Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2015

Open Access 01-12-2015 | Research article

Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq

Authors: Ameen Mosa Mohammad, Hekmat Izzat Jehangeer, Sabri Khalif Shaikhow

Published in: BMC Cardiovascular Disorders | Issue 1/2015

Login to get access

Abstract

Background

Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. Given the lack of such studies in the country, this study examines the prevalence, associated cardiovascular risk factors, and coronary angiographic profile of the disease in Iraq.

Methods

Data was collected from a total of 445 adult patients undergoing coronary angiography at Duhok Heart Center, Kurdistan in a period between March and September 2014. Patients were divided into PCAD (male <45 years and female < 55 years) and mature coronary artery disease (MCAD).

Results

The prevalence of the angiographically documented PCAD was 31 %. The PCAD had higher rates of hyperlipidemia (p = 0.04), positive family history of coronary artery disease (p = 0.002), type A lesions (p = 0.02), single vessel disease (p = 0.01) and medical treatment (p = 0.01) than the MCAD. Logistic regression model indicated that male sex (OR 3.38, C.I 1.96–7.22), smoking (OR 2.08, C.I 1.05–4.12), hypertension (OR 1.58, C.I 1.25–2.03), hyperlipidemia (OR 1.89, C.I 1.17–2.42) and positive family history of coronary artery disease (OR 2.62, C.I 1.38–9.54) were associated with the PCAD. Sensitivity analysis showed highest specificity (94.2 %) and positive predictive value (96.5 %) in patients with coronary stenosis >70 % compared to lesser obstruction.

Conclusions

Premature coronary artery disease is alarming  in the country. Cardiovascular risk factors are clustered among them. But the angiographic profile and therapeutic options of PCAD are close to those reported from previous studies.
Literature
1.
go back to reference Shemirani H, Separham KH. The relative impact of smoking or Hypertension on severity of premature coronary artery disease. IRCMJ. 2007;9(4):177–81. Shemirani H, Separham KH. The relative impact of smoking or Hypertension on severity of premature coronary artery disease. IRCMJ. 2007;9(4):177–81.
2.
go back to reference Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al. Acute ischemic Heart disease: acute myocardial infarction in the young-the university of Michigan experience. Am Heart J. 2002;143(1):56–62.CrossRefPubMed Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al. Acute ischemic Heart disease: acute myocardial infarction in the young-the university of Michigan experience. Am Heart J. 2002;143(1):56–62.CrossRefPubMed
3.
go back to reference Jamil G, Jamil M, AlKhazraji H, Haque A, Chedid F, Balasubramanian M, et al. Risk factor assessment of young patients with acute myocardial infarction. Am J Cardiovasc Dis. 2013;3(3):170–4.PubMedPubMedCentral Jamil G, Jamil M, AlKhazraji H, Haque A, Chedid F, Balasubramanian M, et al. Risk factor assessment of young patients with acute myocardial infarction. Am J Cardiovasc Dis. 2013;3(3):170–4.PubMedPubMedCentral
4.
go back to reference Guipeng A, Zhongqi D, Xiao M, Tao G, Guishuang L, Yuguo C, et al. Risk Factors for Long-term Outcome of Drug-eluting Stenting in Adults with Early-onset Coronary Artery Disease. Int J Med Sci. 2014;11(7):721–5.CrossRef Guipeng A, Zhongqi D, Xiao M, Tao G, Guishuang L, Yuguo C, et al. Risk Factors for Long-term Outcome of Drug-eluting Stenting in Adults with Early-onset Coronary Artery Disease. Int J Med Sci. 2014;11(7):721–5.CrossRef
5.
go back to reference Wijns W, Kolh P, Danchin N, DiMario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization. Eur Heart J. 2010;31(20):2501–55.CrossRefPubMed Wijns W, Kolh P, Danchin N, DiMario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization. Eur Heart J. 2010;31(20):2501–55.CrossRefPubMed
6.
go back to reference Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Bojan C, et al. ACCF/AHA/SCAI Practice Guideline:2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention:A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:e574–651.CrossRefPubMed Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Bojan C, et al. ACCF/AHA/SCAI Practice Guideline:2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention:A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:e574–651.CrossRefPubMed
7.
go back to reference O'Gara PT, Kushner FG, Ascheim DD, et al. ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78–e140.CrossRefPubMed O'Gara PT, Kushner FG, Ascheim DD, et al. ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78–e140.CrossRefPubMed
8.
go back to reference JL Anderson, CD Adams, EM Antman, CR Bridges, RM Califf, DE Casey Jr, et al. Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice. J Am Coll Cardiol. 2007;50(7):e1–e157.CrossRefPubMed JL Anderson, CD Adams, EM Antman, CR Bridges, RM Califf, DE Casey Jr, et al. Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice. J Am Coll Cardiol. 2007;50(7):e1–e157.CrossRefPubMed
9.
go back to reference Fihn SD, Gardin JM, Abrams J, et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60(24):e44–e164.CrossRefPubMed Fihn SD, Gardin JM, Abrams J, et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60(24):e44–e164.CrossRefPubMed
11.
go back to reference Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7 Report. JAMA. 2003;289(19):2560–71.CrossRefPubMed Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7 Report. JAMA. 2003;289(19):2560–71.CrossRefPubMed
12.
go back to reference Pasternak RC. Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults. Cardiol Clin. 2003;21:393–8.CrossRefPubMed Pasternak RC. Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults. Cardiol Clin. 2003;21:393–8.CrossRefPubMed
13.
go back to reference Parmar MS. Family history of coronary artery disease — need to focus on proper definition. Euro Heart J. 2003;24(22):2073.CrossRef Parmar MS. Family history of coronary artery disease — need to focus on proper definition. Euro Heart J. 2003;24(22):2073.CrossRef
14.
go back to reference Ryan H, Trosclair A, Gfroerer J. Adult Current Smoking: Differences in Definitions and Prevalence Estimates—NHIS and NSDUH, 2008. J Environ Public Health. 2012;2012:1–11.CrossRef Ryan H, Trosclair A, Gfroerer J. Adult Current Smoking: Differences in Definitions and Prevalence Estimates—NHIS and NSDUH, 2008. J Environ Public Health. 2012;2012:1–11.CrossRef
15.
go back to reference Scanlon P, Faxon D, Audet A, et al. ACC/AHA guidelines for coronary angiography123: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999;33(6):1756–824.CrossRefPubMed Scanlon P, Faxon D, Audet A, et al. ACC/AHA guidelines for coronary angiography123: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999;33(6):1756–824.CrossRefPubMed
16.
go back to reference Mohammad AM, Sheikho SK, Tayib JM. Relation of Cardiovascular Risk Factors with Coronary Angiographic Findings in Iraqi Patients with Ischemic Heart Disease. Am J Cardiovasc Dis Res. 2013;1(1):25–9. Mohammad AM, Sheikho SK, Tayib JM. Relation of Cardiovascular Risk Factors with Coronary Angiographic Findings in Iraqi Patients with Ischemic Heart Disease. Am J Cardiovasc Dis Res. 2013;1(1):25–9.
17.
go back to reference Prashanth P, Kadhim S, Ibrahim A-Z, Said A. Acute Coronary Syndrome in Young Adults from Oman: Results from the Gulf Registry of Acute Coronary Events. Heart Views. 2010;11(3):93–8.CrossRef Prashanth P, Kadhim S, Ibrahim A-Z, Said A. Acute Coronary Syndrome in Young Adults from Oman: Results from the Gulf Registry of Acute Coronary Events. Heart Views. 2010;11(3):93–8.CrossRef
18.
go back to reference Al-Nozha MM, Arafah MR, Al-Mazrou YY, Al-Maatouq MA, Khan NB, Khalil MZ, et al. Coronary artery disease in Saudi Arabia. Saudi Med J. 2004;25(9):1165–71.PubMed Al-Nozha MM, Arafah MR, Al-Mazrou YY, Al-Maatouq MA, Khan NB, Khalil MZ, et al. Coronary artery disease in Saudi Arabia. Saudi Med J. 2004;25(9):1165–71.PubMed
19.
go back to reference Cole JH, Sperling LS. Premature coronary artery disease: Clinical risk factors and prognosis. Curr Atheroscler Rep. 2004;6(2):121–5.CrossRefPubMed Cole JH, Sperling LS. Premature coronary artery disease: Clinical risk factors and prognosis. Curr Atheroscler Rep. 2004;6(2):121–5.CrossRefPubMed
20.
go back to reference Sharma M, Ganguly NK. Premature Coronary Artery Disease in Indians and its Associated Risk Factors. Vasc Health Risk Manag. 2005;1(3):217–25.PubMedPubMedCentral Sharma M, Ganguly NK. Premature Coronary Artery Disease in Indians and its Associated Risk Factors. Vasc Health Risk Manag. 2005;1(3):217–25.PubMedPubMedCentral
21.
go back to reference Sang Z, Jin H, Tao C, Shen J, Xu Y, Liu Z. Temporal Trends in Young Chinese Patients with Acute Myocardial Infarction. Exp Clin Cardiol. 2014;20(7):1105–28. Sang Z, Jin H, Tao C, Shen J, Xu Y, Liu Z. Temporal Trends in Young Chinese Patients with Acute Myocardial Infarction. Exp Clin Cardiol. 2014;20(7):1105–28.
22.
go back to reference Satoh H, Nishino T, Tomita K, Saijo Y, Kishi R, Tsutsui H. Risk factors and the incidence of coronary artery disease in young middle-aged Japanese men: results from a 10-year cohort study. Intern Med. 2006;45(5):235–9.CrossRefPubMed Satoh H, Nishino T, Tomita K, Saijo Y, Kishi R, Tsutsui H. Risk factors and the incidence of coronary artery disease in young middle-aged Japanese men: results from a 10-year cohort study. Intern Med. 2006;45(5):235–9.CrossRefPubMed
23.
go back to reference Muda Z, Kadir AA, Yusof Z, Yaacob LH. Premature Coronary Artery Disease among Angiographically Proven Atherosclerotic Coronary Artery Disease in North East of Peninsular Malaysia. Int J Collaborative Res Intern Med Public Health. 2013;5(7):507–16. Muda Z, Kadir AA, Yusof Z, Yaacob LH. Premature Coronary Artery Disease among Angiographically Proven Atherosclerotic Coronary Artery Disease in North East of Peninsular Malaysia. Int J Collaborative Res Intern Med Public Health. 2013;5(7):507–16.
24.
go back to reference Sadeghi R, Adnani N, Erfanifar A, Gachkar L, Maghsoomi Z. Premature Coronary Heart Disease and Traditional Risk Factors-Can We Do Better? Int Cardiovasc Res J. 2013;7(2):46–50.PubMedPubMedCentral Sadeghi R, Adnani N, Erfanifar A, Gachkar L, Maghsoomi Z. Premature Coronary Heart Disease and Traditional Risk Factors-Can We Do Better? Int Cardiovasc Res J. 2013;7(2):46–50.PubMedPubMedCentral
25.
go back to reference Saghir T, Qamar N, Sial J. Coronary angiographic characteristics of coronary artery disease in young adults under age of forty years compared to those over age forty. Pakistan Heart J. 2008;41(3):49–56. Saghir T, Qamar N, Sial J. Coronary angiographic characteristics of coronary artery disease in young adults under age of forty years compared to those over age forty. Pakistan Heart J. 2008;41(3):49–56.
26.
go back to reference Siddique A, Shrestha MP, Mohammad S, Sirajul Haque KMHS, Ahmed K, Sultan AU. Age-Related Differences of Risk Profile and Angiographic Findings in Patients with Coronary Heart Disease. BSMMU J. 2010;3(1):13–7. Siddique A, Shrestha MP, Mohammad S, Sirajul Haque KMHS, Ahmed K, Sultan AU. Age-Related Differences of Risk Profile and Angiographic Findings in Patients with Coronary Heart Disease. BSMMU J. 2010;3(1):13–7.
27.
go back to reference D’Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, et al. Sex differences in reperfusion in young patients with ST-segment elevation myocardial infarction: results from the VIRGO study. Circulation. 2015;14(131):1324–32.CrossRef D’Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, et al. Sex differences in reperfusion in young patients with ST-segment elevation myocardial infarction: results from the VIRGO study. Circulation. 2015;14(131):1324–32.CrossRef
28.
go back to reference Wegner NK. Disparities in STEMI management for the young goose and young gander: clinical, organizational, and educational challenges. Circulation. 2015;131:1310–2.CrossRef Wegner NK. Disparities in STEMI management for the young goose and young gander: clinical, organizational, and educational challenges. Circulation. 2015;131:1310–2.CrossRef
29.
go back to reference Fakhir Nafakhi HA. Coronary angiographic findings in young patients with coronary artery disease. Intern J Collaborative Res Intern Med Public Health. 2013;5(1):48–53. Fakhir Nafakhi HA. Coronary angiographic findings in young patients with coronary artery disease. Intern J Collaborative Res Intern Med Public Health. 2013;5(1):48–53.
30.
go back to reference Noeman A, Ahmad N, Azhar M. Coronary artery disease in young: faulty life style or heredofamilial or both. Annals. 2007;13(2):162–4. Noeman A, Ahmad N, Azhar M. Coronary artery disease in young: faulty life style or heredofamilial or both. Annals. 2007;13(2):162–4.
31.
go back to reference Foroughi M, Ahranjani SA, Ebrahimian M, Saieedi M, Safi M, Abtahian Z. Coronary artery disease in Iranian young adults, similarities and differences. Open J Epidemiol. 2014;4(1):19–24.CrossRef Foroughi M, Ahranjani SA, Ebrahimian M, Saieedi M, Safi M, Abtahian Z. Coronary artery disease in Iranian young adults, similarities and differences. Open J Epidemiol. 2014;4(1):19–24.CrossRef
32.
go back to reference Badran HM, Elnoamany MF, Khalil TS, Eldin MME. Age-Related Alteration of Risk Profi le, Inflamatory Response, and Angiographic Findings in Patients with Acute Coronary Syndrome. Clin Med: Cardiol. 2009;3:15–28. Badran HM, Elnoamany MF, Khalil TS, Eldin MME. Age-Related Alteration of Risk Profi le, Inflamatory Response, and Angiographic Findings in Patients with Acute Coronary Syndrome. Clin Med: Cardiol. 2009;3:15–28.
33.
go back to reference Pineda J, Marín F, Roldán V, Valencia J, Marco P, Sogorb F. Premature myocardial infarction: clinical profile and angiographic findings. Int J Cardiol. 2008;126(1):127–9.CrossRefPubMed Pineda J, Marín F, Roldán V, Valencia J, Marco P, Sogorb F. Premature myocardial infarction: clinical profile and angiographic findings. Int J Cardiol. 2008;126(1):127–9.CrossRefPubMed
34.
go back to reference Nesligul Y, Nurcan A, Sait DM, Yeliz S, Firat O. Comparison of traditional risk factors, natural history andangiographic findings between coronary heart disease patients with age <40 and ≥40 years old. Anatolian J Cardiol. 2007;7:124–7. Nesligul Y, Nurcan A, Sait DM, Yeliz S, Firat O. Comparison of traditional risk factors, natural history andangiographic findings between coronary heart disease patients with age <40 and ≥40 years old. Anatolian J Cardiol. 2007;7:124–7.
35.
go back to reference Fabrizio D’A, Enrico C, Darryn A, Claudio M, Andrea C, Nayef A, et al. Prognostic Indicators for Recurrent Thrombotic Events in HIV-infected Patients with Acute Coronary Syndromes: Use of Registry Data From 12 sites in Europe, South Africa and the United States. Thromb Res. 2014;134(3):558–64.CrossRef Fabrizio D’A, Enrico C, Darryn A, Claudio M, Andrea C, Nayef A, et al. Prognostic Indicators for Recurrent Thrombotic Events in HIV-infected Patients with Acute Coronary Syndromes: Use of Registry Data From 12 sites in Europe, South Africa and the United States. Thromb Res. 2014;134(3):558–64.CrossRef
36.
go back to reference Shah I, Faheem M, Shahzeb R, Hafizullah M. Clinical Profile, Angiographic Characteristics and Treatment Recommendations in Patients with Coronary Artery Disease. J Pak Med Stud. 2013;3(2):94–100. Shah I, Faheem M, Shahzeb R, Hafizullah M. Clinical Profile, Angiographic Characteristics and Treatment Recommendations in Patients with Coronary Artery Disease. J Pak Med Stud. 2013;3(2):94–100.
37.
go back to reference Sadiq Shah S, Lubna N, Syed Habib S, Shahsawar, Shahab Ud D, Zahid Aslam A, et al. Myocardial Infarction in young versus older adults: Clinical characteristics and angiographic features. J Ayub Med Coll Abbottabad. 2010;22(2):187–90.PubMed Sadiq Shah S, Lubna N, Syed Habib S, Shahsawar, Shahab Ud D, Zahid Aslam A, et al. Myocardial Infarction in young versus older adults: Clinical characteristics and angiographic features. J Ayub Med Coll Abbottabad. 2010;22(2):187–90.PubMed
38.
go back to reference Ahmed Hussein A-M. Coronary Artery Disease in Young versus Older Adults in Hilla City: Prevalence, Clinical Characteristics and Angiographic Profile. Karbala J Med. 2012;5(1):1328–33. Ahmed Hussein A-M. Coronary Artery Disease in Young versus Older Adults in Hilla City: Prevalence, Clinical Characteristics and Angiographic Profile. Karbala J Med. 2012;5(1):1328–33.
39.
go back to reference Christus T, Shukkur AM, Rashdan I, Koshy T, Alanbaei M, Zubaid M, et al. Coronary Artery Disease in Patients Aged 35 or less. Heart Views J Gulf Heart Assoc. 2011;12(1):7–11.CrossRef Christus T, Shukkur AM, Rashdan I, Koshy T, Alanbaei M, Zubaid M, et al. Coronary Artery Disease in Patients Aged 35 or less. Heart Views J Gulf Heart Assoc. 2011;12(1):7–11.CrossRef
40.
go back to reference Tewari S, Kumar S, Kapoor A, Singh U. Premature CAD in north india: an angiography study of 1971 patients. Indian Heart J. 2005;57(4):311–8.PubMed Tewari S, Kumar S, Kapoor A, Singh U. Premature CAD in north india: an angiography study of 1971 patients. Indian Heart J. 2005;57(4):311–8.PubMed
41.
go back to reference Farhan HA. Coronary Artery Disease: Conventional Risk Factors & Angiographic Findings among Young Iraqi Adults. Univ Babylon J. 2010;2(18):644–50. Farhan HA. Coronary Artery Disease: Conventional Risk Factors & Angiographic Findings among Young Iraqi Adults. Univ Babylon J. 2010;2(18):644–50.
Metadata
Title
Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq
Authors
Ameen Mosa Mohammad
Hekmat Izzat Jehangeer
Sabri Khalif Shaikhow
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2015
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-015-0145-7

Other articles of this Issue 1/2015

BMC Cardiovascular Disorders 1/2015 Go to the issue