Smoking Effect on Ischemic Heart Disease in Young Patients

Background: Smoking predisposes individuals to several atherosclerotic clinical syndromes, including myocardial infarction and other acute coronary syndromes, stable angina and sudden death. Smoking can trigger myocardial infarction in individuals with minimal atherosclerosis or even with normal coronary arteries, especially among the young, promoting temporary coronary vessel occlusion, as a result of thrombus formation, coronary artery spasm or both. This study aims to evaluate the effect of tobacco smoking on the risk of ischemic heart disease (ST elevation myocardial infarction, non ST elevation myocardial infarction, unstable angina, and Prinzmetal's angina) in young adults (<= 45 years). Methods: A retrospective study was conducted over a 2-year Period from January 2008 to March 2010. One hundred and thirty five consecutive cases of acute myocardial infarction (STEMI and NSTEMI), Unstable angina, and Prinzmetal's angina in young patients (<= 45 years) who present to the emergency department (ED) of the Aleppo University Hospital, Aleppo University Heart Hospital, and admitted to the cardiovascular care unit (CCU). Data were compared between smoker patients and non smoker patients. Results: The mean age was 39.7 +/- 3 years (range20-45), 87.60% were males. The major risk factor was tobacco use (78.48%), followed by hypertension (23.70%), dyslipidemia (21.48%), obesity (18.51%), family history of IHD (15.55%), and diabetes mellitus (3.7%). (56.6%) of patients had a smoking as a single risk factor for ischemic heart disease without another risk factors. (59.25%) of patients had STEMI; (22.96%) had NSTEMI; (16.29%) had unstable angina; and (1.48%) had Prinzmetal's angina. (56.89%) of patients had single vessel disease as documented by angiography; (20.68%) had tow-vessel disease, (13.79%) had three-vessel disease; and (8.62%) had normal coronary arteries. Conclusions: The study focuses our attention on the rising incidence of acute MI in young individuals. Smoking was the major risk factor followed by hypertension, dyslipidemia, obesity, family history of IHD, and diabetes mellitus. These observations are important for primary prevention of such diseases in young individuals.