Coronary artery disease in young adult patients undergoing coronary angiography at JKCI: prevalence and associated risk factors

Abstract

ABSTRACT Background: Coronary artery disease (CAD) is characterized by decrease in blood flow to the myocardium brought by formation of atherosclerotic plaques in the heart's blood vessels. Premature Coronary Artery Diseases transpires in men and women before the hit 45 and 55 years of age, respectively. CAD is expounded as CAD observed in men aged more than 55 years of age and in women aged more than 65. (9) It is one among the Non-Communicable Diseases that possess a major challenge to the health system worldwide and attains top cause of death globally, contributing to number exceeding 350,000 annually in USA. Objective: To determine the prevalence, associated cardiovascular risk factors and coronary angiographic profile among the patient clinically diagnosed with premature coronary artery diseases and scheduled for coronary angiograph at Jakaya Kikwete Cardiac Institute (JKCI). Methodology: A prospective cross-sectional study was conducted involving patients with Premature CAD.The study was done for 7 months beginning from september 2023 to march 2024. It was conducted in Dar es Salaam- Tanzania at JKCI, the only cardiac institute in Tanzania. The target population was all patients who were admitted due to clinical diagnosis of CAD and schedulled for coronary angiography at JKCI during the study period.Cases were Consecutively recruited to meet the targeted sample. Patients admitted due to CAD and scheduled for coronary angiography aged 18 and above were enrolled after they had read, understood and sign the consent form. A standardized questionnaire administered by researcher and the assistant was used for data collection from the participants and also from the patient hospital record. The following data were collected; social demographic characteristics(sex, age, residency, occupation and education level), physical activities status, history of alcohol use, blood pressure, blood sugar, electrocardiogram finding, family social history, laboratory parameters (total cholesterol, triglycerides and low density lipoprotein,) and angiographic results from CATH-LAB. Participants were categorized as premature CAD encompassing men aged 45 years and below and women with 55 five years and below based on the life expectancy in Tanzania. Matured CAD encompasses participants aged 60 and above. The collected data was entered in SPSS version 23 and summarized as means and proportions. Multivariate analysis was used for analyzing confounding in all variables with a p value <0.2 in bivariate analysis where those variables with a p value <0.05 was documented as being statistically significant. Logistic regression technique was used to determine the associations of variables. Results: The prevalence of the angiographically documented premature CAD was 14.9 %. Participants with PCAD had higher rates of low physical activities (p=0.01), hyperlipidemia (p =<0.00001), obesity (p=0.00001), positive family history of coronary artery disease (p = <0.00001), single vessel disease (p = 0.013), NSTEMI presentation (0.216) and alcohol use (p = 0.018). Logistic regression model indicated that male sex (OR 3.8, C.I 1.43–6.73), obesity (OR 3.3, C.I 1.13–9.63), low level of physical activity (OR 1.72, C.I 1.11–2.66) and positive family history of coronary artery disease (OR 1.97, C.I 1.28–3.03) were associated with the premature CAD. Conclusions: The study highlights the alarming prevalence of premature CAD in the country, predominantly affecting men with low physical activity, obesity, and family history of heart disease as key independent risk factors. Controlling modifiable risk factors is crucial to reducing the incidence and impact of premature CAD.