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ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 342-346

Risk factor profile and in-hospital complications in patients admitted with acute coronary syndrome in Menoufia Governorate


Department of Cardiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission09-Jun-2013
Date of Acceptance22-Aug-2013
Date of Web Publication26-Sep-2014

Correspondence Address:
Mohammed M Galal Elsawaf
MBBCh, Berma, Abo El nour St Tanta, Al-Gharbia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141705

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  Abstract 

Objective
The aim of this work was to study the pattern of risk factors in patients admitted with acute coronary syndrome (ACS) to the coronary care unit in Menoufia Governorate and their relationship with the in-hospital complications.
Background
Coronary artery disease is a progressive disease process that generally begins in childhood and manifests clinically in mid-to-late adulthood.
Patients and methods
The study included 120 patients admitted to Coronary Care Unit with ACS during the period from October 2009 to April 2010. Patients were divided into three groups according to their age (≤40, 40-60, and ≥60 years) and followed up during the period of their admission, and the in-hospital complications were recorded. Statistical presentation and analysis of the present study was conducted using the mean, SD, and the c2 -test by SPSS v. 16.
Results
Our study included 95 men (79.1%) and 25 women (20.9%). ACS was higher in the older women group III than in the other groups (P < 0.05). Family history and smoking were prevalent in the younger patients group I than in other groups; fasting and 2-h postprandial patients were higher in group II than in other groups; and waist circumference and BMI were significantly higher in group II than in other groups. Women had a higher incidence of diabetes mellitus and hypertension, and more atherogenic lipid profile pattern than men. In contrast, smoking was more prevalent in men (63.1%) than in women (0%).
Conclusion
Group I (<40 years) had fewer risk factors as they represented the lowest incidence of diabetes mellitus, hypertension, obesity, and metabolic syndrome. In addition, they had better pattern of lipid profile than the other groups. In contrast, they had increased incidence of other risk factors such as positive family history of premature coronary artery disease, higher incidence of current smoking, low HDL value, and being male sex.

Keywords: Acute coronary syndrome, coronary artery disease, risk factors


How to cite this article:
Reda AA, Abdelazez WF, Yaseen RI, Galal Elsawaf MM. Risk factor profile and in-hospital complications in patients admitted with acute coronary syndrome in Menoufia Governorate. Menoufia Med J 2014;27:342-6

How to cite this URL:
Reda AA, Abdelazez WF, Yaseen RI, Galal Elsawaf MM. Risk factor profile and in-hospital complications in patients admitted with acute coronary syndrome in Menoufia Governorate. Menoufia Med J [serial online] 2014 [cited 2019 Nov 15];27:342-6. Available from: http://www.mmj.eg.net/text.asp?2014/27/2/342/141705


  Introduction Top


Patients with acute coronary syndrome (ACS) include unstable angina (UA), non-ST-elevation myocardial infarction (MI), and ST-elevation MI [1]. Diagnosis of ACS (to be differentiated from other causes of acute chest pain) requires focused history including the risk factors analysis, physical examination, ECG, and serum level of the cardiac biomarkers [2]. Many of the risk factors such as age, male, sex, and race cannot be changed (nonmodifiable cardiovascular risk factors), whereas tobacco smoking, diabetes mellitus (DM), high blood cholesterol, high blood pressure, obesity, and physical activity are examples for modifiable cardiovascular risk factors [3]. It has been previously demonstrated that heart failure commonly develops after acute MI and is associated with poor prognosis [4]. Decreasing morbidity and mortality from coronary artery disease (CAD) will necessitate the early diagnosis as well as early detection of risk factors for prevention of CAD and provide optimal care [5].


  Patients and methods Top


This study included 120 patients with ACS admitted to Coronary Care Unit in Menoufia Governorate during the period from October 2009 to April 2010. The patients were further subdivided into three groups according to their age and followed up during the period of their admission, and the in-hospital complications were recorded.

Methods

All patients were subjected to the following:

(1) Full history taking:

  1. Smoking (current, former, nonsmoker).
  2. Medical diseases [hypertension (HTN), diabetes, dyslipidemia].
  3. Cerebrovascular accident (CVA), peripheral vascular disease, COPD, and liver and renal failure.
  4. Previous coronary revascularization (PCI, CABG).
  5. Family history of CAD.


(2) Complete clinical examination including:

(a) Anthropometric measures.

  1. Weight in kilograms.
  2. Height in meters.
  3. Waist circumference in centimeters: The waist circumference was measured at the part of the trunk located midway between the lower costal margin and the iliac crest at the end of expiration while the person is standing with feet about 25-30 cm apart. An increased waist circumference was defined as being greater than 88 cm in women and 102 cm in men [6].
  4. Hip circumference in centimeters.
  5. Waist-hip ratio.
  6. BMI: BMI was calculated as weight in kilograms divided by the square of height in meters, and obesity was defined as a BMI of at least 30 kg/m 2 [7].


(3) 12-lead ECG:

The initial ECG was used for the diagnosis of:

  1. ST-elevation myocardial infarction, UA, and non-ST-elevation myocardial infarction.
  2. Arrhythmias [atrial fibrillation (AF), ventricular tachycardia, and heart block].
  3. Left ventricular hypertrophy.


(4) Laboratory results:

(a) Routine laboratory tests: fasting blood glucose and 2-h postprandial and 24-h fasting samples were collected for lipid profile [total cholesterol (TCH), triglycerides, LDL, and HDL] during in-hospital stay of the patient.

(5) Cardiac enzymes including:

(a) Troponin, lactate dehydrogenase, and CK-MB when available on admission followed by every 6 h for 24-48 h, and then daily to determine maximum value.

Statistical methods

Statistical presentation and analysis of the present study was conducted using mean, SD, and the c2 -test by SPSS v. 16.

The Pearson correlation coefficient is a measure of the strength of the linear relationship between two variables. The correlation is computed as:

  1. P-value less than 0.05 was considered statistically mildly significant.
  2. P-value less than 0.001 was considered statistically moderately significant.
  3. P-value less than 0.0001 was considered statistically highly significant.
  4. P-value greater than 0.05 was considered statistically nonsignificant.



  Results Top


This study included 120 patients with ACS admitted to Coronary Care Unit in Menoufia Governorate. The patients were further subdivided into three groups according to their age:

Group I: 26 patients, age of 40 years or below.

Group II: 31 patients, age from 40 to 60 years.

Group III: 63 patients, age of 60 years and above.

As shown in [Figure 1], our study included 95 men (79.1%) and 25 women (20.9%). The number of women with ACS was highest in group III than in other groups (P < 0.05).
Figure 1:

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As shown in [Table 1], regarding positive family history, the younger patients group I had higher positive family history than other groups (P < 0.05). Regarding prevalence of DM and hypertensive patients, DM was more prevalent in group II than in other groups, and hypertensive patients were more prevalent in group II than in other groups; these differences were statistically nonsignificant (P > 0.05). In addition, patients with previous cardiac events were more prevalent in group II than in other groups (P-value > 0.05). In contrast, smoking was prevalent in the younger patients group I than in other groups; this difference was statistically significant (P < 0.05). As shown in [Table 2], waist circumference and BMI were significantly higher in group II than in other groups (P < 0.05). In addition, female patients were more obese than male patients, and this difference was statistically significant (P < 0.05). As shown in [Table 3], diabetic patients had higher TCH, LDL, and were more obese than nondiabetic, and this difference was statistically nonsignificant (P > 0.05). In addition, diabetic patients had higher triglyceride and lower HDL than nondiabetic, and [Table 4] shows that diabetes was more prevalent in women (56%) than in men (27.3) (P < 0.05). In addition, HTN was more prevalent in women (68%) than in men (31.5%) (P < 0.05). In contrast, smoking was more prevalent in men (63.1%) than in women (0%) (P < 0.001). As shown in [Table 5], female patients had higher values of TCH and LDL than male patients, but this difference was statistically nonsignificant (P > 0.05). In addition, female patients had higher values of triglycerides than male patients (P < 0.05). Female patients were more obese than male patients, and this difference was statistically significant (P < 0.05). As presented in [Figure 2], congestive heart failure, recurrent MI, shock, CVA, and AF were highest in group II than in other groups, but these differences were statistically nonsignificant (P > 0.05). In addition, UA was higher in group II than in other groups, but this difference was statistically significant (P < 0.05). In contrast, the incidence of acute MR was lowest in group II than in other groups; this difference was statistically nonsignificant (P < 0.05). None of our patients had the possibility of primary PCI and there was no significant difference in management between all age groups.
Figure 2:

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Table 1: The prevalence of risk factors in the studied groups

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Table 2: Anthropometric measures among the studied groups

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Table 3: The difference of lipid profile, BMI, and waist circumference between diabetic and nondiabetic patients

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Table 4: Prevalence of diabetes, hypertensive, and smoking between male and female patients

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Table 5: The difference of lipid profile, BMI, and waist circumference between male and female patients

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  Discussion Top


With respect to male sex, 79.1% of our study population were men and only 20.9% were women. The sex as a risk factor was more pronounced in the younger age group (presenting 96.1% of patients <40 years) and decreased as age advances (to reach only 69.8% of patients >60 years of age). Although the risk of developing CAD is much higher among men than in women until they reach around 60 years of age, this relationship changes after menopause when the risk increases rapidly in women so that it equals that of men [8]. This may be because estrogen may have cardioprotective effects through glucose metabolism and the hemostatic system, and it may also have a direct effect on endothelial cell function [9]. In agreement with our study, Rosengren et al. [10] in the Euroheart ACS survey found that the proportion of women increased from 17% among patients aged less than 55 years to 56% among patients aged 85 years. Positive family history was an important one among the younger age group as we had 55% of patients below 40 years of age with positive family history, and this percent decreased with age. In agreement with our study, Osula et al. [11] found that the presence of family history of CAD was in 35% of the study population, and it was one of the more prevalent risk factors in young adults. Smoking represented higher incidence among the younger age groups and the percentage decreased with age. Similarly, Khot et al. [12] studied the incidence of smoking among patients with ACS and reported that smoking was less prevalent with age. This may be related to the encouragement of smokers to quit smoking after the first cardiac event and also may be due to the increase in smoking habit in young population [13]. With respect to DM and HTN, our study population revealed that their incidence increased with age; this is in agreement with the results of MONICA Agugsburg cohort study (1984-1995), which showed that the prevalence of DM and HTN increased with age [14] then decreased in older groups. Our study revealed that BMI and obesity were significantly higher in group II than in other groups. Burazeri et al. [15] in Albania found that the mean BMI was greater than 25 kg/m 2 and at the same time, obesity was prominent at middle age (group II) than at old age; this is in agreement with our study. On comparing risk factors between men and women, It was found that the prevalence of diabetes and HTN among women was significantly higher than in men; this is in agreement with the results obtained from the studies of Hochman et al. [16] who reported that the incidence of DM and HTN is more prevalent in female patients when compared with male patients in all types of ACS. In contrast, smoking was more prevalent in male patients than in female patients. This is similar to the findings in the study conducted by Hochman et al. [16] in which smoking was more prevalent in male patients in all types of ACS. Regarding obesity, in the present study, female patients were more obese than male patients, and this was confirmed by BMI and waist circumference. This is in accordance with the findings in the study conducted by Kanamasa et al. [17] in Japan, where 18.7% male patients compared with 29.4% female patients were obese. With respect to in-hospital complication, we found that congestive heart failure, UA, recurrent MI, shock, CVA, and AF were highest in group II than in other groups. In contrast, the incidence of acute MR was lowest in group II than in other groups. Rosengrenl et al. [10] found that complication such as heart failure was increasing more commonly with age, particularly pulmonary edema. AF occurred in few of the youngest patients but increased in older patients. Recurrent ischemia and reinfarction increased only very slightly with age. This is not in accordance with our study because they studied only patients with acute MI, not patients with the full spectrum of ACS.


  Conclusion Top


Male sex, current cigarette smoking, and family history of either premature CAD or sudden cardiac death were more prominent in the younger age groups. Group I had fewer risk factors as they represented the lowest incidence of DM, HTN, obesity, and metabolic syndrome. In addition, they had better pattern of lipid profile than the other groups. Female patients had a higher incidence of DM and HTN and more atherogenic lipid profile pattern than male patients. Congestive heart failure, UA, recurrent MI, shock, CVA, and AF were highest in group II than in other groups. In contrast, the incidence of acute MR was lowest in group II than in other groups.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.Fesmire FM, Hughes AD, Fody EP, et al. The Erlanger chest pain evaluation protocol: a one-year experience with serial 12-lead ECG monitoring, two-hour delta serum marker measurements, and selective nuclear stress testing to identify and exclude acute coronary syndromes. Ann Emerg Med 2002; 40 :584-594.  Back to cited text no. 1
    
2. Achar SA, Kundu S, Norcross WA, et al. Diagnosis of acute coronary syndrome. Am Fam Physician 2005; 72 :119-126.  Back to cited text no. 2
    
3. Wilson PW, D′Agostino RB, Levy D, Belanger AM, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97 :1837-1847.  Back to cited text no. 3
    
4. McManus DD, Chinali M, Saczynski JS, et al. 30-year trends in heart failure in patients hospitalized with acute myocardial infarction. Am J Cardiol 2011; 107 :353-359.  Back to cited text no. 4
    
5. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics 2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; 115 :e69-171.  Back to cited text no. 5
    
6. World Health Organization (WHO). Waist circumference and waist-hip ratio. Report of a WHO Expert Consultation. Geneva: WHO; 2008.  Back to cited text no. 6
    
7. World Health Organization (WHO). Obesity: preventing and managing the global epidemic of obesity. Report of the WHO Consultation of Obesity. Geneva: WHO; 1997.  Back to cited text no. 7
    
8. Rosengren A, Spetz CL, Koster M, et al. Sex differences in survival after myocardial infarction in Sweden; data from the Swedish National Acute Myocardial Infarction Register. Eur Heart J 2001; 22 :314-322.  Back to cited text no. 8
    
9. Shahar E, Folsom AR, Salomaa VV, Wu KK, et al. for the Atherosclerosis Risk in Communities (AR1C) Study Investigators. Relation of hormone-replacement therapy to measures of plasma fibrinolytic activity. Circulation 1996; 93 :1970-1975.  Back to cited text no. 9
    
10.Rosengren A, Wallentin L, Simoons M, et al. Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey 2006; 108 :572-576.  Back to cited text no. 10
    
11.Acute myocardial infarction in young adults. Am Heart J 2000; 139 :979-984.  Back to cited text no. 11
    
12.Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290 :898-904.  Back to cited text no. 12
    
13.Akosah KO, Schaper A, Cogbill C, et al. Smoking and the risk of myocardial infarction in women and men: longitudinal population study. BMJ 1998; 316 :1043.  Back to cited text no. 13
    
14.WHO MONICA Project Principal Investigators. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease: a major international collaboration. J Clin Epidemiol 1988; 41 :105-114.  Back to cited text no. 14
    
15.Burazeri G, Goda A, Sulo G, et al. Conventional risk factors and acute coronary syndrome during a period of socioeconomic transition: population-based case-control study in Tirana, Albania. Croat Med J 2007; 48 :225-233.  Back to cited text no. 15
    
16.Hochman JS, Tamis JE, Thompson TD, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndrome. N Engl J Med 1999; 341 :226-232.  Back to cited text no. 16
    
17.Kanamasa K, Ishikawa K, Hayashi T, et al. Increased cardiac mortality in women compared with men in patients with acute myocardial infarction. Intern Med 2004; 43 :911-918.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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