Impact of novel risk factors of atherosclerosis on severity of coronary artery disease in young Indian patients suffering from Myocardial Infarction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Asian Indians are affected at least a decade earlier with cardiovascular diseases (CVD), in their most productive midlife years as compared to people of European ancestry. This is the first study from Indian sub-continent assessing the impact of novel risk factors of atherosclerosis on angiographic severity of coronary artery disease (CAD) in terms of SYNTAX scores in young patients (<40 years) suffering myocardial infarction (MI). Purpose This study was undertaken to evaluate the association of novel risk factors of atherosclerosis with severity of CAD at the index hospitalization in young MI patients. Methods In this single center observational study, 75 consecutive young MI patients were included. Patients having previous CVD, chronic kidney disease, chronic Liver disease and any bleeding diathesis were excluded. Homocysteine, highly sensitive C- reactive protein (hs-CRP) and lipoprotein- a (Lp-a) were measured and correlated with SYNTAX I and SYNTAX II. Results Smoking (85.5%) was the most common traditional risk factor for MI while other traditional risk factors did not have significant effect on severity of CAD in young patients with MI. The mean homocysteine level was 24.43± 10.02 micromole/L, hs-CRP 8.2± 1.44 mg/L and Lp(a) 59± 23.10 mg/dL. The sensitivity and specificity of hs-CRP ³8.5 mg/L for prediction of multivessel disease was 67% and 70% respectively while that of Lp(a) ³ 66.5 mg/dL was 71% and 67% respectively. On further analysis, the sensitivity and specificity of hs-CRP value ³8.5 mg/L for prediction of SYNTAX I score > 22 was 75% and 65% respectively while that of Lp(a) ³ 66.5 mg/dL was 75% and 60% respectively. On multivariate linear regression, hs-CRP was the significant predictor of SYNTAX I score (p=0.03) when adjusted for homocysteine and Lp (a). Conclusions hs-CRP and Lp(a) levels are significantly associated with the severity of CAD in young MI patients. hs-CRP and Lp(a) should be evaluated along with routine risk factors of atherosclerosis in young patients at risk of CAD for early detection, timely management and prevention of major cardiac events.