• Lubna Noor
  • Yasir Adnan
  • Sher Bahadar Khan
  • Hafiz ur Rehman
  • Farooq Ahmad
  • Mohammad Hafizullah


Background: Once considered as disease of the affluent and developed countries, coronary arterydisease is emerging as epidemic in the developing world in general and South Asia in particular.Objective: To observe the trend of presentation of acute coronary syndrome in the local populationover the last 16 years. Material and Methods: Clinical audit from 1995 to 2010 was carried out inwhich the data was retrieved from the computerised database of the Department of Cardiology, LadyReading Hospital Peshawar. The period was divided into four quartiles, and the data of each quartilewas analyzed for the total number of admissions, the type of ACS, whether ST-elevated MI or non-STelevated ACS (comprising unstable angina and non-STEMI), age, gender and mortality. Results: Thetotal admissions into the unit in the first quartile (1995–1998) were 23,827, in the second quartile(1999–2002) 29,005, in the third quartile (2003–2006) 33,206 and in the fourth quartile (2007–2010)were 40,110. Total ACS brunt constituted 8340 (35%), 10,384 (35.8%), 12,180 (36.68%) and 14,920(37.2%) patients respectively. The mean age of patients was 49.70±6.4 years, 48.21±7.2 years,47.38±7.1 years and 46.81±6.2 years respectively. Women were 2356 (28.25% of the total ACSburden) in the first quartile, increasing to 3554 (34.225%), 4817 (39.55%) and 6281 (42.1%) in thefollowing quartiles. STEMI constituted 45.88% (3826) of the total ACS presentations in the firstquartile, 47.24% (4905) in the second, 49.55% (6035) in the third and 49.87% (7440) in the lastquartile. The mortality rate, however, remained constant throughout (8.4% to 8.8%). Conclusion: Anincreasing trend is seen in the burden of CAD in the local population with increasing presentation asSTEMI. It is also evident that CAD is occurring at younger ages and more so in the female population.Keywords: Coronary artery disease, myocardial infarction, unstable angina


Lopez AD. Assessing the burden of mortality from

cardiovascular disease. World Health Stat Q 1993;46:91–6.

J Ayub Med Coll Abbottabad 2011;23(2) 139

Murray CJL, Lopez AD. Global Comparative Assessments in the

Health Sector. Geneva, Switzerland: World Health Organization;

Nishtar S. Coronary artery disease burden in Pakistan -A review.

J Pak Inst Med Sci 2001;8(12):592–4.

Whelton PK, Brancati FL, Appel LJ, Klag MJ. The challenge of

hypertension and atherosclerotic cardiovascular disease in

economically developing countries. High Blood Press


Lopez AD, Mathers CD, Ezzati M. Global and regional burden

of disease and risk factors, 2001: systematic analysis of

population health data. Lancet 2006;367:1747–57.

Gupta M, Singh N, Verma S. South Asians and cardiovascular

risk: what clinicians should know? Circulation 2006;113:924–9.

Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al.

Risk factors for early myocardial infarction in South Asians

compared with individuals in other countries. JAMA


Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of

diseases, part 1: general considerations, the epidemiologic

transition, risk factors and impact of urbanization. Circulation


Reddy KS. Cardiovascular diseases in non-Western countries. N

Engl J Med 2004;350:2438–40.

Noor L, Shah SS, Adnan Y, Sawar S, Din SU, Amina, et al.

Pattern of coronary artery disease with no risk factors under age

years. JAMC 2010;22(4):115–9.

Anand SS, Yusuf S, Vuksan V. Differences in risk factors,

atherosclerosis, and cardiovascular disease between ethnic groups

in Canada: the Study of Health Assessment and Risk in Ethnic

groups (SHARE). Lancet 2000;356:279–84.

Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of

cardiovascular diseases, part II: variations in cardiovascular

diseases by specific ethnic groups and geographic and prevention

strategies. Circulation 2001;104:2855–64.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et

al. INTERHEART Study Investigators. Effect of potentially

modifiable risk factors associated with myocardial infarction in

countries (the INTERHEART Study): case-control study.

Lancet 2004;364:937–52.

Jafar TH, Levey AS, Jafary FH, White F, Asma G, Rahbar MH,

et al. Ethnic subgroup differences in hypertension in Pakistan. J

Hypertens 2003;21:905–12.

Ismail J, Jafar TH, Jafary FH, White F, Faruqui AM, Chatuurvedi

N. Risk factors for non-fatal myocardial infarction in young

South Asian adults. Heart 2004;90:259–63.

Jafar TH, Jafary FH, Jessani S, Chaturvedi N. Heart disease

epidemic in Pakistan: Women and men at equal risk. Am Heart J


McKeigue PM, Miller GJ, Maromot MG. Coronary heart disease

in South Asians overseas: a review. J Clin Epidemiol

;42:597– 609.

Harding S. Mortality of migrants from the Indian subcontinent to

England and Wales: effect of duration of residence.

Epidemiology 2003;14:287–92.

Pirzada. MA, Khan AH. Coronary Heart Disease in West

Pakistan. Pak J Med Res 1962;2:9–37.

Beg MA, Siddique MKJ, Abbasi AS, Ahmad N. Atherosclerosis

in Karachi. J Pak Med Assoc 1967;17:236–40.

Khan NA. Epidemiology of coronary heart disease in Peshawar.

Pakistan Heart J 1973;6:64–7.

Patil SS, Joshi R, Gupta. Risk factors for acute myocardial

infarction in a rural population of central India: a hospital-based

case-control study. Natl Med J India 2004;17:189–94.

Schreiner PJ, Niemela M,. Miettinen H, Mahonen M., Ketonen

M.,.Mmonen P, et al; Gender differences in recurrent coronary

events; The FINMONICA MI Registers. Eur Heart J


Shah SS, Noor L, Shah SH, Shahsawar, Din SU, Awan ZA, et al.

Myocardial infarction in young versus older adults: clinical

characteristics and angiographic features. J Ayub Med Col


Khan MA, Hassan MU, Hafizullah M. Coronary artery disease,

is it more frequently effecting younger age group and women?

Pak Heart J 2006;39(1-2):17–21.

Palaniappan L, Wang Y, Fortmann SP. Coronary heart disease

mortality for six ethnic groups in California, 1990–2000. Ann

Epidemiol 2004;14:499 –506.

Rogers WJ, Canto JG, Lambrew CT. Temporal trends in the

treatment of 1.5 million patients with myocardial infarction in the

US from 1990 through 1999: The National Registry of

Myocardial Infarction1, 2 and 3. J Am Coll Cardiol


Kesteloot H, Sans S, Kromhout D. Evolution of all-causes and

cardiovascular mortality in the age-group 75-84 years in Europe

during the period 1970-1996: A comparison with worldwide

changes. Eur Heart J 2002;23:384–9.

Marrugat J, Garcia M, Elosua R, Aldasoro E, Omro MJ, Zurriaga

O et al. Short-term (28 days) prognosis between genders

according to the type of coronary event (Q-wave versus non-Qwave acute myocardial infarction versus unstable Angina

pectoris). Am J Cardiol 2004;94:1161–5.

Aziz K, Azhar Masood AF, Manoli T, Davis CE, Abenathy J.

Blood Pressure and Hypertension Distribution in a lower middle

Class of urban community in Pakistan. J Pak Med Assoc




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