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

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.

TFIIIC binding sites function as both heterochromatin barriers and chromatin insulators in Saccharomyces cerevisiae.

Chromosomal sites of RNA polymerase III (Pol III) transcription have been demonstrated to have "extratranscriptional" functions, as the assembled Pol III complex can act as chromatin boundaries or pause sites for replication forks, can alter nucleosome positioning or affect transcription of neighboring genes, and can play a role in sister chromatid cohesion. Several studies have demonstrated that assembled Pol III complexes block the propagation of heterochromatin-mediated gene repression. Here we show that in Saccharomyces cerevisiae tRNA genes (tDNAs) and even partially assembled Pol III complexes containing only the transcription factor TFIIIC can exhibit chromatin boundary functions both as heterochromatin barriers and as insulators to gene activation. Both the TRT2 tDNA and the ETC4 site which binds only the TFIIIC complex prevented an upstream activation sequence from activating the GAL promoters in our assay system, effectively acting as chromatin insulators. Additionally, when placed downstream from the heterochromatic HMR locus, ETC4 blocked the ectopic spread of Sir protein-mediated silencing, thus functioning as a barrier to repression. Finally, we show that TRT2 and the ETC6 site upstream of TFC6 in their natural contexts display potential insulator-like functions, and ETC6 may represent a novel case of a Pol III factor directly regulating a Pol II promoter. The results are discussed in the context of how the TFIIIC transcription factor complex may function to demarcate chromosomal domains in yeast and possibly in other eukaryotes.