Autopsy-based morphometric study of coronary atherosclerosis in young adults

Abstract

Background & objectives: The burden of cardiovascular diseases is high in Kerala, India, and a considerable proportion of these occur in young people. The objective of this study was to estimate the severity of atherosclerosis in autopsies done for accidental and suicidal deaths in victims below 40 yr of age. Methods: Coronary arteries from 77 autopsies done for unnatural deaths in a population below 40 yr were graded, and the degree of stenosis, intimal thickness index (ITI) and the intima-media ratio (IMR) were measured. Results: There were 65 males and 12 females in the sample. The American Heart Association (AHA) type 3-6 (pathological intimal thickening) was seen in 55.4 per cent [95% confidence interval (CI): 42.5-67.7%] of males and 25 per cent (95% CI: 5.5-57.2%) of females and advanced lesions (type 4-6) in 44.6 per cent (95% CI: 32.3-57.5%) of males and 8.3 per cent (95% CI: 0.2-38.5%) of females. Types 5 or 6 lesions were seen in 32.2 per cent (95% CI: 21.2-45.1%) of males. The mean stenosis was 57.3 per cent in males and 40.6 per cent in females. More than 40 per cent stenosis was seen in 76.6 per cent cases, more than 50 per cent in 54.5 per cent cases and more than 75 per cent stenosis in 14.3 per of the sample. The mean ITI (MIT) was 1.85 and the mean IMR was 4.11. The degree of stenosis, MIT and IMR were significantly associated with male sex, overweight and smoking. Interpretation & conclusions: Morphometric data showed that the degree of atherosclerotic narrowing of coronary arteries in young non-diseased population was high. It portends a danger to the community unless preventive measures are taken up.

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“…This accumulation makes endothelial injury release macrophage and proinflammatory reagents from plaque 18 . Inflammatory markers such as IL6, TNFα, monocytes, leukocytes, macrophages, small thrombus, fibrinogen and clotting factors are released after the bursting of plaque 19 .…”

Karakteristik Klinikopatologik Aterosklerosis Koroner Dan Morfologi Miokardium Kasus Otopsi Di Rsup Prof. Dr. I.G.N.G. Ngoerah Tahun 2017 – 2021

“…di Kerala, India dengan subjek penelitian akibat kecelakaan atau bunuh diri <40 tahun dimana ditemukan kasus terbesar yaitu pada level sumbatan >40% sebesar 76,6%, diikuti sumbatan >50% sebesar 54,5%, dan terakhir sumbatan >75% sebesar 14,3%. 18 Adapun hasil penelitian ini berbeda dengan penelitian di Klang Valley, Malaysia yang menunjukkan bahwa sebesar 73% dari total subjek tidak ada sumbatan arteri koroner dan 5,4% mengalami critical stenosis. Hal ini karena subjek penelitian di Klang Valley, Malaysia mayoritas adalah korban kecelakaan lalu lintas.…”

“…mengenai studi otopsi perubahan histopatologi jantung ditemukan bahwa sebesar 53 kasus normal, 10 kasus hipertrofi, 43 kasus infark akut, dan 40 kasus infark lama. 18 Penelitian lainnya yang dilakukan di Shaheed Hasan Khan Govt Medical College, India menunjukkan bahwa dari 141 kasus ditemukan hipertrofi sebanyak 10 kasus, infark baru sebanyak 6 kasus, dan infark lama sebanyak 14 kasus. 26 Adapun penelitian oleh Vyass dkk.…”