High altitude and other risk factors for coronary artery disease in Yemen; prevalence, clinical presentation, complications and prognosis
| dc.contributor.author | Al-Huthi, Mohammed All | |
| dc.date.accessioned | 2015-06-25T07:15:29Z | |
| dc.date.available | 2015-06-25T07:15:29Z | |
| dc.date.issued | 2008 | |
| dc.description.abstract | The main objectives of this thesis are to estimate the prevalence of risk factors, to investigate the clinical presentation, complications, prognosis, echocardiographic characteristics and coronary angiography findings among ACS patients at high and low altitudes. Study 1 was a retrospective review of records aimed at estimating the prevalence of risk factors in the ACS patients living at high and low altitudes. It was also aimed to investigate the clinical presentation and complications of these patients. Seven hundred and sixty eight (768) ACS patients from high and low altitudes were studied. Results of study 1 showed that the mean age of ACS patients at high altitude was significantly younger. Heart rate, systolic blood pressure (SBP) and diastolic blood pressure (OBP) were significantly higher at high altitude. High altitude patients were also seen to have significantly higher hemoglobin (Hb), hematocrit, white blood cells (WBC), creatine kinase (CK), creatine kinase-isoenzyme (CK-MB), total cholesterol, low density lipoprotein cholesterol (LDL-C) and triglycerides (TG). The prevalence of past history of hyperlipidemia and history of coronary artery disease (CAD) were significantly higher for high altitude patients. The prevalence of past history of diabetes mellitus (OM) and smoking were higher with border line significance for high altitude. Cardiac wall motion abnormalities detected by echocardiography was higher for high altitude patients. Left ventricular ejection ventricular E:jection fraction (LVEF) was significantly lower at high altitude. High altitude patients were seen to have significantly higher rate of stroke. Arrhythmias, heart failure and death did not show any difference. Study 2 was a cohort study, aimed at evaluating the prognosis of ACS among patients at high and low altitudes. One hundred and fifty seven (157) ACS patients from high and low altitudes were evaluated from admission to CCU for up to 12 months. Results of study 2 showed that the mean age of ACS patients at high altitude was younger. Heart rate, SBP and DBP were higher for patients at high altitude. High altitude patients had higher CK-MB, WBC, total cholesterol, LDL-C and random blood glucose. The prevalence of past history of hyperlipidemia among ACS patients was higher for patients at high altitude. Left ventricular ejection fraction during hospitalization was lower for high altitude patients. Beta-blocker use was significantly higher at low altitude. Usage of thrombolytic agent, heparin, aspirin, angiotensin converting enzyme inhibitor (ACE-I), nitrates, lipid lowering agent, diuretics, and calcium channel blocker (CCB) were comparable. After six months of follow up, HR, SBP, DBP and incidence of heart failure were higher for high altitude patients. At the end of 1 year follow up, high altitude patients were seen to have higher HR, SBP, DBP and have more diagnostic coronary angiography done. Heart failure was more frequent among high altitude patients and L VEF was lower for high altitude patients. Betq-blocker use was significantly higher at low altitude, the rest of medication usage were comparable. Study 3 was a retrospective review of records aimed at investigating echocardiographic characteristics and severity of coronary artery occlusions among high and low altitudes ACS patients. Records of six hundred and two (602) ACS patients from high and low altitudes who underwent diagnostic coronary angiography were reviewed. Results of study 3 showed that the mean age of high altitude patients who underwent coronary angiography was younger. High altitude patients were seen to have higher HR, SBP and DBP. The prevalence of past history of hyperlipidemia and history of CAD were significantly higher for high altitude patients. Reported family history of CAD was significantly higher among low altitude patients. The prevalence of history of OM and smoking for patients at high altitude were higher with border line significance. Left ventricular ejection fraction was lower for high altitude patients. Three vessel occlusions were significantly more common for patients at high altitude while single vessel occlusion was significantly more common for low altitude patients. High altitude patients were seen to have more occlusions in circumflex coronary artery (CX), left anterior descending artery (LAD) and right coronary artery (RCA). In conclusion, in Yemen, ACS occurs at younger age in high altitude residence. High altitude ACS patients also have more prevalent cardiovascular risk factors. They also demonstrated more severe coronary lesion and more adverse clinical outcome. These findings suggest that high altitude itself should be considered as an independent risk factor for ACS. | en_US |
| dc.identifier.uri | http://hdl.handle.net/123456789/814 | |
| dc.language.iso | en | en_US |
| dc.subject | Coronary artery | en_US |
| dc.subject | Prognosis | en_US |
| dc.title | High altitude and other risk factors for coronary artery disease in Yemen; prevalence, clinical presentation, complications and prognosis | en_US |
| dc.type | Thesis | en_US |
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