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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 35  |  Issue : 2  |  Page : 364-365
 

Risk factors among patients with acute coronary syndrome in rural Kerala


1 Department of Rehabilitation, CSI Mission Hospital, Codacal P.O., Tirur - 676 108, Kerala, India
2 Department of Internal Medicine, CSI Mission Hospital, Codacal P.O., Tirur - 676 108, Kerala, India

Date of Submission25-Jul-2009
Date of Acceptance27-Mar-2010
Date of Web Publication29-Jul-2010

Correspondence Address:
Mohammed Haneef
Department of Internal Medicine, CSI Mission Hospital, Codacal P.O., Tirur - 676 108, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0218.66863

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How to cite this article:
Babu AS, Haneef M, Joseph AN, Noone MS. Risk factors among patients with acute coronary syndrome in rural Kerala. Indian J Community Med 2010;35:364-5

How to cite this URL:
Babu AS, Haneef M, Joseph AN, Noone MS. Risk factors among patients with acute coronary syndrome in rural Kerala. Indian J Community Med [serial online] 2010 [cited 2019 Oct 16];35:364-5. Available from: http://www.ijcm.org.in/text.asp?2010/35/2/364/66863


Sir,

We found the article by Deb et al.[1] both interesting and thought provoking. It was noted that all forms of cardiovascular diseases were included in their study and it was therefore hypothesized that persons with acute coronary syndromes (ACS) may have different risk factors. We report our findings of risk factors among intensive care unit (ICU) patients with ACS from rural Kerala.

A retrospective study of patients admitted to the ICU with ACS during the year 2006-2007 was analyzed. A total of 130 patients were identified from the records. Of these 130 cases, 74.6% (97) were males and 25.4% (33) females with a mean age of 58.4 ΁ 12.5 years with a range between 24 and 91 years. Of those getting admitted with ACS, 27.9% were above the age of 70 while 66.3% were between the ages of 40 and 60 showing that middle-aged persons were more affected by ACS in this community.

The risk factors [Table 1] for ACS seen in this set-up in rural Kerala were: hypertension (HT), smoking, previous myocardial infarction (MI) and type 2 diabetes mellitus (DM). Alcohol consumption, dyslipidemia and obesity were seen in fewer people. HT was seen to occur in 82.3% of those with ACS. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) classification was used to stratify persons into pre-HT, stage-1 HT and stage-2 HT [Table 1]. [2] Most persons in this area were found to have stage-1 HT. Comparison with other studies was not possible due to the variation in classification systems used to grade HT.

Smoking was seen to be a major risk factor in 50.4% of the patients. A recent study from West Bengal found that 20.5% of the persons with ischemic heart disease were smokers. [3]

The high rate of smokers observed here could be due to lack of awareness on the effects of smoking and its relation to coronary artery disease (CAD) in rural Kerala. [4]

Previous MI and type 2 DM were found to occur among 43/130 persons. Of the 33.1% with type 2 DM, 18.5% had it under control with appropriate measures. The number of persons with type 2 DM and CAD was higher in this area than those reported from other parts of India. [1],[5],[6]

A recent study by Gupta et al.,[7] found a low prevalence of multiple risk factors among young people which increased considerably between the age of 30-39 years. In this sub-group of persons admitted to the ICU, the high rates of risk factors were mainly seen between the ages of 40-49 years. As this age group was not studied by Gupta et al.,[7] it can only be assumed that a similar rising trend of risk factors is present in this area as well.

In conclusion, different parts of India seem to demonstrate the same risk factors, but in varied proportions. This sample is not a true representation of the community burden as only cases admitted to the hospital were included. Therefore, large-scale studies covering more geographical areas will be necessary to investigate the risk factors of a particular area and the required preventive measures needed to reduce the prevalence of ACS. Patient education and awareness programs are of great importance in the rural areas to help reduce the burden of ACS.

 
   References Top

1.Deb S, Dasgupta A. A study on risk factors of cardiovascular diseases in an urban health center of Kolkata. Indian J Community Med 2008;33:271-5.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Mandal S, Saha JB, Mandal SC, Bhattacharya RN, Chakraborty M, Pal PP. Prevalence of ischemic heart disease among urban population of Siliguri, West Bengal. Indian J Community Med 2009;34:19-23.  Back to cited text no. 3  [PUBMED]  Medknow Journal  
4.Tiwari R, Deb P, Debbarma A, Chaudhuri R, Chakraborty A, Lepcha M, et al. Tobacco use and cardiovascular disease: A knowledge, attitude and practice study in rural Kerala. Indian J Med Sci 2006;60:271-6.  Back to cited text no. 4  [PUBMED]  Medknow Journal  
5.Reddy NK, Kumar DN, Rayudu NV, Sastry BK, Raju BS. Prevalence of risk factors for coronary atherosclerosis in a cross sectional population of Andhra Pradesh. Indian Heart J 2002;54:697-701.  Back to cited text no. 5  [PUBMED]    
6.Prabakaran D, Shah P, Chaturvedi V, Ramakrishnan L, Manhapra A, Reddy KS. Cardiovascular risk factor prevalence among men in a large industry of northern India. Natl Med J India 2005;18:59-65.  Back to cited text no. 6      
7.Gupta R, Misra A, Vikram NK, Kondal D, Gupta SS, Agrawal A, et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord 2009;9:28.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  



 
 
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