title: Risk factors and in-hospital outcome of acute ST segment elevation myocardial infarction in young Bangladeshi adults.
abstract: BACKGROUND
  South Asians have a higher overall incidence rate and younger age of onset for acute myocardial infarction (AMI) compared to Western populations. However, limited information is available on the association of preventable risk factors and outcomes of AMI among young individuals in Bangladesh. The aim of this study was to determine the risk factors and in-hospital outcome of AMI among young (age ≤40 years) adults in Bangladesh.
  
  
  METHODS
  We conducted a prospective observational study among consecutive 50 patients aged ≤40 years and 50 patients aged >40 years with acute ST Segment Elevation Myocardial Infarction (STEMI) and followed-up in-hospital at the National Institute of Cardiovascular Diseases (NICVD). Clinical characteristics, biochemical findings, diet, echocardiography and in-hospital outcomes were compared between the two groups. Multivariate logistic regression was performed to assess the association between risk factors and in-hospital outcome in young patients adjusting for other confounding variables.
  
  
  RESULTS
  The mean age of the young and older patient groups was 36.5 ± 4.6 years and 57.0 ± 9.1 years respectively. Male sex (OR 3.4, 95 % CI 1.2 - 9.75), smoking (OR 2.4, 95 % CI 1.04 - 5,62), family history of MI (OR 2.4, 95 % CI 1.11 - 5,54), homocysteine (OR 1.2, 95 % CI 1.08 - 1.36), eating rice ≥2 times daily (OR 3.5, 95 % CI 1.15 - 10.6) and eating beef (OR 4.5, 95 % CI 1.83 - 11.3) were significantly associated with the risk of AMI in the young group compared to older group. In multivariate analysis, older patients had significantly greater chance of developing heart failure (OR 7.5, 95 % CI 1.51 to 37.31), re-infarction (OR 7.0, 95 % CI 1.08 - 45.72), arrhythmia (OR 15.3, 95 % CI 2.69 - 87.77) and cardiogenic shock (OR 69.0, 95 % CI 5.81 - 85.52) than the younger group.
  
  
  CONCLUSIONS
  Younger AMI patients have a different risk profile and better in-hospital outcomes compared to the older patients. Control of preventable risk factors such as smoking, unhealthy diet, obesity and dyslipidemia should be reinforced at an early age in Bangladesh.
authors.affiliation: National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. azizulkarim74@yahoo.com.
authors.forename: Mohammad Azizul
authors.initials: MA
authors.lastname: Karim
authors.affiliation: National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. m.abdullaalshafi@yahoo.com.
authors.forename: Abdullah Al Shafi
authors.initials: AA
authors.lastname: Majumder
authors.affiliation: National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. qislam@gmail.com.
authors.forename: Khandaker Qamrul
authors.initials: KQ
authors.lastname: Islam
authors.affiliation: Rangpur Medical College, Rangpur, Bangladesh. Mbadrulalam@yahoo.com.
authors.forename: Muhammad Badrul
authors.initials: MB
authors.lastname: Alam
authors.affiliation: Central Medical College, Comilla, Bangladesh. drmpaul@gmail.com.
authors.forename: Makhan Lal
authors.initials: ML
authors.lastname: Paul
authors.affiliation: Trishal Health Complex, Mymensingh, Bangladesh. Shafiqcard@yahoo.com.
authors.forename: Mohammad Shafiqul
authors.initials: MS
authors.lastname: Islam
authors.affiliation: Department of Epidemiology, National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh. kamrun.nccrfhd@yahoo.com.
authors.forename: Kamrun N
authors.initials: KN
authors.lastname: Chowdhury
authors.affiliation: International Center for Diarrhoeal Disease Research, Bangladesh, Center for Control of Chronic Diseases, Dhaka, Bangladesh. shariful.islam@icddrb.org.|Center for International Health, University of Munich, Munich, Germany. shariful.islam@icddrb.org.|Cardiovascular Division, The George Institute for Global Health, Sydney, Australia. shariful.islam@icddrb.org.
authors.forename: Sheikh Mohammed Shariful
authors.initials: SM
authors.lastname: Islam
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D004562:Electrocardiography; D005247:Feeding Behavior; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography