A study of risk factors for acute myocardial infarction in patients below 35 years in eastern India

Abstract

Background: Coronary artery disease (CAD) is most common cause of mortality. Its incidence in young Indians is about 12%–16%. Myocardial infarction (MI) in young can be divided into two groups, those with angiographically normal coronaries and those with CAD. 15%–20% of those with CAD have no identifiable risk factors and therefore miss the opportunity for primary prevention. Recent reports have suggested that increased lipoprotein a (Lp[a]) and hyperhomocysteinemia play an important role in MI. The true prevalence of CAD in young is grossly underestimated. Aims: (1) Study of risk factors for MI in patients <35 years. (2) Clinical presentation. (3) Disease pattern in coronary angiography. (4) To assess the relationship of emerging risk factors such as homocysteine and Lp(a) with MI. Materials and Methods: Fifty patients aged 35 years or younger diagnosed with acute MI were included. Results: The majority of patients were males (80%). The mean age was 33.3 in males and 31.8 years in females. Chest pain was the most common presenting complaint (94%). Smoking was the most prevalent risk factor (72%). Hyperhomocysteinemia (42%) and raised Lp(a) (24%) were emerging risk factors. Anterior wall MI was most prevalent (64%) and most patients had single vessel disease with left descending coronary being the most commonly involved artery. Conclusions: Homocysteine and Lp(a) should be measured in young MI patients. Smoking cessation and prevention of diabetes and hypertension should be encouraged. As young patients have more discrete lesion, timely revascularization will reduce myocardial damage.