Prevalence of Acute Coronary Syndrome among Diabetic Patients Admitted to Al-Wahdah Teaching Hospital, Yemen

Coronary artery diseases (CAD) are the leading causes of mortality and morbidity among diabetic patients [1]. As diabetic patients are more likely to experience acute myocardial infarction, they are also at greater risk of dying after acute cardiac event or even at least develop woes prognosis than non-diabetic patients. [2,3].

Several mechanisms play role in making acute coronary syndrome (especially MI) the leading cause of death in diabetics the most important mechanisms are: macroangiopathy with accelerated atherosclerosis and hypertension, microangiopathy with related endothelial dysfunction and disturbed plate late function, autonomic neuropathy, and Metabolic alternation with generation, accumulation of free radicals and alternation of ions homeostasis [4].

Therefore, among all patients with acute coronary syndrome (ACS) those with Diabetes Mellitus (DM) are at particularly high risk of recurrent cardiovascular events and premature death [2,3].

CAD is the leading cause of death in diabetic patients and it’s also the most common cause of hospitalization and intensive care unit admission in diabetics. Therefore, this study will provide information to researchers and readers about prevalence and risk factors associated with ACS among Diabetic patients.

To determine the prevalence of acute coronary syndrome and associated risk factors among diabetic patients

Study design

A cross-sectional, hospital-based study was conducted among ACS patients from 2020 to 2021.

Study setting

This study was carried out in internal medicine department in Al-Wahdah teaching hospital, Thamar government, Yemen.

Study population

All patients who had admitted with diagnosis of ACS with DM to in internal medicine department in Al-Wahdah teaching hospital. The inclusion criteria of the study were all patients who present with ACS on top of diabetes mellitus and the exclusion criteria those patients who present with DM or its complications without ACS.

Sampling methods

All patients admitted to the internal medicine department in Al- Wahdah teaching hospital, Thamar government from 2020-2021 were enrolled in the study.

Data collection and Tool

Data were collected as from document and records and a faceto- face interview with patients using questionnaire for assessing the prevalence of acute coronary syndrome and associated risk factors among diabetic patients which covered the following: The first section, was related to demographic characteristics. The information included: Age, gender, educational level, and marital status. The second section was the clinical data. Patients’ clinical data was documented on files- focusing on symptoms) chest pain: At rest, on exertion, not present. Dyspnea: at rest, on exertion, not present. Other symptoms as: lower limb edema, palpitation, dizziness) [5].

Cardiopulmonary examination

(Heart sounds: weak, normal, add sounds. Crepitation: no basal, all over). Patients’ investigation was documented on the sheets including laboratory investigations (RBS, HBA1C, Cardiac enzymes, CBC, RFT, LFT, Serum electrolytes and lipid profiles) and radiological tests (ECG and CXR). The data that suggest risk factors such as family history, long duration of DM, smoking, hypertension, and Khat chewing and Shammah [6].

Data analysis

Analysis was performed using statistical package for social science (SPSS). Demographic characteristics and clinical history of the patients were presented in terms of frequency and percentage. Chi-square was used to find out the association between factors and the ACS outcome [7].

Ethical consideration

Approval was obtained before carrying out this study from Al- Wahdah teaching hospital to conduct this study. Oral consent was obtained upon agreeing to participate in the study.

Demographic characteristics

The demographic characteristics of the patients is presented in Table 1. It was found that about 47% of the patients were male. The age group > 60 years was representing 57%, all of them married 100% and 57% were uneducated (Tables 1-8) (Figures 1-3).

Table 1:Demographic characteristics among patients.

Table 2:Prevalence of ACS among diabetic patients.

Table 3:Clinical data of responders.

Table 4:

Table 5:physical examination of patient of ACS with DM on admission.

Table 6:Laboratory Investigations.

Table 7:ECG abnormalities.

Table 8:Pharmacological and non-pharmacological treatments.

Figure 1:Prevalence of ACS among diabetic patients.

Figure 2:Risk factors of ACS among diabetic patients.

Figure 3:ECG abnormalities.

The current study done on 216 hospitalized patients who admitted as case of diabetes mellitus in Al- Wahda teaching hospital in Thamar governorate, Yemen. In our population study, the overall prevalence of ACS among diabetic patients is 24.5% (53). These results agree with some previous studies. In our study, we observed that female patients 28 (53%) were slightly more than male patients 25(47%). 3 (6%) of all patients with ACS are less than the age of 40, whereas 21 (40%) between 40-60, and 30 (57%) are more than the age of 60 years, which indicates that risk of ACS increased significantly above 40 years old, although most patients are above the age of 60.

In the current study, the characteristic chief complaint of patients on presentation. Were dyspnea 40 (75%), chest pain 34(64%), edema 18 (34%), palpitation 12 (23%), epigastric pain and vomiting 8 (15%) which indicates high incidence of atypical manifestations (dyspnea, and edema) of ACS and therefore high incidence of silent ACS in diabetic patients. Analysis of risk factors reveals most patients were hypertensive 35(66%). These results are consistent with previous studies, also many patients had other risk factors as Khat chawing 25(47%), smoking 11(21%), and Shammah 4 (7.5%) which farther aggravates the risk [8-13].

The result of the current study also shows that the prevalence of STEMI 18 (34%), NSTEMI 10 (19 %), and unstable angina 14 (26%). These results are consistent with previous studies, other patients present with AF, LVH, and non-specific ST segment and T wave changes. People need access to learn about their major risk factors to avoid, and the importance of diabetes control as DM plays the most important role. Additionally, the study results could have been affected by unmeasured confounding variable socioeconomic state and post hospital care.

The prevalence of ACS among diabetic patients is estimated to be 24.5%. Most patients with ACS were hypertensive 66% and increased rate if silent ACS. ACS in Yemeni individuals with DM was associated with increase in age and increase in duration of DM. Females were affected more than males.

Keeping chronic diseases under control and avoiding bad habits will affect positively to improve the outcome of DM. Provide access for patients to learn about their disease and possible complications, to work with their doctors achieve better glycemic control. Aggressive treatment of hypertension and hyperlipidemia solely on the basis of diabetes status. and correction of modifiable risk factors. Such as smoking, obesity, Shammah and Khat chowing.

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