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LDL is currently the primary target of therapy for all patients and there is no special evidence based case for treatment at a lower threshold of LDL in south Asians. Control of the five major risk factors modeled by FINRISK reduces risk by 59 percent in south Asian men and 67 percent in south Asian women, with some subgroup heterogeneity, compared to 50% in European men and 48% in European women. Framingham and FINRISK models give similar results, mostly following expected patterns, but the SCORE model does not, probably reflecting its lack of inclusion of HDL and diabetes as risk factors, which may be more significant in south Asian populations. This suggests potential gains from controlling major established risk factors in south Asians, greater than in white Europeans. Over the past decade, researchers studying heart disease among South Asians have identified additional risk factors that may play a critical role in CAD among the South Asian population. These emerging risk factors include fibrinogen, insulin resistance and metabolic syndrome, low HDL, HDL2b, high triglycerides, small dense LDL, homocysteine.
Incidence of IHD is reported to be increasing sharply and substantial numbers of Pakistanis suffer their first heart attack at relatively younger ages of 40-50. Atherosclerosis of coronary arteries is the main cause of IHD in almost all cases, but the etiology and pathogenesis of atherosclerosis is not fully understood, however various observational epidemiological studies have shown that certain factors predispose to the development of atherosclerosis and resultant IHD. These factors are termed as risk factors. Major modifiable risk factors are hyperlipidemia, hypertension, smoking and diabetes Mellitus. In this study we have basically focused on hyperlipidemia in Acute Coronary Syndrome patients.
In Pakistan such few studies have been conducted at tertiary care or teaching hospitals but at district level no data was ever planned to be collected and analyzed.. The scope for reduction in morbidity and mortality by early detection and treatment of hyperlipidemia has prompted us to conduct this study in our community.
Purpose of Study
Regarding Hyperlipidemia, In Pakistan such few studies have been conducted at tertiary care or teaching hospitals but at district level no data was ever planned to be collected and analyzed.. The scope for reduction in morbidity and mortality by early detection and treatment of hyperlipidemia has prompted us to conduct this study in our community. In our Community of South Asians, along with high LDL risk factor, Low HDL is also getting more importance in patients of ACS. That is why we are conducting this study to observe and compare both high LDL and low HDL levels in CHD, and this study is hypothesized that in ACS , not only high LDL is a major risk factor but Low HDL is also considered as emerging risk factor.
Materials and Methods
The present clinical prospective Cohort study was carried out from dated 1st March,06 to 1st June 06 at Sialkot Medical Complex. A total of about 155 patients (83 were males and 72 were female) of Acute Coronary syndrome were selected on basis of diagnostic criteria described below. Sialkot Medical Complex is equipped with bed sided and central cardiac monitoring, Echocardiography, ETT diagnostic tests. In every case detailed History, complete physical examination of the patient and relevant investigations were done and data was collected and recorded on special proforma.
Number of Patients:
155 Patients (83 males 72 Females) were enrolled in this study.
Inclusion Criteria:
• Age: Between 25 and 75 years
• Established diagnosis of ACS based on history, ECG changes and Cardiac Markers.
• Both Male and Female
Exclusion Criteria:
• Patient not giving consent.
• No specific ECG changes
• Age < 25y and > 75y.
• End organ Damage
• Congenital or valvular heart diseases.
• Cardiomyopathies
Proforma for Data Collection:
A data base of detailed demographic and clinical characteristics including Risk Factors was created prospectively. Data was collected by face to face , closed end questionnaire interview of the patient and attendants , directly by the author and a multivariate form was recorded at the same time.
The predicators for this project were consistent with current guideline and ethical recommendations. The focus was on evidence-based processes of care, according to the Performa attached and on the length and cause of the predictors with aggregate of central tendency.
We used following Proforma for data collection.
Proforma Data Collection Form
Serial # ------------ Ref # ---------------- Date --------------------------
Name:--------------------------------------------------------------------------
Age:---------------Years Sex: Male/Female
Address: Rural/Urban------------------------------------------------------
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Socioeconomic Status: P/M/U (Poor/Middles class/Upper Class)
Diagnoses on bases of:
History: Chest Pain Yes/No, SOB Yes/No, Others Yes/No
ECG: ST segment: Elevation/Depression
Twave inversion Yes/No
Q wave Yes/ No
Cardiac Markers: CK-Total CK-MB Cardiac-T
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