TOBACCO EXPOSURE; A NEGLECTED MODIFIABLE CARDIOVASCULAR RISK FACTOR IN FEMALE PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROME

Abstract

Background: The modifiable cardiovascular risk factors associated with ACS may have different impact on men and women, which may also differ in different population groups. There are limited studies on the subject of modifiable cardiovascular risk factors in general and different type of tobacco exposure in special among female patients with acute coronary syndrome (ACS) in Pakistan. This study has been undertaken to determine the frequency of different type of Tobacco Exposure as one of a modifiable risk factor associated with ACS in female patients admitted to cardiology department, Khyber Teaching Hospital (KTH) Peshawar.Objective: To determine the frequency of different type of Tobacco Exposure as a modifiable risk factor associated with ACS in female patients admitted to cardiology department, Khyber Teaching Hospital, Peshawar.Study Design and Methodology: This cross-sectional study was conducted at Cardiology department, KTH Peshawar. All females who fulfill the diagnostic criteria of ACS, were included in the study by consecutive sampling technique, from Jan’09 to Dec’09. Under these categories the modifiable CV risk factors i.e. different types of tobacco use, along with diabetes mellitus, hypertension, dyslipidemia and lack of physical activity were identified and analyzed with particular reference to age, geographical distribution, education level and socio-economic status.Results: A total of 337 female patients were diagnosed as ACS, these female patients with ACS were reviewed for modifiable CVD risk factors especially for tobacco use. Out of those 337 female patients with ACS, 115(34.1%) were diagnosed as STEMI, 78(23%) as NSTEMI and 144 (42.7%) as UA.ACS appeared to be more common in female age group >55 years of age (54.2%), with mean age of 53yr±8 yrs. Interestingly, 43(12.7%) female presented with ACS were smokers, (52.8%) 178 had positive history of passive smoking and 91 (27%) were addicted to chewable tobacco (including niswar and pan).Lack of physical activity, hypertension, diabetes mellitus and dyslipidemia (84.5%, 76.5%, 63.7%, 42% respectively) appeared to predispose to ACS as well. 70% of patients with ACS had 1-2 modifiable risk factors whereas 23.6% had 3/more than 3 risk factors. 59% of patients with 3/more risk factors were of >55 yrs age group.Conclusion: Frequency of passive smoking is alarmingly high in our study subjects, about one third of study population were addicted to chewable tobacco (including niswar and pan). Lack of physical activity, diabetes and hypertension were identified as other modifiable risk factors for ACS in female patients. Addressing these facts infrot of patients can decrease the disease as wel as financial burden of ACS.