EPIDEMIC OF CAD IN YOUNG INDIANS : THE ACCELERATED ATHEROSCLEROTIC INSULIN RESISTANCE SYNDROME (AAIRS)

Abstract

Introduction: CAD is the leading cause of mortality in India. It affects Indians atleast a decade early compared to the western population. Other than the conventional risk factors, the prevalence of other risk factors like hyperhomocystenemia, lipoprotein(a), metabolic syndrome, insulin resistance and fatty liver was studied in a large registry of documented CAD in patients. To study the prevalence of insulin resi Objectives: stance syndrome and its association with NAFLD, lipoprotein (a) and homocysteine levels in young Indian patients who present with coronary artery disease It is a single centre prospective sub study of the PCAD . Materials and Methods: (Premature coronary artery disease) registry cohort at Jayadeva Institute. : 344 patients and Results 300 controls were studied. The mean age was 32 years. There were 45 females and 299 males in cases, 99 females and 201 males in control group. Smoking was seen in 138 cases compared to 16 controls which was disproportionately high in the cases group. 8% of cases had diabetes whereas only 1.6% of controls had diabetes. 10% of cases had positive family history of CAD compared to 0 in control group. 68% of cases had metabolic syndrome whereas 36% of controls had metabolic syndrome. Elevated serum homocysteine levels were seen in 49 when compared to 46 controls which was statistically signicant. (p <0.001). Homocysteine level more than 15 was seen in 68% of cases compared to 45% in controls which was statistically signicant.Serum lipoprotein a levels was signicantly higher in cases (mean of 52) compared to controls (mean of 26). Lp(a) level more than 30 was seen in 51% of cases compared to 27% of controls. HOMA IR was signicantly high in the cases group when compared to controls which was statistically signicant. Fatty liver grade 0 was seen in 25% of cases compared to 58% in controls. Fatty liver grade 1 was seen in 59% of cases compared to 37% in controls. Fatty liver grade 2 was seen in 15% of cases compared to 3.7% in controls, all were statistically signicant. Novel syndrome of AAIRS Conclusion: incorporating insulin resistance, NAFLD, Lipoprotein a and homocysteine was found to be statistically different between cases and controls. Hence, this can be used to predict the risk of premature coronary disease in young Indians To Aims: formulate a novel clinical syndrome titled Accelerated Atherosclerosis Insulin Resistance Syndrome (AAIRS) which will help to predict the risk of premature coronary heart disease in young Indians To study the prevalence of i Objectives: nsulin resistance syndrome and its association with NAFLD, lipoprotein (a) and homocysteine levels in young Indian patients who present with coronary artery disease