Coronary Artery Disease (CAD) occurs at a younger age in Indians with over 50% of CAD mortality occurring in individuals aged less than 50 years, and one-fourth of all acute Myocardial Infarctions (MIs) are reported in patients below 40 years.
Differing pattern of dyslipidemia combined in inherent insulin resistance and contribution from varying lifestyle makes Indians more vulnerable to CAD at a younger age. Smoking and other forms of tobacco, dyslipidemia and hypertension are major risk factors in the young.
I am presenting 3 cases of ACS (Heart attacks) involving patients under 30 years of age.
Case 1: Mr DP is a 27 year old unmarried businessman, presented with chest pain and was referred following a diagnosis of acute anterior wall MI. He was successfully treated with balloon angioplasty and did not need any stent deployment. His LV function was largerly preserved.
Case 2: Mr DK is a 29 year old MBA graduate and was diagnosed to have acute anterior wall MI. He was diagnosed to be a diabetic at admission with blood sugars over 500mg/dl. He underwent angioplasty and stent procedure which was successful. His LV function was mildly impaired.
Case 3: Mr N is a 29 year old gentleman and was transferred to our hospital with acute pulmonary edema following an anterior myocardial infarction. He underwent a successful angioplasty procedure and received a stent in the LAD artery. He travelled back to the Middle East where he works as a dietician.
Indians have higher risk of CAD at young age compared to other populations.
CAD in the young is increasing in prevalence in India due to changing lifestyle.Family history of premature CAD is one of the strongest risk factor in young individuals.
Investigations like exercise stress testing, stress echocardiography, coronary angiography can help identify young individuals at higher risk of CAD.Risk factor prevention is essential to prevent CAD in young For obstructive CAD, PCI with stenting should be preferred if available and affordable. Thrombolysis still remains one of the major therapeutic approaches even for the young CAD due to ease of availability.
Lone aspiration thrombectomy is another approach, when underlying lesion is insignifi cant and occlusion is predominantly due to a large thrombus. In absence of strong clinical evidence, it should be reserved for selected patients where it would be safe to leave them unstented.
Optimal secondary prevention medications and strict adherence to life style changes should be ensured to reduce future coronary events.