

The data were collected from hospital-based records using a structured questionnaire. The questionnaire contained the following information: demographic data, anthropometric measurements, (height, weight, BMI) risk factors (current smoking status, family history of premature CAD, T2DM, HTN, history of angina. We studied five risk factors of MI:

  1. Alcohol consumption
  2. History of smoking
  3. HTN
  4. T2DM
  5. Hyperlipidemia.


Clinical and laboratory data included were blood pressure (BP), biochemical tests (random blood sugar, fasting lipid profile, troponin-I, fasting blood sugar level (FBSL), post prandial blood sugar level (PPBSL) electrocardiography (ECG), BMI was measured as weight in kilograms2 divided by height in meters. Echocardiographic variables included LVID (d), LVID (s)-(Left ventricular internal diameter end diastolic and end systoloic), regional wall motion abnormality, and left ventricular ejection fraction (LVEF).

ECG diagnosis of STEMI was made in a patient with new ST-segment elevation at the J point in two contiguous leads of more than equal 0.1 mV in all leads other than leads V2-V3. For leads V2-V3, the criteria taken was more than equal 0.2 mV in men more than equal 45 years, More than equal to 0.25 mV in men <45years, or more than equal to 0.15 mV in women.

HTN was defined as >140 mmHg systolic BP (SBP) or >90 mmHg diastolic BP on at least two occasions or current use of any antihypertensive therapy.

Diabetes was described as a fasting blood glucose level of >126 mg/dl or post prandial blood glucose level >200 mg/dl or HbA1c of >6.4% or a patient already being treated for DM.

Smoking was defined as regular tobacco smoking in any form at present or in the last year.

A family history of premature CAD was defined as the documented CAD in a first-degree relative (male <55 years and female <65 years).

Dyslipidemia was defined by the presence of any one of the following: low-density lipoprotein >130 mg/dl, total cholesterol >200 mg/dl, and high-density lipoprotein (HDL) <40 mg/dl in men and <50 mg/dl in women. BMI was classified as kg/m2.

Cardiogenic shock was defined as SBP measurements of <90 mmHg for 30 min or the use of inotropes or mechanical support to maintain an SBP of 90 mmHg.

All the articles were complete in all respects of the study questionnaire.

Ethics approval and human participant protection

Ethics approval for the study was obtained from the Institutional Ethics Committee of the institute (ECR/83/Inst/GOA/2013/RR-20).

Statistical analysis

Statistical analysis was conducted using the SPSS statistical software. Continuous variables would be presented as mean and standard deviation. Unadjusted odds ratios and 95% confidence interval were calculated.


  Results Top


Patients consisted of 162 (92%) males and 14 (8%) females. Among the 176 patients, 73 (42%) patients consumed alcohol, 116 (66%) were current smokers, 48 (28%) were diagnosed with HTN, 92 (52%) were diagnosed with dyslipidemia, and 34 (20%) were diagnosed with diabetes [Table 1].
Table 1: Distribution of biochemical parameters of the patients

Click here to view


Majority of the patients 159 (98%) had the above risk factors for the development of MI. Among them, 18 (11%) had all 5 risk factors, 28 (18%) had 4 risk factors, 62 (39%) had 3 risk factors, 38 (24%) had 2 risk factors, and 13 (8%) had 1 risk factor.

Among the patients, 36 (21%) had a family history of CAD and 56 (32%) had a family history of HTN. Fifty-three (30%) had a family history of T2DM in the family; among them, 27 had diabetes and 10 were prediabetic. Most of the patients suffered from anterior wall MI 91 (48%), septal 60 (34%), inferior wall MI 21 (12%), and lateral wall MI 4 (2%) [Figure 1].
Figure 1: Distribution of study participants according to BMI. BMI: Body mass index

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Most of the patients 91% (31 of 34) of T2DM, 90% (50 of 56) of hypertensives, and 83% (77 of 92) of patients suffering from dyslipidemia were diagnosed after they were admitted with MI [Figure 2].
Figure 2: Number of cases diagnosed before admission and after admission

Click here to view


The mean HbA1c levels ranged from 5.2% to 8.2%, and the mean HbA1c level was 5.85 ± 0.55. FBSL ranged from 67 to 175 with a mean of 96.73 ± 20.22. Among those diagnosed with T2DM, HbA1c levels ranged from 6.2 to 8.2 in them (mean: 7.1 ± 0.12), FBSL –98–175 (mean: 122.12 ± 12.15), and PPBSL –128–284 (mean: 165 ± 20.123). Majority of them had hypercholesterolemia (76 out of 92) and hypertriglyceridemia (42 out of 92) and 74 patients had HDL <50 mg/dl.

The two-dimensional ECHO findings majority had LVEF ≥50% in 146 (83%) patients and 40%–50% in 28 (16%), and 2 (1%) of them had LVEF <40%. Fifty-six (31%) participants were admitted for >7 days following MI. Forty-eight (27%) had complications post-MI and 56 (32%) had a long hospital stay (>7 days) [Table 2].
Table 2: Unadjusted odds ratio of complications of myocardial infarction and long hospital stay after myocardial infarction with independent variables

Click here to view



  Discussion Top


This article describes the association of T2DM and different risk factors in patients of ACS from a retrospective record-based study.

A study conducted by Hoit et al. (92%) and Majumder et al. found that 88% of young patients suffering from MI were males that is comparable (92% males) to our study.[10],[11]

Family history of premature CAD was more common in young patients (41%).[10] Family history of premature CVD and risk factor profiles such as smoking, obesity, diabetes, and dyslipidemia would offer better clues as to the likelihood of atheromatous CAD. In a study done in London among young patients with MI, positive family history of premature CVD was found in 39% of participants.[10],[12]

Young patients with MI are mostly smokers, obese, and have poor lifestyle, like inactivity and alcohol intake, have higher triglycerides levels and lower high-density lipoprotein cholesterol.[13],[14] A study conducted by Lisowska et al. and Chua et al. had a similar percentage of patients suffering from HTN,[14] hypercholesterolemia,[13] and smoking but had a lesser number of patients suffering from DM; this can be attributed to high prevalence of DM in the Indian population.[14],[15]

The prevalence of DM was found to be 13.2% in a study conducted by Alexander et al. which is lower than our study which might be due to higher prevalance of type 2 DM in India.[16]

A study conducted by Myint et al. concluded BMI as a predictor of CVD and mortality. Nearly half of their participants had higher BMI in young AMI patients which is very much similar to our findings.[17]

However, studies in different countries have hinted that although young AMI patients have better inhospital outcomes due to less severe coronary vessel involvements, in the long run, complications such as history of previous MI, peripheral vascular disease, and low ejection fraction are high risks for mortality.[18],[19]

Our study showed no deaths and had lesser complications and lower hospital stay suggestive of better clinical outcome among younger patients which is in agreement with previous reports.[20],[21]

Limitations

It is a retrospective record-based study. No comparison is done with the normal population.


  Conclusion Top


As we already know that the incidence of ischemic heart disease (IHD) is already rising in the general population, there is also an alarming rising trend of IHD in young people too. Earlier, these young people were considered to be at a lesser risk of MI but with changing lifestyles and increased risk factors like alcohol consumption and smoking along with DM and HTN is making this population group also vulnerable. This study provides the prevalence of assorted risk factors in young MI. The rising trend of complications with an increase in risk factors studied in our group makes early diagnosis imperative for better management and prevention of complications. Increased burden of IHF in young will lead to decreased quality of life, increased morbidity, mortality, and also have increased economic burden for the society. This underscores the importance of building capacity of the primary health-care system for early detection of diabetes, HTN, and dyslipidemia and making people aware of unwarranted effects of smoking and alcohol consumption. Proper management and prevention of the abovesaid risk factors would go a long way in preventing young MI as described in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol 2014;64:337-45.  Back to cited text no. 1
    
2.
Translation of clinical trials into practice: A European population-based study of the use of thrombolysis for acute myocardial infarction. European Secondary Prevention Study Group. Lancet 1996;347:1203-7.  Back to cited text no. 2
    
3.
Gupta MD, Girish MP, Kategari A, Batra V, Gupta P, Bansal A, et al. Epidemiological profile and management patterns of acute myocardial infarction in very young patients from a tertiary care center. Indian Heart J 2020;72:32-9.  Back to cited text no. 3
    
4.
Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, Welty TK, et al. Impact of diabetes on cardiac structure and function: The strong heart study. Circulation 2000;101:2271-6.  Back to cited text no. 4
    
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Lu S, Bao MY, Miao SM, Zhang X, Jia QQ, Jing SQ, et al. Prevalence of hypertension, diabetes, and dyslipidemia, and their additive effects on myocardial infarction and stroke: A cross-sectional study in Nanjing, China. Ann Transl Med 2019;7:436.  Back to cited text no. 5
    
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Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current epidemiology and future directions. Circulation 2016;133:1605-20.  Back to cited text no. 6
    
7.
Anjana RM, Shanthi Rani CS, Deepa M, Pradeepa R, Sudha V, Divya Nair H, et al. Incidence of diabetes and prediabetes and predictors of progression among Asian Indians: 10-year follow-up of the Chennai Urban Rural Epidemiology Study (CURES). Diabetes Care 2015;38:1441-8.  Back to cited text no. 7
    
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Dutta D, Mondal SA, Kumar M, Hasanoor Reza AH, Biswas D, Singh P, et al. Serum fetuin-A concentration predicts glycaemic outcomes in people with prediabetes: A prospective study from eastern India. Diabet Med 2014;31:1594-9.  Back to cited text no. 8
    
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Dutta D, Mukhopadhyay S. Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians. Indian J Med Res 2016;143:401-4.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Hoit BD, Gilpin EA, Henning H, Maisel AA, Dittrich H, Carlisle J, et al. Myocardial infarction in young patients: An analysis by age subsets. Circulation 1986;74:712-21.  Back to cited text no. 10
    
11.
Majumder AA, Karim MF, Rahman MA, Uddin MA. Study of association of C-reactive protein with coronary collateral development. Cardiovasc J 2010;3:26-32.  Back to cited text no. 11
    
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Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest 1995;108:364-9.  Back to cited text no. 12
    
13.
Sagris M, Antonopoulos AS, Theofilis P, Oikonomou E, Siasos G, Tsalamandris S, et al. Risk factors profile of young and older patients with myocardial infarction. Cardiovascular Res 2021.  Back to cited text no. 13
    
14.
Chua SK, Hung HF, Shyu KG, Cheng JJ, Chiu CZ, Chang CM, et al. Acute ST-elevation myocardial infarction in young patients: 15 years of experience in a single center. Clin Cardiol 2010;33:140-8.  Back to cited text no. 14
    
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Lisowska A, Makarewicz-Wujec M, Filipiak KJ. Risk factors, prognosis, and secondary prevention of myocardial infarction in young adults in Poland. Kardiol Pol 2016;74:1148-53.  Back to cited text no. 15
    
16.
Alexander T, Kumbhani DJ, Subban V, Sundar H, Nallamothu BK, Mullasari AS. Acute ST-elevation myocardial infarction in the young compared with older patients in the Tamil Nadu STEMI program. Heart Lung Circ 2021;30:1876-82.  Back to cited text no. 16
    
17.
Myint PK, Kwok CS, Luben RN, Wareham NJ, Khaw KT. Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease. Heart 2014;100:1613-9.  Back to cited text no. 17
    
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Shiraishi J, Kohno Y, Yamaguchi S, Arihara M, Hadase M, Hyogo M, et al. Acute myocardial infarction in young Japanese adults. Circ J 2005;69:1454-8.  Back to cited text no. 18
    
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Mukherjee D, Hsu A, Moliterno DJ, Lincoff AM, Goormastic M, Topol EJ. Risk factors for premature coronary artery disease and determinants of adverse outcomes after revascularization in patients ≤40 years old. Am J Cardiol 2003;92:1465-7.  Back to cited text no. 19
    
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Gulati R, Behfar A, Narula J, Kanwar A, Lerman A, Cooper L, et al. Acute myocardial infarction in young individuals. Mayo Clin Proc 2020;95:136-56.  Back to cited text no. 20
    
21.
Shah N, Kelly AM, Cox N, Wong C, Soon K. Myocardial infarction in the “Young”: Risk factors, presentation, management and prognosis. Heart Lung Circ 2016;25:955-60.  Back to cited text no. 21
    


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