Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq

BMC Cardiovascular Disorders

Sabri Khalif Shaikhow²  Hekmat Izzat Jehangeer¹  Ameen Mosa Mohammad² 

[1] Duhok Heart Center, Duhok, Kurdistan, Iraq;Division of Cardiology, Department of Medicine, Medical School, Faculty of Medical Sciences, University of Duhok, Duhok, Kurdistan, Iraq

关键词: Iraq;    Kurdistan;    Coronary angiography;    Cardiovascular risk factors;    Premature coronary artery disease;   

Others  :  1233951
DOI  :  10.1186/s12872-015-0145-7

 received in 2015-05-15, accepted in 2015-11-09,  发布年份 2015

【 摘 要 】

Background

Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. Given the lack of such studies in the country, this study examines the prevalence, associated cardiovascular risk factors, and coronary angiographic profile of the disease in Iraq.

Methods

Data was collected from a total of 445 adult patients undergoing coronary angiography at Duhok Heart Center, Kurdistan in a period between March and September 2014. Patients were divided into PCAD (male <45 years and female < 55 years) and mature coronary artery disease (MCAD).

Results

The prevalence of the angiographically documented PCAD was 31 %. The PCAD had higher rates of hyperlipidemia (p = 0.04), positive family history of coronary artery disease (p = 0.002), type A lesions (p = 0.02), single vessel disease (p = 0.01) and medical treatment (p = 0.01) than the MCAD. Logistic regression model indicated that male sex (OR 3.38, C.I 1.96–7.22), smoking (OR 2.08, C.I 1.05–4.12), hypertension (OR 1.58, C.I 1.25–2.03), hyperlipidemia (OR 1.89, C.I 1.17–2.42) and positive family history of coronary artery disease (OR 2.62, C.I 1.38–9.54) were associated with the PCAD. Sensitivity analysis showed highest specificity (94.2 %) and positive predictive value (96.5 %) in patients with coronary stenosis >70 % compared to lesser obstruction.

Conclusions

Premature coronary artery disease is alarming  in the country. Cardiovascular risk factors are clustered among them. But the angiographic profile and therapeutic options of PCAD are close to those reported from previous studies.

【 授权许可】

   
2015 Mohammad et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Shemirani H, Separham KH: The relative impact of smoking or Hypertension on severity of premature coronary artery disease. IRCMJ 2007, 9(4):177-181.
• [2]Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al.: Acute ischemic Heart disease: acute myocardial infarction in the young-the university of Michigan experience. Am Heart J 2002, 143(1):56-62.
• [3]Jamil G, Jamil M, AlKhazraji H, Haque A, Chedid F, Balasubramanian M, et al.: Risk factor assessment of young patients with acute myocardial infarction. Am J Cardiovasc Dis 2013, 3(3):170-174.
• [4]Guipeng A, Zhongqi D, Xiao M, Tao G, Guishuang L, Yuguo C, et al.: Risk Factors for Long-term Outcome of Drug-eluting Stenting in Adults with Early-onset Coronary Artery Disease. Int J Med Sci 2014, 11(7):721-725.
• [5]Wijns W, Kolh P, Danchin N, DiMario C, Falk V, Folliguet T, et al.: Guidelines on myocardial revascularization. Eur Heart J 2010, 31(20):2501-2555.
• [6]Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Bojan C, et al.: ACCF/AHA/SCAI Practice Guideline:2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention:A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011, 124:e574-e651.
• [7]O'Gara PT, Kushner FG, Ascheim DD, et al.: ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013, 61(4):e78-e140.
• [8]Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al.: Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice. J Am Coll Cardiol 2007, 50(7):e1-e157.
• [9]Fihn SD, Gardin JM, Abrams J, et al.: ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012, 60(24):e44-e164.
• [10]American Diabetes Association: Standards of Medical Care in Diabetes—2010 Diabetes Care 2010, 33(Suppl 1):S11-S61.
• [11]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7 Report. JAMA 2003, 289(19):2560-2571.
• [12]Pasternak RC: Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults. Cardiol Clin 2003, 21:393-398.
• [13]Parmar MS: Family history of coronary artery disease — need to focus on proper definition. Euro Heart J 2003, 24(22):2073.
• [14]Ryan H, Trosclair A, Gfroerer J: Adult Current Smoking: Differences in Definitions and Prevalence Estimates—NHIS and NSDUH, 2008. J Environ Public Health 2012, 2012:1-11.
• [15]Scanlon P, Faxon D, Audet A, et al.: ACC/AHA guidelines for coronary angiography123: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 1999, 33(6):1756-1824.
• [16]Mohammad AM, Sheikho SK, Tayib JM: Relation of Cardiovascular Risk Factors with Coronary Angiographic Findings in Iraqi Patients with Ischemic Heart Disease. Am J Cardiovasc Dis Res 2013, 1(1):25-29.
• [17]Prashanth P, Kadhim S, Ibrahim A-Z, Said A: Acute Coronary Syndrome in Young Adults from Oman: Results from the Gulf Registry of Acute Coronary Events. Heart Views 2010, 11(3):93-98.
• [18]Al-Nozha MM, Arafah MR, Al-Mazrou YY, Al-Maatouq MA, Khan NB, Khalil MZ, et al.: Coronary artery disease in Saudi Arabia. Saudi Med J 2004, 25(9):1165-1171.
• [19]Cole JH, Sperling LS: Premature coronary artery disease: Clinical risk factors and prognosis. Curr Atheroscler Rep 2004, 6(2):121-125.
• [20]Sharma M, Ganguly NK: Premature Coronary Artery Disease in Indians and its Associated Risk Factors. Vasc Health Risk Manag 2005, 1(3):217-225.
• [21]Sang Z, Jin H, Tao C, Shen J, Xu Y, Liu Z: Temporal Trends in Young Chinese Patients with Acute Myocardial Infarction. Exp Clin Cardiol 2014, 20(7):1105-1128.
• [22]Satoh H, Nishino T, Tomita K, Saijo Y, Kishi R, Tsutsui H: Risk factors and the incidence of coronary artery disease in young middle-aged Japanese men: results from a 10-year cohort study. Intern Med 2006, 45(5):235-239.
• [23]Muda Z, Kadir AA, Yusof Z, Yaacob LH: Premature Coronary Artery Disease among Angiographically Proven Atherosclerotic Coronary Artery Disease in North East of Peninsular Malaysia. Int J Collaborative Res Intern Med Public Health 2013, 5(7):507-516.
• [24]Sadeghi R, Adnani N, Erfanifar A, Gachkar L, Maghsoomi Z: Premature Coronary Heart Disease and Traditional Risk Factors-Can We Do Better? Int Cardiovasc Res J 2013, 7(2):46-50.
• [25]Saghir T, Qamar N, Sial J: Coronary angiographic characteristics of coronary artery disease in young adults under age of forty years compared to those over age forty. Pakistan Heart J 2008, 41(3):49-56.
• [26]Siddique A, Shrestha MP, Mohammad S, Sirajul Haque KMHS, Ahmed K, Sultan AU: Age-Related Differences of Risk Profile and Angiographic Findings in Patients with Coronary Heart Disease. BSMMU J 2010, 3(1):13-17.
• [27]D’Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, et al.: Sex differences in reperfusion in young patients with ST-segment elevation myocardial infarction: results from the VIRGO study. Circulation 2015, 14(131):1324-1332.
• [28]Wegner NK: Disparities in STEMI management for the young goose and young gander: clinical, organizational, and educational challenges. Circulation 2015, 131:1310-1312.
• [29]Fakhir Nafakhi HA: Coronary angiographic findings in young patients with coronary artery disease. Intern J Collaborative Res Intern Med Public Health 2013, 5(1):48-53.
• [30]Noeman A, Ahmad N, Azhar M: Coronary artery disease in young: faulty life style or heredofamilial or both. Annals 2007, 13(2):162-164.
• [31]Foroughi M, Ahranjani SA, Ebrahimian M, Saieedi M, Safi M, Abtahian Z: Coronary artery disease in Iranian young adults, similarities and differences. Open J Epidemiol 2014, 4(1):19-24.
• [32]Badran HM, Elnoamany MF, Khalil TS, Eldin MME: Age-Related Alteration of Risk Profi le, Inflamatory Response, and Angiographic Findings in Patients with Acute Coronary Syndrome. Clin Med: Cardiol 2009, 3:15-28.
• [33]Pineda J, Marín F, Roldán V, Valencia J, Marco P, Sogorb F: Premature myocardial infarction: clinical profile and angiographic findings. Int J Cardiol 2008, 126(1):127-129.
• [34]Nesligul Y, Nurcan A, Sait DM, Yeliz S, Firat O: Comparison of traditional risk factors, natural history andangiographic findings between coronary heart disease patients with age <40 and ≥40 years old. Anatolian J Cardiol 2007, 7:124-127.
• [35]Fabrizio D’A, Enrico C, Darryn A, Claudio M, Andrea C, Nayef A, et al.: Prognostic Indicators for Recurrent Thrombotic Events in HIV-infected Patients with Acute Coronary Syndromes: Use of Registry Data From 12 sites in Europe, South Africa and the United States. Thromb Res 2014, 134(3):558-564.
• [36]Shah I, Faheem M, Shahzeb R, Hafizullah M: Clinical Profile, Angiographic Characteristics and Treatment Recommendations in Patients with Coronary Artery Disease. J Pak Med Stud 2013, 3(2):94-100.
• [37]Sadiq Shah S, Lubna N, Syed Habib S, Shahsawar , Shahab Ud D, Zahid Aslam A, et al.: Myocardial Infarction in young versus older adults: Clinical characteristics and angiographic features. J Ayub Med Coll Abbottabad 2010, 22(2):187-190.
• [38]Ahmed Hussein A-M: Coronary Artery Disease in Young versus Older Adults in Hilla City: Prevalence, Clinical Characteristics and Angiographic Profile. Karbala J Med 2012, 5(1):1328-1333.
• [39]Christus T, Shukkur AM, Rashdan I, Koshy T, Alanbaei M, Zubaid M, et al.: Coronary Artery Disease in Patients Aged 35 or less. Heart Views J Gulf Heart Assoc 2011, 12(1):7-11.
• [40]Tewari S, Kumar S, Kapoor A, Singh U: Premature CAD in north india: an angiography study of 1971 patients. Indian Heart J 2005, 57(4):311-318.
• [41]Farhan HA: Coronary Artery Disease: Conventional Risk Factors & Angiographic Findings among Young Iraqi Adults. Univ Babylon J 2010, 2(18):644-650.