Medical Department- Faculty of medicine-sanaa university Cardiac Center- Al-thawrah Modern General teaching Hospital

Transcription

1 ACS In Yemeni Khat Chewers & Cardiac Bio-markers Trends, Facts From Gulf RACE- I Mohammed Al-Kebsi, MD, PhD, FGHA A-Nasser Munibari MD, FACC & A. Al-Motarreb MD, PhD,FGHA Medical Department- Faculty of medicine-sanaa university Cardiac Center- Al-thawrah Modern General teaching Hospital

2 GHA: GHA was born and it became a landmark accomplishment for the GCC states. Member countries : Bahrain, Kuwait, Qatar, KSA, Oman, UAE & Yemen Aims : The main aim of GHA is to improve the quality of cardiac care in the GCC states through its various activities. Achievements : GHA organizes annual symposium & conferences : e.g. : Doha, Manama, Sanaa and Dubai, Muscat, and Riyadh. GHA develops & update guidelines for the treatment of various CVD: e.g: ACS, STEMI & anticoagulants, HTN, Soon HF. GHA established a peer-reviewed reviewed journal called 'Heart Views' which is published quarterly. GHA organizes teams with expertise to perform invasive cardiac procedures and cardiovascular operations within the GCC countries. GHA and GCC Heart Disease Registry [ (Gulf RACE-I) GulfRACE II- Gulf SAFE]

3 What is Khat

4 What is Khat Khat (Catha edulis) is a large green shrub that grows at high altitudes in the region extending from eastern to southern Africa, as well as on the Arabian peninsula (Yemen). The impact of khat chewing in Yemen is considerable. It is deep-rooted in the Yemenite society where khat is consumed in social gatherings with family and friends while holding conversations, smoking cigarettes and drinking tea and soft drinks.

5 What is Khat About 44 different types of khat exist originating from different geographic areas of the country. Users chew Khat habitually for its euphoric effects and as a recreational drug that also improves performance.

6 What is Khat

7 Integrated into the social life of the societies. It is rapidly distributed around the day

8 Pharmacology Main Constituents: Cathinone and Cathine. Varies from to mg/100g Natural Amphetamine:

9 O CH 3 NH 2 Cathinone OH OH CH 3 CH 3 NH NH 2 H 3 C Ephedrine Norpseudoephedrine (Cathine)

10 Pharmacological effect Central Increases the levels of Dopaminergic and Noradrenergic transmission in the brain Serotonin levels are increased in response to Cathinone administration Uptake-1 inhibition Peripheral indirect sympathomimetic actions The average maximal plasma concentration of Cathinone (Tmax) occurred at 2.3 hours and 2.6 hours for Cathine Toennes, SW et al. (2003) Pharmacokinetics of cathinone, cathine and norephedrine after the chewing of khat leaves. British Journal of Clinical Pharmacology, 56: Kalix, P & Khan, I. (1984) Khat: an amphetamine-like plant material. Bulletin of the World Health Organization, 62,

11 CV Effect of Khat Increases HR and BP. Risk factor for acute MI. Causes coronary vasospasm. Increases active smoking and leads to passive smoking. Sympathomemtic ti action (vasospasm, plat aggregation) Associated with increase risk of stroke in ACS patients (GulfRace I). A Al M t b t l HEART VIEWS VOLUME 5 NO 3 SEPTEMBER NOVEMBER A. Al-Motarreb et al. HEART VIEWS VOLUME 5 NO. 3 SEPTEMBER - NOVEMBER 2004 : J R Soc Med 2006;99: A. Al-Motarreb et al. British Journal of Clinical Pharmacology Zubaid et al. Mayo Clin Proc. 2010;85(11):

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13 This is a prospective registry of all consecutive patients admitted to all general hospitals in participating countries, over a period of six months with the discharge diagnosis of acute coronary syndrome (ACS) including: 1. ST-segment elevation myocardial infarction (STEMI) 2. Non ST-segment elevation myocardial infarction (NSTEMI) 1. Unstable stabe angina a (UA)

14 Diagnosis of the different types of ACS and definitions of data variables were based on the (ACC) clinical data standards, published in These definitions are based on clinical These definitions are based on clinical presentations, (ECG) findings and cardiac biomarkers.

15 Biochemical marker The biomarkers were measured locally at each hospital s laboratory using its own assays and reference ranges. 1. Troponin 001f 0.01 for both sex 2. CK-MB/ CK-MB mass 7-25 for both sex 3. Total CK: Male Female

16 RESULTS

17 KUWAIT % BAHRAIN 230 3% QATAR 359 5% YEMEN UAE % 1054 YEMEN 16% OMAN % 24%

18 1054 Khat Chewer 757 (78%) Non-Khat Chewer 297 (22%) STEMI 551 (73%) NSTEMI 138 (18%) UA 68 (9%) STEMI 201 (68%) NSTEMI 84 (28%) UA 12 (4%)

19 Baseline Characteristics Khat Non-Khat 757 (78%) 297 (22%) P value Mean age (years) 58±11 62±13 <0.001 Sex Male (%) Female (%) Smoker (%) ECG (%) Normal New LBBB Old LBBB ST-Dep STEMI Others 05 09

20 Baseline Characteristics Khat Non-Khat 757 (78%) 297 (22%) P value Mean age (years) 58±11 62±13 <0.001 Sex Male (%) Female (%) Smoker (%) ECG (%) Normal New LBBB Old LBBB ST-Dep STEMI Others 05 09

21 Baseline Characteristics Khat Non-Khat 757 (78%) 297 (22%) P value Mean age (years) 58±11 62±13 <0.001 Sex Male (%) Female (%) Smoker (%) ECG (%) Normal New LBBB Old LBBB ST-Dep STEMI Others 05 09

22 Khat & Biomarkers

23 Cardiac enzymes utilization CKMB CK TREPONIN Done Missed

24 Khat and Biomarkers

25 Khat and Biomarkers TROPONIN 22% KHAT NON 78%

26 Khat and Biomarkers Khat 757 (78%) Non-Khat 297 (22%) P value CK +ve <0.001 CK-MB +ve 836 Troponin +ve <

27 Khat & Mortality

28 Khat & Mortality % % 90.00% 80.00% 70.00% 60.00% Khat 50.00% Non-Khat 40.00% 30.00% 20.00% 00% 10.00% 0.00% DEAD ALIVE Khat 8.20% 91.80% Non-Khat 8% 92% Courtesy of Zubaid, Regional Comparisons: Findings and Implications of Gulf RACE

29 Khat & Morbidity

30 KILLIP Class Khat Non-Khat I II III IV Khat Non-Khat

31 Khat & EF 50.00% 45.00% 40.00% 00% 35.00% 30.00% 25.00% 20.00% Khat Non-Khat 15.00% 10.00% 00% 5.00% 0.00% <35% 35-50% >50% Khat 8.20% 45.90% 45.90% Non-Khat 13% 44% 43%

32 Khat & Stroke NO STROKES STROKE NON KHAT KHAT

33 Hospital stay (day) mean no. of pt khat no no. of pt mean

34 Received Thrombolytic Ttl Total 218 thromblytic khat no thromblytic

35 Door to needle time (min) no. of pt. mean khat no no. of pt mean

36 Arrhythmias Khat Non-Khat Sinus 2/3block AF SVT VT Others Khat Non-Khat

37 Conclusion Khat is a significant socio-economic and health problem in Yemen. Age of presentation ti in Khat chewers was significantly younger in comparison to Non-Khat chewers in ACS. Associated habits like smoking was prevalent among Khat chewers and hence the risk of CAD was much higher.

38 Conclusion Hospital stay was longer among Khat chewers which indicates a big economic burden in the form of the health expenses in the country. Morbidity in the form of HF & stroke were higher among Khat chewers patients with ACS which alter the sequels of the disease.

39 Recommendations Involvement of health authorities in further phases of registry which emphasize an improvement of quality of work. Awareness program about the hazards of Khat chewing in Yemeni people health should be established in all levels of society.

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