Clinical findings and educational status in chest pain patients admitted to an emergency department. Report from a three-month survey at Be'sat hospital, Teheran, Iran.
BACKGROUND
Cardiovascular disease is a major cause of death in Iran. With regard to the socio-economic status, a low educational level is associated with a higher frequency of disease. The aim of this study was to investigate, in a developing country, the influence of educational level and gender on the prevalence of coronary artery disease and cardiovascular risk factors in patients with chest pain at the time of admission and after 3 months of follow-up.


METHODS
We studied 240 consecutive patients (113 males, 127 females, age 16-97 years) who presented with chest pain believed to be of cardiac origin. The patients were admitted to a metropolitan hospital in Teheran from September 8, 2001 to December 8, 2001.


RESULTS
Males were found to have a higher educational level than females (p = 0.0001). Females more frequently had a history of hypertension (44.9 vs 23%, p = 0.0001) and of diabetes mellitus (24.4 vs 11.5%, p = 0.01) and presented with more electrocardiographic abnormalities (37.0 vs 27.4%, p = 0.033) than males. Furthermore, patients with a low educational level were less likely to be on beta-blockers (23.9 vs 53.3%, p = 0.000), nitrates (20.2 vs 42.2%, p = 0.002) and acetylsalicylic acid (22.4 vs 50%, p = 0.000) compared to patients with a high educational level. Males were more often transported by ambulance to the hospital than females (p = 0.001). There was a high prevalence of risk factors for ischemic heart disease (cigarette smoking, diabetes mellitus, hypertension and dyslipidemia) (65% had one or more risk factors) with no relation to educational level.


CONCLUSIONS
We found a high prevalence of risk factors for coronary artery disease in an Iranian population admitted with chest pain. In particular less educated women were at an increased risk and had more electrocardiographic abnormalities. Our findings stress the importance of the socio-economic status in cardiovascular disease and of the need for health promotion and lifestyle changes.
Pahlavan
Payam Samareh
PS
Shaheed Beheshti University of Medical Sciences. payamsp@hotmail.com
Frøbert
Ole
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology* / Q000503:physiopathology; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000503:physiopathology; D004522:Educational Status; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class