Young South Asian heart attack patients more likely to be obese, use tobacco

A new study examining why young South Asian heart attack patients have more adverse outcomes found this patient population was often obese, used tobacco products, and had a family history of heart disease or risk factors that could have been prevented, monitored for or treated before heart attacks happen. The study will be presented at the ACC Asia 2021 Together with SCS 32nd Annual Scientific Meeting Virtual being held July 9-11, 2021.

"South Asians tend to have multiple co-morbidities including diabetes and obesity at younger ages which is different from the white population," said Salik ur Rehman Iqbal, MBBS, Cardiologist, Aga Khan University Hospital in Karachi, Pakistan, and the study's lead investigator. "This can impact the complexity of coronary lesions and success of revascularization. Moreover, due to lack of awareness and system delays, a significant proportion of patients present to the hospital late translating into adverse outcomes."

Researchers examined heart attack patients less than 45 years old who underwent primary percutaneous coronary intervention between 2013-2019. Patients with previous heart attack or revascularization were excluded, leaving a total of 165 patients. The patient population was:

• 90.3% male
• 48.3% obese
• 45% tobacco-users
• 48.4% positive family history of Ischemic Heart Disease

For patients with delayed presentation at the hospital (more than four hours), 27.3% experienced delayed discharge of more than five days. Thirty-day all-cause mortality was seen in six patients. According to the researchers, learning more about the common clinical, prognostic features and differences in young South Asian heart attack patients could have important clinical, as well as quality of life implications, for this patient population. Iqbal said more than 90% of the young patients with STEMI in this study were males, who are often the sole breadwinners of their families.

"This can translate into a significant impact on their families and dependents," Iqbal said. "Moreover, these same patients will be at risk for recurrent heart attacks and other cardiovascular events. This will also put a great burden on our health budget. Targeting these modifiable risk factors, creating awareness and decreasing system delays should be our goals towards reducing the cardiovascular risk in this population."

Iqbal noted another important aspect particular to South Asians is the presence of abnormal lipids, due to mutations, like higher Lipoprotein-A and Apo B-100. Studies focusing on these abnormal lipids are lacking and identification and treatment of dyslipidemia may be a significant future step, he said.

In another study being presented by the investigators at ACC Asia 2021, the researchers examined 23 young South Asian women who presented with heart attack at Aga Khan University Hospital between 2013 and 2020. The median age was 41 years, 53% had uncontrolled Type 2 diabetes and 50% were obese. A positive family history of ischemic heart disease was found in a third of the patients as was a history of high blood pressure. No patients reported smoking.