Ischaemic heart disease (IHD) is defined as a condition wherein the supply of blood and oxygen to a portion of the myocardium is inadequate; it occurs due to an imbalance between the myocardial oxygen supply and demand[1]. The most common cause of myocardial ischaemia is atherosclerosis of an epicardial coronary artery (or arteries) which can lead to inadequate perfusion of the portion of the myocardium supplied by the involved coronary artery[2].

Coronary Artery Disease in young adults (CADY) is no longer an uncommon entity. Its worldwide distribution is well known and its rising incidence and prevalence is also reflected amongst the patients in India[3-4]. In Global Registry of Acute Coronary Events (GRACE) study, the prevalence of acute coronary syndrome (ACS) in young adults was 6.3%, in Thai ACS Registry it was 5.8% and in Spain Registry, it was 7%.

Similarly, it was seen in the Framingham heart study that the overall incidence of myocardial infarction over a 10 year follow up was 12.9/1000 in men 30-34 years old and 5.2/1000 in women 35-44 years old[5-7].

According to the World Heart Federation, 35% of all cardiovascular deaths in India occur in those aged 35–64 years out of which 90–95% of cases and deaths are due to coronary artery disease. Approximately one-sixth of the world’s population lives in India and CAD remains the highest cause of mortality in India

This prospective study undertaken in the department of Medicine of SAMC & PGI, Indore, In the present study 50 patients of acute myocardial infarction and 50 patients of ischaemic stroke of age 45 years and below admitted for 01 Year were studied with reference to clinical profile, risk factor analysis, serum homocysteine profile and correlation of serum homocysteine levels with the clinical severity of acute myocardial infarction and of ischaemic stroke.

INCLUSION CRITERIA

1. ACUTE MI.
2. Young patients of age 18 to 45 years presenting with definite evidence of acute myocardial infarction.
3. ACUTE ISCHAEMIC STROKE.
4. Young Adults of age 18 to 45 years presenting with acute stroke of ischaemic type.

EXCLUSION CRITERIA

FOR ACUTE MI

1. Age < 18 years or > 45 years.
2. Chronic renal failure.
3. SLE
4. Psoriasis
5. Hypothyroidism
6. Leukemia
7. Patients who had a history of taking methotrexate or vitamin B complex supplements in the last 6 months.

Table No. 1: Age and Sex Distribution of Young AMI

There was 1 (2.0%) patient in the age group 18-25 years, 5 (10.0%) patients were in the age group 26-30 years, 10 (20.0%) patients were in the age group 31-35 years, 26 (52.0%) patients were in the age group 36-40 years and 8 (16.0%) patients were in the age group 41-45 years. Majority of the patients were in the age group 36-40 years.

Table No. 2: Serum Homocysteine profile in vegetarian versus non-vegetarian patients of young MI

The distribution of patients according to serum homocysteine level in relation to their type of diet. In the vegetarian group, 5 (20.8%) patients were having normal serum homocysteine level, 6 (25.0%) patients were having moderately raised serum homocysteine level, 7 (29.2%) patients were having intermediately raised serum homocysteine level and 6 (25.0%) patients were having severely raised serum homocysteine level.

Table No. 3: Homocysteine Profile in our Young Patients of AMI

The distribution of patients according to homocysteine profile, 18 (36.0%) patients were having normal homocysteine level, 10 (20.0%) patients were having mild homocysteine level, 12 (24.0%) patients were having moderate homocysteine level and 10 (20.0%) patients were having severe homocysteine level.Majority of the patients (64%) were having raised serum homocysteine level.

Table No. 4: Conventional Risk Factors in Young Ischaemic Stroke Patients

The distribution of patients according to conventional risk factors in ischaemic stroke. Smoking was seen in 15 (30%), hypertension was seen in 10 (20%), dyslipidaemia was seen in 8 (16.0%) patients, diabetes was seen in 2 (4.0%) patients and positive family history was seen in 2 (4.0%) patients. Smoking, hypertension and dyslipidaemia were the commonest among the conventional risk factors in ischaemic stroke in young patients.

There was 1 (2.0%) patient in the age group 18-25 years, 5 (10.0%) patients were in the age group 26-30 years, 10 (20.0%) patients were in the age group 31-35 years, 26 (52.0%) patients were in the age group 36-40 years and 8 (16.0%) patients were in the age group 41-45 years[8].

Majority of the patients were in the age group 36-40 years. The mean age of the patients with acute MI was found to be 35.00 ± 4.67 years in the study by Shah V et al (2016) consistent with our study. In the present study of 50 young patients of AMI 46 (92%) were male and only 4(8%) were female. In the vegetarian group, 5 (20.8%) patients were having normal serum homocysteine level, 6 (25.0%) patients were having moderately raised serum homocysteine level, 7 (29.2%) patients were having intermediately raised serum homocysteine level and 6 (25.0%) patients were having severely raised serum homocysteine level[9].

In the non-vegetarian group, 13 (30.0%) patients were having normal serum homocysteine level, 4 (15.4%) patients were having moderately raised serum homocysteine level, 5 (19.2%) patients were having intermediately raised serum homocysteine level and 4 (15.4%) patients were having severely raised serum homocysteine level. Thus, the homocysteine profile was comparable in vegetarians and non-vegetarians[10].

This is in accordance with the literature according to which, in diet homocysteine is present in only trace amount; dietary intake does not affect the plasma homocysteine levels. Smoking was seen in 16 (32%) patients, hypertension was seen in 11 (22%) patients, positive family history was seen in 6 (12%) patients, diabetes was seen in 4 (8.0%) patients and dyslipidaemia was seen in 3 (6.0%) patients.

Smoking, hypertension and positive family history were the commonest conventional risk factors for AMI in young patients in our study.

In the study by Shah et al[11] smoking was found to be the most common risk factor for MI (35, 32.71%) in the young adults; diabetes mellitus being the second common risk factor (22, 20.56%). In one study by SK Sinha et all, 20.5% of the patients had hypertension while the South Asian cohort of INTERHEART study had 31.1% patients of hypertension as population subgroups were different[12].

Majority of the young patients of acute myocardial infarction (AMI) in our study were in the age group 36-40 years. AMI in young patients is seen predominantly in males (92%). Serum homocysteine level was comparable in the vegetarian and non-vegetarian patients of AMI. Serum homocysteine level was comparable in the vegetarian and non-vegetarian patients of AMI.

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