Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka.

BACKGROUND: Acute Coronary Syndrome (ACS) is one of the leading causes of death worldwide and studies have shown higher mortality rates and premature death in South Asian countries. The occurrence and effect of risk factors differ by type ofACS.Epidemiological studies in the Sri Lankan population are limited. METHODS: This is a cross sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka among patients presenting with ACS. Data was collected by an interviewer administered structured questionnaire and epidemiological patterns and risk factors were analyzed. RESULTS: The sample of 300 patients had a mean age of 61.3+/- 12.6 and male sex showed higher association with all three type of ACS compared to female with a P value of 0.001. This study showed higher mean age of 62.2 ± 11.4 years amongst unstable angina (UA) patients and 61.9 ± 14.5 years amongst non ST elevation myocardial infarction (NSTEMI) patients compared to 59.2 ± 11.2 years for ST elevation myocardial infarction (STEMI) patients with no significant statistical difference (P = 0.246). Approximately 55.8% STEMI patients, 39.8% UA and 35.5% NSTEMI patients were smokers indicating a significant association between smoking and STEMI (P = 0.017). Nearly 54.5% STEMI, 35.4% UA and 32.7% NSTEMI patients consumed alcohol and there was a very strong association between alcohol consumption and STEMI (P = 0.006). Almost 51.8% NSTEMI patients, 47.8% UA patients and 29.9% STEMI patients had hypertension(HT) (P = 0.008) indicating significant association of HT with UA and NSTEMI. About 33.6% UA patients and 30.0% NSTEMI patients had DM whilst only 22.1% of STEMI patients had DM of no significance (p = 0.225). Around 15.0% patients with UA, 25.5% with NSTEMI and 11.7% with STEMI had dyslipidemia (P = 0.032). There was a very strong association between a past history of ACS or stable angina with NSTEMI and UA (P = 0.001). CONCLUSION: Smoking and alcohol abuse are significantly associated with STEMI.Patients with NSTEMI or Unstable Angina had higher rates of hypertension and were more likely to have a history of ACS or stable angina than STEMI patients. Patients with NSTEMI were more likely than patients with STEMI or UA to have dyslipidemia.

Epidemiology of newly diagnosed hypertensives in a tertiary care hospital in a developing country.

BACKGROUND: Cardiovascular diseases are the main cause of death in most countries and the past two decades have shown a global increase. Hypertension (HTN) was found to be the leading risk factor in 2010 as qualified by Disability Adjusted Life Years. Epidemiological studies in this regard in Sri Lanka are scarce. Thus, describing epidemiological patterns of HTN in the Sri Lankan population will help policy makers in planning preventive healthcare programs and aid in preparing strategies to cope with the increasing demand for healthcare facilities. METHODS: This is a cross-sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka, among newly diagnosed hypertensives according to the JNC 7 report, attending the hypertensive clinic through referral. Data were collected by an interviewer administered structured questionnaire, and epidemiological patterns were analyzed. RESULTS: Among 244 newly diagnosed hypertensives, the mean age was 58.3 years (SD = 12.3) and the majority were females. 66.8% had stage 2 HTN (>160 mmHg) at the time of first presentation to a tertiary care center. There was no statistically significant difference of the stage of HTN based on sex, education level, occupation, marital status, consumption of alcohol, and smoking. CONCLUSION: Majority of the population had very high blood pressure at first diagnosis, indicating delay in the detection of HTN at an early stage. Therefore, measures to increase the probability of early detection of HTN will be useful in reducing morbidity and mortality associated with HTN.