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Atherothrombotic risk factors & premature coronary heart disease in India: a case-control study
Raja Babu Panwar1, Rajeev Gupta, Bal Kishan Gupta
1Department of Cardiology, SP Medical College & Associated Group of Hospitals, Bikaner, India. bkgbkn@rediffmail.com
Insights
Premature coronary heart disease (CHD) in young Indians is linked to both thrombotic factors like smoking and homocysteine, and atherosclerotic factors including hypertension and high-fat diets. Comprehensive prevention strategies are crucial for this population.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Premature coronary heart disease (CHD) poses a significant health challenge in young Indian populations.
- Both thrombogenic and atherogenic factors are hypothesized to contribute to the development of premature CHD in this demographic.
Purpose of the Study:
- To investigate and identify key cardiovascular risk factors associated with premature CHD in young Indian patients.
- To compare risk factor profiles between young Indian patients with CHD and age- and gender-matched controls.
Main Methods:
- A case-control study design was employed, enrolling 165 young patients (<55 years) with acute coronary events or recent CHD diagnosis (cases) and 199 controls without clinical CHD.
- Comprehensive data collection included demographic, anthropometric, clinical, hematological, and biochemical parameters.
- Univariate and multivariate logistic regression analyses were utilized to determine significant risk factors.
Main Results:
- Cases exhibited significantly higher systolic and diastolic blood pressure, platelet counts, LDL cholesterol, non-HDL cholesterol, triglycerides, and fibrinogen, along with lower HDL cholesterol compared to controls (P<0.001).
- Key risk factors identified in cases included current smoking, low fruit and vegetable intake, high-fat diet, hypertension, diabetes, dyslipidemia (low HDL, high LDL, high total:HDL ratio), elevated fibrinogen, and high homocysteine.
- Multivariate analysis confirmed smoking, high-fat intake, low fruit/vegetable intake, hypertension, high LDL, low HDL, high triglycerides, high total:HDL ratio, high fibrinogen, and high homocysteine as significant predictors of premature CHD.
Conclusions:
- Both thrombotic factors (smoking, low fruit/vegetable intake, fibrinogen, homocysteine) and atherosclerotic factors (hypertension, high-fat diet, dyslipidemia) play critical roles in premature CHD among young Indians.
- Multipronged prevention strategies targeting these identified risk factors are essential for mitigating premature CHD in this vulnerable population.
Background & Objectives:
It was hypothesized that both thrombogenic and atherogenic factors may be responsible for premature coronary heart disease (CHD) in young Indians. A case-control study was performed to determine cardiovascular risk factors in young patients with CHD in India.
Methods:
Successive consenting patients <55 yr with an acute coronary event or recent diagnosis of CHD were enrolled (cases, n=165). Age- and gender-matched subjects with no clinical evidence of CHD were recruited as controls (n=199). Demographic, anthropometric, clinical, haematological, and biochemical data were obtained in both groups. Univariate and multivariate logistic regression were performed to identify important risk factors.
Results:
In cases vs. controls mean systolic BP, diastolic BP, platelet counts, LDL cholesterol, non-HDL cholesterol, triglycerides, and fibrinogen were higher and HDL cholesterol lower (P<0.001). The presence of current smoking, low fruit and vegetables intake, high fat intake, hypertension, diabetes, low HDL cholesterol, and high LDL cholesterol, total:HDL ratio, fibrinogen and homocysteine was significantly higher in cases (P<0.05). Multivariate logistic regression analysis (age adjusted odds ratio, 95% confidence intervals) revealed that smoking (19.41, 6.82-55.25), high fat intake (1.66, 1.08-2.56), low fruit and vegetables intake (1.99, 1.11-3.59), hypertension (8.95, 5.42-14.79), high LDL cholesterol [2.49 (1.62-3.84)], low HDL cholesterol (10.32, 6.30-16.91), high triglycerides (3.62, 2.35-5.59) high total:HDL cholesterol (3.87, 2.35-5.59), high fibrinogen (2.87, 1.81-4.55) and high homocysteine (10.54, 3.11-35.78) were significant.
Interpretation & Conclusions:
Our results showed that thrombotic (smoking, low fruit/vegetables intake, fibrinogen, homocysteine) as well as atherosclerotic (hypertension, high fat diet, dyslipidaemia) risk factors were important in premature CHD. Multipronged prevention strategies are needed in young Indian subjects.
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