title: Acute coronary syndrome and khat herbal amphetamine use: an observational report.
abstract: BACKGROUND
  The khat plant is a stimulant similar to amphetamine and is thought to induce coronary artery spasm. Khat is widely chewed by individuals originating from the Horn of Africa and the Arabian Peninsula. The aim of this study was to evaluate the clinical characteristics and outcome of khat chewers presenting with acute coronary syndrome.
  
  
  RESULTS
  From October 1, 2008, through June, 30, 2009, 7399 consecutive patients with acute coronary syndrome were enrolled in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Nineteen percent of patients were khat chewers; 81% were not. Khat chewers were older, more often male, and less likely to have cardiovascular risk factors. Khat chewers were less likely to have a history of coronary artery disease and more likely to present late and to have higher heart rate and advanced Killip class on admission. Khat chewers were more likely to present with ST-segment-elevation myocardial infarction. Overall, khat chewers had higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non-khat chewers. After adjustment for baseline variability, khat chewing was found to be an independent risk factor of death and for recurrent ischemia, heart failure, and stroke.
  
  
  CONCLUSIONS
  Our data confirm earlier observations of worse in-hospital outcome among acute coronary syndrome patients who chew khat. This worse outcome persists up to 1 year from the index event. This observational report underscores the importance of improving education concerning the cardiovascular risks of khat chewing.
authors.affiliation: Department of Cardiology, Hamad Medical Corp, Qatar.
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Ali
authors.forename: K F
authors.initials: KF
authors.lastname: Al Habib
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Motarreb
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hersi
authors.forename: Hussam
authors.initials: H
authors.lastname: Al Faleh
authors.forename: Nidal
authors.initials: N
authors.lastname: Asaad
authors.forename: Shukri
authors.initials: S
authors.lastname: Al Saif
authors.forename: Wael
authors.initials: W
authors.lastname: Almahmeed
authors.forename: Kadhim
authors.initials: K
authors.lastname: Sulaiman
authors.forename: Haitham
authors.initials: H
authors.lastname: Amin
authors.forename: Jawad
authors.initials: J
authors.lastname: Al-Lawati
authors.forename: Nizar
authors.initials: N
authors.lastname: Al Bustani
authors.forename: Norah Q
authors.initials: NQ
authors.lastname: Al-Sagheer
authors.forename: Awad
authors.initials: A
authors.lastname: Al-Qahtani
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality*; D000328:Adult; D000368:Aged; D000661:Amphetamine / Q000009:adverse effects*; D029754:Catha / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000401:mortality; D028321:Plant Preparations / Q000009:adverse effects*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D015996:Survival Rate
chemical_list: D028321:Plant Preparations; D000661:Amphetamine