Comparison of Risk Factors between Younger and Older Patients of Myocardial Infarction among Bangladeshi Rural People: A Hospital Based Study.

Abstract

Myocardial infarction among patients is a concern as young patients live longer in the aftermath of this critical illness. Still, there is a wide knowledge gap about modifiable risk factors that may help to alter the course of this extreme end of coronary artery disease spectrum among young patients. The trend of socioeconomic changes in developing countries like Bangladesh has resulted in increasing non-communicable diseases like coronary artery disease. Prevalence and risk factors of myocardial infarction among people living in a rural community are largely unknown, particularly in the younger age group. We tried to find out the risk factors differences between young and old MI groups as well as proportion of myocardial infarction among patients out of total hospitalized MI patients. This cross-sectional analytical study was done among the patients admitted to a rural cardiac center. For risk factor analysis, patients with new MI, including both non-ST-elevation and ST-elevation myocardial infarction were included according to preset inclusion and exclusion criteria. Patients were grouped as young (age ≤45 years) MI and old (age >45 years) MI. Data was collected using a questionnaire after informed consent was taken. American Heart Association's continuous dietary scoring system and Holmes Rahe Stress Scale were used to identify dietary patterns and mental stress levels, respectively, among the sample. Logistic regression analysis was performed to explore the risk factors of premature MI. On the other hand, to identify the proportion of young MI patients among the hospitalized MI patient's hospital registry was used to count the cases over almost one year. For risk factor analysis between young and old MI groups, 137 MI patients were selected according for inclusion and exclusion criteria. Out of them 62 and 75 patients were in the young and old age groups, respectively. The mean ages of younger and older groups were 39.0±5.9 years and 58.8±8.2 years, respectively. In both groups, 112(81.8%) patients were male. Only 42(30.7%) patients had BMI ≥25kg/m². In the unadjusted analysis, hypertension, family history of hypertension, consumption of fatty food, dairy products, and free-range chicken were found to be associated with premature MI. No significant difference in triglyceride, cholesterol or LDL level was found between the groups. But in the multivariate analysis, only the male gender was a significantly higher risk of premature MI (aOR 7.00; 95% CI: 1.51-42.42). Interestingly, HTN (aOR 0.46; 95% CI: 0.19-1.14) and smoking (aOR 0.26; 95% CI: 0.05-0.98) tend towards increased the risk of MI among the older age group compared to the younger group. According to hospital registry analysis, 22.9% of total MI patients admitted in the cardiac center were younger than 45 years. The incidence of myocardial infarction among young patients in rural areas in Bangladesh is probably more than what is known. Other than the male gender, which is a significant un-modifiable risk factor for young myocardial infarction patients; dietary factors, diabetes, and increased body mass index may play a vital role. On the contrary, hypertension and family history of hypertension are significantly higher among the older age group.