Study of atherosclerotic coronary artery disease in young adults- an autopsy based prospective study

Abstract

Cardiovascular disease is now the most common cause of death worldwide. The sudden death in apparently healthy young individuals is always a devastating and shocking event. According to WHO, Ischemic Heart Disease is our modern epidemic. The occurrence of Ischemic Heart Disease in developing countries is a decade earlier compared with the age incidence in developed countries. Now because of change in lifestyle and habits, atherosclerotic coronary artery disease is noticed in comparatively younger age group even in a developing country like India. Bangalore is an IT hub. Many IT Professionals are working in this city. We have noticed atherosclerotic coronary artery disease, occurring in young IT professionals because of their sedentary lifestyles, smoking and drinking (alcohol) habits. Hence an autopsy based prospective study was conducted at the department of Forensic Medicine, Victoria Hospital, Bangalore Medical College & Research Institute, Bangalore, over a period of 18 months from November 2013 to May 2015, in young adults aged between 18 to 40 years dying due to various reasons like road traffic accidents, poisoning, burns, hanging, sudden natural deaths, assaults, electrocution, snake bite etc, and autopsy findings of total 200 cases subjected for medicolegal autopsy were studied, to know the incidence and study the pattern of underlying atherosclerotic coronary artery disease so that we can counsel the close family members of the deceased to go through essential investigations and take preventive measures. In this way we can protect the close family members of the deceased from fatal inheritable atherosclerotic coronary artery disease in future. Out of 200 cases, majority of cases 143 (71.5%) cases showed underlying Atherosclerotic Coronary Artery Disease which also included fixed coronary obstruction, thrombus, recent and healed Myocardial Infarction. Out of that, 117 (81.8%) were males and 26 (18.2%) were females. Out of total 143 cases of atherosclerotic coronary artery disease 27 (18.9%) cases were associated with myocardial infarction (Ischemic Heart Disease). Among that 26 (96.3%) were males and 1 (3.7%) was female. Out of total 27 myocardial infarction (Ischemic Heart Disease) cases, 15 (55.5%) cases showed recent (fresh) infarct in the myocardium. Overall Grade 2 AHA grade of atherosclerosis was found in majority of cases 46 (32.2%), in both the sexes. Majority of cases 14 (40%) in 18-25 years age group and 23 (38.3%) cases in 26-33 years age group showed Grade 2 atherosclerosis followed by Grade 3. While in 34-40 years age group majority 15 (31.2%) of cases showed Grade 4 atherosclerosis followed by Grade 5. Majority of cases 123 (86%) showed atherosclerosis in Left main coronary artery but in 55 (44.7%) cases the lumen was normal while 35 (28.5%) cases showed less than 25% lumen narrowing. Whereas 117 (81.8%) cases showed atherosclerosis in Left anterior descending artery. Out of that 34 (29.1%) cases showed more than 75% narrowing of the lumen. Most 66 (46.2%) of the cases showed atherosclerosis in all four major coronary vessels. Out of total 143 atherosclerotic coronary artery disease cases coronary thrombus was found in 23 (16.1%) cases, calcification in 3 (2.1%) cases and cardiac rupture in 1 (0.7%) case. Atherosclerotic coronary artery disease was the most frequently encountered underlying cardiac pathology even in young adults in a country like India. It is very significant and is a matter of concern.