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A comparative retrospective study was performed to compare the distribution of risk factors and complications in patients with acute coronary syndrome (ACS) at high-altitude vs low-altitude
areas in Yemen. The study records of 768 patients from Sana’a (high altitude) and Aden (low altitude). The assessed Risk factors were age, hypertension, diabetes mellitus, hyperlipidemia, cigarette smoking, and reported history and family history of coronary artery disease (CAD). Complications of ACS of interest were heart failure, arrhythmias, cerebrovascular accident (CVA), and death.
The objective of the study was to estimate the prevalence of risk factors in patients with ACS in high- vs low-altitude areas and also to investigate the clinical presentation and complications of ACS among high- vs low-altitude patients.
This study was done on diagnosed adult ACS Yemeni patients aged 30–69 years residing in high- and low-altitude areas. The lifestyles were almost comparable in the two populated areas, except for dietary habits: Coastal people mostly consume seafood and rice, whereas high-altitude people consume cereals, poultry, and red meat.
The selected samples were ACS patients admitted to the CCU and had diagnosis of ACS according to the World Health Organization (WHO) criteria for the diagnosis of ACS and the records of consecutive patients were reviewed retrospectively.
The data of this study were collected according to Clinical presentation Chest pain (pressure, tightness, discomfort, or ache, lasting for at least 20 minutes without other noncardiac causes), Shortness of breath (considered as atypical chest pain), Clinical examination findings (especially blood pressure, heart rate, and signs of heart failure). Reported history of CAD risk factors, including hypertension, diabetes mellitus, tobacco smoking, dyslipidemia, and family history of CAD. Laboratory investigations and procedures. Laboratory investigations included complete blood cell count, total cholesterol, HDL-C, LDL-C, triglycerides, fasting blood glucose, random blood glucose, CK, and CK-MB.ECG ( Parameters of interest were ST-elevation with or without Q-wave and T-wave changes, R-wave changes, and arrhythmias). Echocardiography examination.
A total of 768 patients who were admitted in the CCU as cases of ACS at high- and low-altitude hospitals were studied. Three hundred eighty-four patients were from high altitudes and an equal number were from low altitudes.
The data of this study were analyzed by an SPSS program to calculate percentages and mean ± SD. The 2-tailed test was used to assess the differences between continuous variables. Chi-squared tests were used to compare categoric variables. Odds ratios (ORs) were calculated. Data are presented as means (SD). They set the level of the statistical significance at a P value of less than.05. Statistical tests with P <.10 and P >.05 were considered to be of borderline significance.
The results showed that the mean age of ACS patients at high altitude was significantly lower than those at low altitude (55.3 years [SD = 8.2] vs 56.8 years [SD = 7.1]; P =.007). History of hyperlipidemia was significantly higher in high-altitude patients than in low-altitude patients (49.2% vs 38.3%; odds ratio [OR] = 1.563; P =.002). Reported history of CAD was also significantly higher at higher altitudes (16.7% vs 9.4%; OR = 1.933; P =.003). Previous history of diabetes mellitus and tobacco smoking was slightly higher with borderline significance. Hypertension and reported family history of CAD were comparable among high- and low-altitude patients. In terms of in-hospital complications, CVAs were significantly higher in high-altitude patients than in low-altitude patients (7.8% vs 4.4%; P =.0001). Heart failure, arrhythmias, and death rates were comparable in both groups of patients. Wall motion abnormalities were comparable, whereas the ejection fraction was lower in the high-altitude patients (49.8% [SD = 16.08] vs 54.8% [SD = 16.23]; P =.0001).
The conclusion was that High-altitude living predisposes Yemenis to CVD, particularly ACS. They develop ACS at a younger age and have a more adverse CVD risk profile. They demonstrate more adverse outcomes, both in terms of investigational findings and clinical events. This suggests that higher altitudes may be a risk factor for ACS and should be taken into account when evaluating cardiovascular risk.
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