Risk factors associated with Acute Myocardial Infarction (MI) in patients reporting at tertiary care hospitals in Karachi

doi:10.21203/rs.3.rs-4372701/v1

Background:

Cardiovascular diseases have a multi-factorial etiology, that includes hypertension, diabetes, stress, smoking, dyslipidemia and positive family history. Of them Acute myocardial infarction remains one of the most life threatening condition that can lead to post MI complications or death.

Objective:

To determine the risk factors associated with Acute Myocardial infarction in patients presenting in tertiary care hospitals in Karachi.

Method:

A cross sectional study was conducted on a sample size of 377 Acute Myocardial Infarcted patients .The sample was taken through non probability purposive sampling from Dr. Ruth K. M. Pfau Civil Hospital Karachi and National institute of Cardiovascular Diseases (NICVD) Karachi.. Data was then analyzed using SPSS version 22 with 95% confidence interval, margin of error was taken 5% and P-value 0.05 was significant.

Results:

A study was conducted to characterize patient demographics and assess the prevalence of various health factors among individuals presenting with Acute Myocardial Infarction (MI) at a tertiary care hospital in Karachi. Among the 377 patients analyzed, 40.3% fell within the age range of 56-65 years, totaling 152 individuals. The male representation was higher, constituting 57.8% (218 out of 377), compared to females at 42.2%. A considerable proportion, totaling 77.7%, had hypertension, while approximately 52.5% were smokers. Diabetes was present in only 36.3% of participants, whereas 38.2% reported dyslipidemia. Additionally, 67.4% had a positive family history of MI, and a mere 9.5% engaged in regular exercise. Consumption of whisky was reported by 19.6% of participants, and 60.5% had undergone surgical procedures.

Significantly, male participants exhibited a higher prevalence of smoking (83%) compared to females at 10.69% (p-value = 0.000). Alcohol consumption was also notably higher in males, reported at 30.7%, in contrast to females at 4.40% (p-value = 0.000). Surgical procedures were more prevalent among female participants, with 77.35% having undergone them, compared to 48.16% of males (p-value = 0.000).Furthermore, there was a significant association between age groups and the presence of hypertension, diabetes, and dyslipidemia (p-values = 0.000, 0.001, and 0.000, respectively), suggesting variations in prevalence across different age brackets.

Conclusion:

The study highlights the prevalence of various health factors among the sampled population, with significant gender disparities observed in smoking, alcohol consumption, and surgical procedures. Understanding these factors is crucial for implementing targeted interventions and public health initiatives to address prevalent health issues within the community. Further research may delve into the underlying factors contributing to these disparities and explore effective strategies for health promotion and disease prevention.

Acute MI

HTN

DM

Dyslipidemia

Smoking

Karachi

It is well known that cardiovascular disease (CVD) has a multifactorial etiology, and a number of variables, including elevated BMI, hypertension (HTN), stress, and diabetes, influence CVD risk.¹⁴ The best strategy for battling the CVD epidemic in resource-constrained countries is CVD prevention.²¹ The most common risk factors include smoking, dyslipidemia, sedentary lifestyles, obesity, hypertension, diabetes, and a positive family history or prior MI experience. One potentially fatal disorder that can cause complications or even death is acute myocardial infarction The European Society of Cardiology and the American College of Cardiology established criteria for the diagnosis of Acute Myocardial Infarction, which included the presence of two out of the three following factors::.

1. Regular chest pain that lasts at least 20 minutes

2. An electrocardiogram with ST elevation in two or more consecutive leads that is at least 2 mm elevated and subsequent ECG evolution.

3. A diagnostic marker for the heart, like a two-fold increase in creatinine kinase with at least 10% MB fraction or a positive or increased troponin I (T) level. ¹⁴

A study that examined parental history of modifiable risk factors and the relationship with long-term cardiovascular risk in the offspring used a special inter-generational longitudinal community-based cohort. They discovered a link between parental obesity and smoking and eventual CVD in the offspring. Intriguingly, independent of the offspring's obesity state, a family history of obesity was linked to a higher risk of developing cardiovascular disease in the future. On the other hand, the offspring's smoking status appeared to be a mediating factor in the connection between parental smoking status and offspring CVD. Although having a parent with cardiovascular disease increased the likelihood of developing the disease as well as some cardiac events like MI, HF, and AF, parental risk variables had no effect on this association.

Further, findings from the Physician's Health Study cohort suggest that leading a healthy lifestyle was related with a decreased risk of heart failure (HF) with antecedent MI in children with a positive family history of premature MI; this association appeared to be stronger in the younger demographic.²

Early-onset or premature MI is catastrophic because it stunts economic growth by forcing young persons to retire early, take excessive amounts of time off work due to illness, or both Hospitalization, treatment, and rehabilitation expenses connected to MI drive up healthcare spending and put a pressure on national economies.¹⁶

By evaluating the major and modifiable risk factors of acute MI in patients presenting to tertiary care hospital, we will expand our knowledge regarding the preventive strategies that include lifestyle and dietary changes. Our study's objective is to identify the risk factors for MI in Karachi residents and to evaluate the condition in detail.

A cross-sectional study will be conducted on a sample size of 377 MI patients calculated by RAOSOFT software with an estimated population size of 200000. The sample will be taken through nonprobability purposive sampling from Dr. Ruth K. M. Pfau Civil Hospital Karachi and National Institute of Cardiovascular Diseases (NICVD) Karachi, within a period of 6 months from November 2023 to January 2024. Informed verbal consent will be taken from the patient. A study will be conducted to assess the validity of the questionnaire. A structured questionnaire will be distributed for data collection by the researcher. Data will be analyzed using SPSS Version 22 with a 95% confidence interval, the margin of error will be taken as 5% and a P-value of 0.05 was considered significant. Effect modifiers, Chi-square values of age, gender, educational status, and history of diabetes and hypertension will be controlled with stratification.

A study was conducted to characterize patient demographics and assess the prevalence of various health factors among individuals presenting with Acute Myocardial Infarction (MI) at a tertiary care hospital in Karachi. Among the 377 patients analyzed, 40.3% fell within the age range of 56–65 years, totaling 152 individuals. The male representation was higher, constituting 57.8% (218 out of 377), compared to females at 42.2%. A considerable proportion, totaling 77.7%, had hypertension, while approximately 52.5% were smokers. Diabetes was present in only 36.3% of participants, whereas 38.2% reported dyslipidemia. Additionally, 67.4% had a positive family history of MI, and a mere 9.5% engaged in regular exercise. Consumption of whisky was reported by 19.6% of participants, and 60.5% had undergone surgical procedures.

Significantly, male participants exhibited a higher prevalence of smoking (83%) compared to females at 10.69% (p-value = 0.000). Alcohol consumption was also notably higher in males, reported at 30.7%, in contrast to females at 4.40% (p-value = 0.000). Surgical procedures were more prevalent among female participants, with 77.35% having undergone them, compared to 48.16% of males (p-value = 0.000). Furthermore, there was a significant association between age groups and the presence of hypertension, diabetes, and dyslipidemia (p-values = 0.000, 0.001, and 0.000, respectively), suggesting variations in prevalence across different age brackets.

The prevalence of cardiovascular diseases (CVDs), including acute myocardial infarction (MI), poses a significant public health concern worldwide. A comprehensive understanding of the risk factors associated with acute MI is essential for devising effective preventive strategies and mitigating the burden of this life-threatening condition. In a recent study conducted at a tertiary care hospital in Karachi, several key findings shed light on the prevailing risk factors and their implications for preventive interventions.

Among individuals aged 56–65 years, the prevalence of heart disease was notably high at 40.3%. This underscores the substantial burden of CVDs within this age group, highlighting the need for targeted screening and management efforts to identify and address cardiovascular risk factors effectively. Furthermore, the study revealed a gender disparity in the distribution of risk factors, with a higher prevalence of heart disease among males (57.8%) compared to females (42.2%). Such differences emphasize the importance of considering gender-specific factors in cardiovascular risk assessment and intervention strategies. Hypertension emerged as the most significant risk factor, affecting 77.7% of the study participants. This finding aligns with previous research highlighting hypertension as a leading risk factor for CVDs, including MI.¹⁴ Effective management and control of hypertension are crucial in reducing the risk of adverse cardiovascular events and improving patient outcomes. Moreover, the high prevalence of hypertension underscores the importance of population-wide initiatives aimed at promoting healthy lifestyle choices and enhancing awareness about the importance of blood pressure monitoring and management. Smoking was identified as another prominent risk factor for acute MI, with 52.5% of participants reporting a history of smoking. Notably, there was a stark gender difference in smoking prevalence, with a significantly higher proportion of males (83%) reporting smoking habits compared to females (10.69%). This observation underscores the need for targeted smoking cessation interventions, particularly among male populations, to reduce the incidence of smoking-related cardiovascular complications.¹⁶

Diabetes mellitus was found to be less prevalent but remains a significant risk factor for acute MI, affecting 36.3% of the study population. The association between diabetes and increased mortality rates in diabetic patients underscores the importance of effective diabetes management in preventing adverse cardiovascular outcomes. Comprehensive diabetes care, including glycemic control, lifestyle modifications, and cardiovascular risk factor management, is essential in reducing the burden of diabetes-related cardiovascular complications. Dyslipidemia, characterized by abnormal lipid levels, was present in 38.2% of participants, indicating its role as a modifiable risk factor for acute MI. The prevalence of dyslipidemia was higher than observed in a similar study conducted in Karachi, highlighting the need for targeted lipid-lowering interventions and lifestyle modifications to reduce cardiovascular risk.² A notable proportion of participants reported a positive family history of CVD, consistent with the intergenerational transmission of cardiovascular risk observed in previous studies. Family history serves as a crucial marker for identifying individuals at higher risk of developing CVDs, emphasizing the importance of targeted screening and preventive interventions in high-risk populations. Physical inactivity was prevalent among the study participants, with only 9.5% engaging in regular exercise. Low levels of physical activity are associated with an increased risk of CVDs, underscoring the importance of promoting active lifestyles through community-based interventions and public health initiatives.¹³

In conclusion, the study findings provide valuable insights into the prevalence of various risk factors associated with acute MI in a Karachi population. The high prevalence of hypertension, smoking, diabetes, dyslipidemia, and physical inactivity underscores the urgent need for comprehensive preventive strategies aimed at addressing modifiable risk factors and reducing the burden of CVDs. Effective management of cardiovascular risk factors, promotion of healthy lifestyle behaviors, and targeted interventions tailored to individual patient needs are essential components of a holistic approach to CVD prevention and control.

Limitations :

Limitations of the study, including its cross-sectional design and reliance on data from two hospitals, are acknowledged, emphasizing the importance of future research using longitudinal studies and multi-center collaborations to validate findings and inform evidence-based interventions. Overall, the study contributes valuable insights into the epidemiology of acute MI in Karachi and provides a foundation for developing effective strategies to improve cardiovascular health outcomes in the region.

The study highlights the prevalence of various health factors and significant gender disparities observed in smoking, alcohol consumption, surgical procedures. Understanding these factors is crucial for implementing targeted interventions and public health initiatives to address prevalent health issues within the community.

Funding :

The authors received no extramural funding for the study.

Author Contribution :

Concept & Design of Study : Syed Rohan Ali

Drafting: Fatima Amin Moti

Data Analysis: Syed Rohan Ali

Revisiting Critically: Tanzeel Guzdar

Final Approval of version: Gulzar Ali Buriro

Syed Rohan Ali, Fatima Amin Moti ,Fawad Farooq , Sawera Khan , Faraz Sikander ,Ghulam Muhammad ,

played a crucial role in refining the content, conducting a final round of editing, and presenting the article in a structured and balanced format , ensuring it was ready for publication.

IRB Reference no : IRB-83/2023 NICVD, Karachi

Ethics approval granted by IRB Committee NICVD , KHI

Verbal consent was obtained from the participates.

Data was collected by the investigator. If required data and materials access can be granted.

Conflict of Interest:

The study has no conflict ofinterest to declare by any author.

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Table no 01 Demographic Information:

Category	Frequency	Percent
Age
35 to 45	82	21.8
46 to 55	91	24.1
56 to 65	152	40.3
66 to 75	52	13.8
Gender
Male	218	57.8
Female	159	42.2

Table no 2 Cross tab summary with P value.

Question	Categories	Count	Total	P-Value
Do you have Hypertension?	yes, no	293, 84	377	0.000
Since when you are Hypertensive?	< 5yrs, 5 to 10 yrs, 10 to 20 yrs, 20 + yrs, nil	98, 87, 85, 26, 81	377	0.000
Are you diabetic?	yes, no	137, 240	377	0.001
Since when were you diabetic?	< 5yrs, 5 to 10 yrs, 11 to 15 yrs, > 15yrs, nil	53, 45, 27, 21, 231	377	0.005
Do you have Dyslipidemia?	yes, no	144, 233	377	0.000
Does anyone from your family has an MI?	yes, no	254, 123	377	0.001
Do you exercise daily?	yes, no	36, 341	377	0.017
Do you take any other drugs?	naswar, gutka, betel nuts, pan, none, others	52, 52, 107, 35, 93, 38	377	0.000
Are you a smoker?	yes, no	198, 179	377	0.000
How many cigarettes do you smoke daily?	1 to 5, 6 to 10, 10 to 20, 20+, nil	59, 57, 46, 4, 211	377	0.000
Do you drink whisky/vine occasionally?	yes, no	74, 303	377	0.000
Have you ever gone through any operation(s)?	yes, no	228, 149	377	0.000
Do you take any other drugs?	naswar, gutka, betel nuts, pan, none, others	52, 52, 107, 35, 93, 38	377	0.000

Table no 03 : Medical Information.

Category	Frequency	Percent
Hypertension
Yes	293	77.7
No	84	22.3
Smoker
Yes	198	52.5
No	179	47.5
Diabetic
Yes	137	36.3
No	240	63.7
Dyslipidemia
Yes	144	38.2
No	233	61.8
Family history of MI
Yes	254	67.4
No	123	32.6
Whisky/vine occasional drink
Yes	74	19.6
No	303	80.4
Previous operation(s)
Yes	228	60.5
No	149	39.5
Other drug use
Naswar	52	13.8
Gutka	52	13.8
Betel nuts	107	28.4
Pan	35	9.3
None	93	24.7
Others	38	10.1

Charts 1 and 2 are available in the Supplementary Files section

No competing interests reported.

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Bar Chart 01.
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Bar Chart 2.

Risk factors associated with Acute Myocardial Infarction (MI) in patients reporting at tertiary care hospitals in Karachi

Status:

Version 1

Abstract

Introduction

Material and method

Results

Discussion

Conclusion

Declarations

References

Tables

Charts

Additional Declarations

Supplementary Files

Status:

Version 1