Risk factor profile of female patients presenting with acute myocardial infarction: a South African perspective.
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Date
2017
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Abstract
The study was a retrospective single center study conducted at RK Khan hospital in
Durban. The primary aim was to look at the incidence of acute myocardial infarction
(AMI) in the female population in our setting with particular interest in the
cardiovascular risk profile of female patients presenting with AMI. Data was
extracted from a computerized database for the duration of the study period, which
was from 2003 to 2016. Patient anonymity was maintained.
All adult female patients that presented to the study center during the study period,
with a diagnosis of AMI, based on the European and American Society of Cardiology
guidelines, were included in the study. Females with unstable angina were excluded.
The cardiovascular disease (CVD) risk factor profile was based on the Framingham
risk profile for CVD and included the following: diabetes mellitus (DM),
hypertension (HPT), cigarette smoking, dyslipidemia, obesity, a previous history of
coronary artery disease and positive family histories of DM, HPT and coronary artery
disease. The study population was broadly categorized into 2 age groups, namely <65
years of age and >65 years. Both groups were analyzed identically in terms of their
age, clinical presentation, CVD risk factors, initial electrocardiogram, medical
therapies and whether or not they were referred for an angiogram and/or coronary artery
bypass surgery. We also divided the study population into those with ST elevation
myocardial infarction (STEMI) versus Non ST elevation myocardial infarction. In the
STEMI group we assessed the use of thrombolytic therapy or not. Finally we looked
at the presence of major adverse cardiac events (MACE) in each of the age groups.
MACE was defined as follows: Arrhythmias, cardiac failure, cardiogenic shock,
complete heart block, recurrence of angina or myocardial infarction and death. In addition to the primary study aim, by categorizing patients into 2 age groups we
could determine if there was a difference in CVD risk factor profile and the presence
of MACE between the younger and older age groups. Finally, by comparing the
outcome of our study to studies done in male counterparts we were able to see if there
was a difference in CVD risk profile between male and female patients, which in fact
there was not. So basically in the presence of the traditional risk factors for coronary
artery disease (CAD), males and females can be considered at equal risk of
developing acute myocardial infarction and females are not protected by the cardioprotective
effects of oestrogen hormone in the pre-menopausal age group as was
previously thought. Females are an understudied population when it comes to
coronary artery disease and very few studies have been conducted on females with
cardiac disease. We believe that this study offers some very valuable information with
regards to cardiac disease in females and that treatment strategies should be targeted
to include optimizing risk factor control in at-risk females, so that the burden of
disease can be reduced in this population.
Description
Masters Degree. University of KwaZulu-Natal, Durban.