Association of Coronary Protective Factors among Patients with Acute Coronary Syndromes

INTRODUCTION: Coronary risk factors (CRF) and acute coronary syndromes have become a major health problem in most middle income countries, although they are decreasing in developed countries. The increased risk of ACS  in South Asians is not explained by conventional CRF, hence this study examines the coronary protective factors(CPF) to explain the cause of remaining of the risk. SUBJECTS AND METHODS: Case control study including 435 patients with ACS who were compared with 495 age and sex matched control subjects. Clinical, electrocardiographic, radiological and laboratory data were obtained in all the patients for confirmation of diagnosis by WHO  and AHA criteria. Multivariate logistic regression analysis was conducted after adjustment of age, and body mass index(BMI) to determine the association of CPF with ACS, RESULTS : Coronary protective factors; healthy diet (Fruit, vegetable legume, and nuts(>400g/day)(31.0 vs 52.7%) moderate physical activity(23.4 vs 68.0%),  meditation and yoga (>5days/week ) 5.7 vs 25.2 %), moderate alcohol(<10drinks/week)(2.7 vs 24.6%), lean body weight (BMI<25 Kg/M2) (7.8 vs 51.5%) and never tobacco intake (48.9 vs 68.0%) were significantly lower among ACS patients compared to control subjects. Multivariate logistic regression analysis revealed that after adjustment of age,  and BMI, the association of odds ratio (99% confidence interval) for healthy diet (male 0.57 (0.45-0.69)**female 0.59 (0.48-0.68)**, moderate physical activity (male 0.62(0.51-0.69**, female 0.67(0.55-0.75)**),  meditation and yoga ( male 0.46 (0.35-0.56)* female 0.48 (0.40-0.59)*, lean body weight (male 0.61 (0.53-0.72)* female 0.62(0.52-0.71)* and never tobacco intake (male 0.48 (0.43-0.55)** female0.51 (0.45-0.67)* as well as moderate alcohol intake (male 0.42 (0.34-0.54)* were  inversely associated with ACS. No such association of moderate alcohol was noted among females due to less numbers. Conclusions : This study shows that decreased adherence to healthy diet and moderate physical activity were highly significant CPF of ACS. Lean body weight, meditation and yoga were also significantly less CPF but had weak association. Never tobacco and moderate alcohol intake(males) were also significant CPF but with only weak association among females with ACS. Moderate alcohol intake was not a protective factor of ACS among females.