Demographics and Coronary Angiographic Patterns in Young Adults in a Sub-Saharan Referral Hospital

Demographics and Coronary Angiographic Patterns in Young Adults in a Sub-Saharan Referral Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Demographics and Coronary Angiographic Patterns in Young Adults in a Sub-Saharan Referral Hospital Ishak Ahmed Abdi, Can Baba Arin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5437995/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The objective of this study was to determine the demographic and Coronary Angiographic trends in young adults diagnosed significant coronary artery disease (CAD) at a referral hospital, Somalia. We performed a retrospective cross-sectional study in 81 patients who were 40 years of age or younger and underwent coronary angiography from October 2022 to October 2024. Results: The analysis showed a majority of male patients (74%) with an average age at 33.6 years. Nearly two thirds of patients (67.1%) had a history of smoking and more than half used Khat (55.6%); No risk factors were identified in 12.5% of the patients. Additionally, other notable risk factors included hypertension (27.2%), diabetes (13.6%), and Dyslipidemia (12.3%), indicating a multifactorial etiology of CAD in this population. The most frequent clinical presentation was ST-segment elevated myocardial infarction (STEMI) observed in 61% of the patients, with single-vessel disease being more common and almost two thirds involving left anterior artery (LAD). Smoking duration was significantly correlated with vessel involvement (r = 0.265, p = 0.017) and khat use showed an independent association to number of affected vessels (p = 0.044). Conclusion — these findings confirm the increasing burden of CAD among young people in sub-Saharan Africa and support a public health approach to preventive measures. Coronary Artery Disease AngiographicPatterns YoungAdults Sub-Saharan Africa Figures Figure 1 Figure 2 Introduction Cardiovascular disease (CVD) has become a serious public health concern in Africa, with substantial implications for healthcare systems and individual health ( 1 ).Over a million deaths in sub-Saharan Africa were linked to cardiovascular disease (CVD) in 2019, accounting for 5.4% of all deaths worldwide and 13% of all deaths in the continent ( 2 ). Over the past few decades, there has been a noticeable shift in the epidemiology of CVD in Africa, which is indicative of a shift away from infectious diseases and toward a greater burden of non-communicable diseases, including CVD. Aging populations, changes in lifestyle, and urbanization all contributed to this transition. Changes in sedentary behavior, higher stress levels, and dietary choices brought about by rapid urbanization all contribute to the rising prevalence of CVD ( 3 , 4 ). Somalia had some of the highest rates of coronary heart disease-related deaths among middle-aged males worldwide in the 1960s. The middle-aged male death rate fell by almost 25% of its highest level starting in 2000. In 2016, it was estimated that over 12,000 Somalis will die from coronary heart disease annually ( 5 ). The onset of coronary artery disease (CAD) before the age of 40 is known as premature CAD ( 6 , 7 ). The African cases' initial myocardial infarction presentation age on average is 54 years old ( 8 ). Young individuals are being diagnosed with acute myocardial infarction (AMI) more frequently these days. This condition may be linked to a higher risk of developing heart problems, including work-related stress, bad eating habits, sedentary lifestyles, obesity, smoking, and addictions. The fact that acute myocardial infarction (AMI) incidence and death have decreased in several nations over the past few decades is noteworthy; however, this trend has not been seen in young people, since there has been an increase in incidence in this age range ( 9 ). In light of this, we will conduct a study to evaluate the risk factors and demographic and angiographic profile of significant CAD in younger patients undergoing evaluation for acute coronary syndrome (ACS) or chronic stable angina in sub-Saharan country. Materials and Methods This was retrospective cross-sectional, record based study done in largest tertiary care hospital, a Turkish based hospital in Somalia. In a 2 year 756 patients underwent coronary angiography. The study population consisted of 81 patients aged 40 years or less, who underwent coronary angiogram between October 2022 to October 2024. Demographic data e.g. age; gender, risk factors as well as coronary angiography results were recorded on the proforma. Patients with concomitant severe valvular heart disease or cardiomyopathy were excluded. Severe renal impairment and hepatic impairment were also excluded. Those aged above 40 years were excluded from the study. The research protocol was approved by the Ethics Committee of Mogadishu Somali Türkiye Training and Research Hospital with the reference (MSTH/19892) and the study complied with the ethical guidelines outlined in the Declaration of Helsinki. All data fully anonymized to ensure patient confidentiality and compliance with ethical standards. No identifiable information was used at any stage of the research process. Diagnostic CAG was performed by interventional cardiologists through radial or femoral route. A detailed analysis of angiographic images was interpreted by the operator. Elective coronary angiography in multiple (≥ 2) views was performed by standard technique to define both the extent and severity of disease. Significant CAD was defined as at least 70% reduction in the diameter of major epicardial coronary arteries i.e. left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) and their branches; or at least 50% luminal narrowing of the left main coronary artery (LMCA). Patients were classified as having single-vessel disease (SVD), double-vessel disease (DVD) or triple vessel disease (TVD) accordingly. Data were processed by SPSS 27.0. For categorical variables, data was described as frequency or percentage. For continuous variables, if they conform to normal distribution, data was presented as mean ± standard deviation, otherwise, data was presented as quartiles [median (quartile 25, 75%)]. If continuous data satisfied normality, comparison between two groups or among multiple groups was analyzed by t -test, otherwise, non-parametric test was used. Fisher’s exact or Chi-square test was used for comparison of categorical variables. Confidence intervals were given at the 95% level (95% CI) and p < 0.05 was taken to indicate statistical significance. Results In this study examined the results of CAD from 81 young patients with coronary artery disease. Most of them were men 60 (74%) with women 21 (26%) (Table 1 ) and the mean age was 33.6 ± 5.3 years. The data revealed that smoking was most prevalent risk factor for 55 patients (67. 1%) Followed by Khat use, in 45 patients (55.5%). Dyslipidemia in 10 patients (12.4%). Surprisingly enough, 10 people (12.5%) did not display any risk factors. refer to (Table 1 ). Table 1: Baseline characteristics of the study group According to the clinical presentation, the majority had ST segment elevated infarction (STEMI) accounting for 61%. Others arrived with ST segment elevated myocardial infarction (16%) unstable angina (around 74%) or chronic stable angina (nearly 15%) as shown in Fig. 1. Among the patients studied in this research, single vessel disease was found to be the most affected with 54 patients (66.67%]. It was observed that the left anterior descending (LAD) artery was the most impacted artery in 50. 5% of instances [see Fig. 2& Table 2]. LAD : Left anterior Descending, LCX : Left circumflex, RCA : right coronary artery. Smoking and sex were found to have a statistically significant association with coronary artery disease in young patients (χ² = 44.33, p < 0.001). There is also significant association between Khat chewing and the number of affected coronary vessels, supported by the Fisher-Freeman-Halton Exact Test (p-value = 0.044) and the likelihood ratio (p-value = 0.043). Conversely, no significant relationship was observed between other traditional risk factors and the number of affected vessels checks (Table 3). Table 3 Statistical interpretation Risk factor Related to Test statistic p-value Khat Chewing Number of Affected Vessels Fisher-Freeman-Halton Exact Test - 0.044 Smoking & Sex Coronary Artery Disease (in young patients) Chi-Square χ² = 44.33 < 0.001 Khat Chewing Number of Affected Vessels Likelihood Ratio χ² = 14.49 0.043 Other Risk Factors Number of Affected Vessels (Not Significant) - - Discussion The characteristics of angiographic morphologic features in young patients in Africa are not well documented in the literature. This is one of the few data that are now available for further research on coronary artery disease in young individuals in Sub-Saharan Africa. This cross-sectional, retrospective observational study assessed coronary artery disease in adults under 40 years of age. We analyzed the results of 81 scenarios' coronary angiography. Of the 81 cases who were taken into the study, 21 (26%) were female and 60 (74%) were male. Candidates under 40 had a mean age (SD) of 33.6 years. The mean age was 36 years for Tricot ( 10 ) and 35.4 years for Dolder [11]. However, a 14-year-old was the youngest in India to be diagnosed with acute coronary syndrome ( 12 ). In our analysis, smoking was the most significant risk factor for coronary artery disease (67.9%). In line with our research, a sample of 21 young people with acute coronary syndrome from Sub-Saharan Africa revealed that 54% had a smoking risk factor ( 10 ). This highlights how smoking tobacco is a significant risk factor for coronary artery disease in young individuals in Sub-Saharan Africa. In fact, the majority of researches on the incidence of coronary syndrome among young people show that smoking repeatedly is the primary cause of the disease ( 13 , 14 ). Most of the studies, younger people with coronary artery disease are more likely to have normal coronary arteries with only mild narrowing ( 15 , 16 ). Our study’s results show a higher incidence of angiographically significant coronary artery disease, which is in contrast to what has been published generally. This study's scope went beyond only elucidating the distinction. The higher frequency of severe coronary artery disease in our study may be explained by the prevalence of tobacco and chat smoking in this cohort, but more research revealing specifics and associations should be pursued. This increased significant incidence is consistent with a Kenyan study ( 17 ). Our study's angiographic results, which show an inclination for Left Anterior Descending Artery ( 18 , 19 ) and a preponderance of single vessel disease, accord with earlier studies ( 20 , 21 ). This study highlights the rising incidence of acute coronary syndrome (ACS) among young adults in Somalia, a sub-Saharan country, emphasizing the need for urgent action from healthcare professionals and policymakers. Future research should focus on mortality rates associated with ACS in this demographic, as understanding these factors is crucial for developing effective interventions to reduce mortality and improve health outcomes. Study limitations Concerning the limitations, there are some. The limitation of that study is the small number (n = 81) and single-center design. Its retrospective nature opens questions of potential incomplete data, lifestyle factors and medication non-adherence. Insufficient follow-up data limit observations on longer-term outcomes, and a focus only from young adults could fail to capture differences in coronary artery disease (CAD) related to age. Moreover, given that risk factor analysis provides no information on the intensity and duration of such exposures or socioeconomic factors which can be associated with CAD occurrence. Thirdly, the issue of confounding factors such as medication history and other comorbidities is not adequately taken into account that may in turn affect its final results. Additional, better studies are required to answer these limitations and improve the resolution of CAD in young adults. Conclusion The rising incidence of coronary artery disease in young adults is thought to be caused by rapid changes in lifestyle, unhealthy habits like smoking, chat chewing, etc., as well as a larger prevalence of diabetes and hypertension. Overall, young patients with severe CAD had the highest prevalence of SVD. The most often affected coronary arteries are the LAD, RCA, and LCX. At the conclusion of this study, we suggest early risk stratification, disease identification, and management to prevent fatal outcomes in many cases, even though extensive survey and clinical research should be carried out to ascertain the various aspects of CAD in Somalia for primary and secondary prevention strategies of CAD in young people. Declarations Clinical Trial Number : Not applicable. The study is not associated with a registered clinical trial. Ethics approval and consent to participate The research protocol was approved by the Ethics Committee of Mogadishu Somali Türkiye Training and Research Hospital with the reference (MSTH/19892) and the study complied with the ethical guidelines outlined in the Declaration of Helsinki. consent was waived for the retrospective analysis. Consent for publication The study is retrospective in nature and involves anonymized data. Availability of data and material The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Funding No funding was received for this study. Competing interests The authors declare that they have no competing interests. References Bulto LN, Hendriks JM. The burden of cardiovascular disease in Africa: prevention challenges and opportunities for mitigation. Eur J Cardiovasc Nurs. 2024;23(6):e88–90. Keates AK, Mocumbi AO, Ntsekhe M, Sliwa K, Stewart S. Cardiovascular disease in Africa: epidemiological profile and challenges. Nat Reviews Cardiol. 2017;14(5):273–93. Yuyun MF, Sliwa K, Kengne AP, Mocumbi AO, Bukhman G. Cardiovascular diseases in sub-Saharan Africa compared to high-income countries: an epidemiological perspective. Global heart. 2020;15(1). Stower H. A disease transition in sub-Saharan Africa. Nat Med. 2019;25(11):1647. Köprülü D, Ahmed SA, Hassan MS, Waberi MM, Abdi IA, Abdi AE, Ali AA, Omar Hassan M. The severity and complexity of coronary artery disease in Khat user somali patients: a study in a PCI-Capable Tertiary Center in Somalia. Research Reports in Clinical Cardiology. Dec. 2023;31:85–90. Prajapati J, Jain S, Virpariya K, Rawal J, Joshi H, Sharma K, Roy B, Thakkar A. Novel atherosclerotic risk factors and angiographic profile of young Gujarati patients with acute coronary syndrome. J Assoc Physicians India. 2014;62(7):584–8. Siddique MA, Shrestha MP, Salman M, Haque KS, Ahmed MK, Sultan MA, Hoque MH, Zaman SM. Age-related differences of risk profile and angiographic findings in patients with coronary heart disease. Bangabandhu Sheikh Mujib Med Univ J. 2010;3(1):13–7. Steyn K, Sliwa K, Hawken S, Commerford P, Onen C, Damasceno A, Ounpuu S, Yusuf S. Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study. Circulation. 2005;112(23):3554–61. Dattoli-García CA, Jackson-Pedroza CN, Gallardo-Grajeda AL, Gopar-Nieto R, Araiza-Garygordobil D, Arias-Mendoza A. Acute myocardial infarction: Review on risk factors, etiologies, angiographic characteristics and outcomes in young patients. Arch Cardiol Mex. 2021;91(4):485–92. Sarr M, Ba DM, Ndiaye MB, Bodian M, Jobe M, Kane A, Diao M, Mbaye A, Dia MM, Pessinaba S, Kane A. Acute coronary syndrome in young Sub-Saharan Africans: a prospective study of 21 cases. BMC Cardiovasc Disord. 2013;13:1–4. Dolder MA, Oliver MF. Myocardial infarction in young men. Study of risk factors in nine countries. Heart. 1975;37(5):493–503. Al-Khadra AH. Clinical profile of young patients with acute myocardial infarction in Saudi Arabia. Int J Cardiol. 2003;91(1):9–13. Joussein-Remacle S, Delarche N, Bader H, Lasserre R, Estrade G. Facteurs de risque de l'infarctus du myocarde du sujetjeune: registreprospectif sur un an. InAnnales de cardiologie et d'angeiologie 2006 Aug 1 (Vol. 55, No. 4, pp. 204–9). Elsevier Masson. Collet JP, Ripoll L, Choussat R, Lison L, Montalescot G. La maladieathérothrombotiquecoronaire du sujetjeune: état des lieux. Sang Thrombose Vaiss. 2000;12(4):218–5. Gurevitz O, Jonas M, Boyko V, Rabinowitz B, Reicher-Reiss H. Clinical profile and long-term prognosis of women ≤ 50 years of age referred for coronary angiography for evaluation of chest pain. Am J Cardiol. 2000;85(7):806–9. Sullivan AK, Holdright DR, Wright CA, Sparrow JL, Cunningham D, Fox KM. Chest pain in women: clinical, investigative, and prognostic features. BMJ. 1994;308(6933):883–6. Kassam N, Ngunga M, Varwani M, Msunza M, Jeilan M. Acute coronary syndrome patterns in the Young: risk factor profile and in-hospital outcomes in a tertiary referral hospital in Kenya. BMC Cardiovasc Disord. 2024;24(1):192. Fournier JA, Sanchez A, Quero J, Fernandez-Cortacero JA, González‐Barrero A. Myocardial infarction in men aged 40 years or less: A prospective clinical‐angiographic study. Clin Cardiol. 1996;19(8):631–6. Porter A, Wurzel M, Ben-Gal T, Sulkes J, Sagie A. Long-term prognosis of 210 patients who underwent coronary angiography before 40 years of age. Am J Cardiol. 1998;81(9):1168–70. Wolfe CM, Vacek JL. Myocardial infarction in the young: angiographic features and risk factor analysis of patients with myocardial infarction at or before the age of 35 years. Chest. 1988;94(5):926–30. Davia JE, Hallal FJ, Cheitlin MD, Gregoratos G, McCarty R, Foote W. Coronary artery disease in young patients: arteriographic and clinical review of 40 cases aged 35 and under. Am Heart J. 1974;87(6):689–96. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5437995","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":390324477,"identity":"a5065f79-498c-4899-9e9d-da341e92ff6b","order_by":0,"name":"Ishak Ahmed Abdi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYBACNgYGZgbGBmYe+8PMB4B8CRnitTAcb0sAaeEhxiKwFgaGM2cMQDzCWvj4Dz82+LnDWoZxRs7nVzdqLHgY2A8f3YDXYRJpxom9Z9J5mCVyt1nnHAM6jCct7QZ+LQzGB3jbDvOwAbUY57ABtUjwmOHXwn/888G/QC08EjnPjHP+EaOFIcc4GWSLBM8Z5se5bcRokcgpNpYF+sWAvc2MObdPgoeNkF/k+49vlny7w9regJn58eecb3Vy/OyHj+HVgmojxKkkAOYPpKgeBaNgFIyCkQMANbVBQc3i8jwAAAAASUVORK5CYII=","orcid":"","institution":"Health Science University, Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ishak","middleName":"Ahmed","lastName":"Abdi","suffix":""},{"id":390324480,"identity":"44169159-0567-401a-89be-6bd079f881d4","order_by":1,"name":"Can Baba Arin","email":"","orcid":"","institution":"Health Science University, Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Can","middleName":"Baba","lastName":"Arin","suffix":""}],"badges":[],"createdAt":"2024-11-12 09:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5437995/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5437995/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71806355,"identity":"299b2ec9-b380-4489-89d0-5f7199b41e95","added_by":"auto","created_at":"2024-12-18 17:36:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16056,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of cases based on their presentation\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5437995/v1/99e2ee792576fdbde6212cc0.png"},{"id":71806357,"identity":"c5a4f3d4-6d6b-433a-aeb9-1e509bc202a3","added_by":"auto","created_at":"2024-12-18 17:36:45","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127284,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCoronary angiographic findings\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5437995/v1/18bf448b37a26cbf90f9c96c.jpeg"},{"id":85550976,"identity":"6a8c059f-7343-4a13-86ec-38d1f3eb67b5","added_by":"auto","created_at":"2025-06-27 09:47:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":655158,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5437995/v1/d24e9516-1066-48dc-9b7f-ea7cd11a08de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Demographics and Coronary Angiographic Patterns in Young Adults in a Sub-Saharan Referral Hospital","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiovascular disease (CVD) has become a serious public health concern in Africa, with substantial implications for healthcare systems and individual health (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).Over a million deaths in sub-Saharan Africa were linked to cardiovascular disease (CVD) in 2019, accounting for 5.4% of all deaths worldwide and 13% of all deaths in the continent (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Over the past few decades, there has been a noticeable shift in the epidemiology of CVD in Africa, which is indicative of a shift away from infectious diseases and toward a greater burden of non-communicable diseases, including CVD.\u003c/p\u003e \u003cp\u003eAging populations, changes in lifestyle, and urbanization all contributed to this transition. Changes in sedentary behavior, higher stress levels, and dietary choices brought about by rapid urbanization all contribute to the rising prevalence of CVD (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Somalia had some of the highest rates of coronary heart disease-related deaths among middle-aged males worldwide in the 1960s. The middle-aged male death rate fell by almost 25% of its highest level starting in 2000. In 2016, it was estimated that over 12,000 Somalis will die from coronary heart disease annually (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The onset of coronary artery disease (CAD) before the age of 40 is known as premature CAD (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The African cases' initial myocardial infarction presentation age on average is 54 years old (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eYoung individuals are being diagnosed with acute myocardial infarction (AMI) more frequently these days. This condition may be linked to a higher risk of developing heart problems, including work-related stress, bad eating habits, sedentary lifestyles, obesity, smoking, and addictions. The fact that acute myocardial infarction (AMI) incidence and death have decreased in several nations over the past few decades is noteworthy; however, this trend has not been seen in young people, since there has been an increase in incidence in this age range (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn light of this, we will conduct a study to evaluate the risk factors and demographic and angiographic profile of significant CAD in younger patients undergoing evaluation for acute coronary syndrome (ACS) or chronic stable angina in sub-Saharan country.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This was retrospective cross-sectional, record based study done in largest tertiary care hospital, a Turkish based hospital in Somalia. In a 2 year 756 patients underwent coronary angiography. The study population consisted of 81 patients aged 40 years or less, who underwent coronary angiogram between October 2022 to October 2024.\u003c/p\u003e \u003cp\u003eDemographic data e.g. age; gender, risk factors as well as coronary angiography results were recorded on the proforma.\u003c/p\u003e \u003cp\u003ePatients with concomitant severe valvular heart disease or cardiomyopathy were excluded. Severe renal impairment and hepatic impairment were also excluded. Those aged above 40 years were excluded from the study.\u003c/p\u003e \u003cp\u003eThe research protocol was approved by the Ethics Committee of Mogadishu Somali T\u0026uuml;rkiye Training and Research Hospital with the reference \u003cb\u003e(MSTH/19892)\u003c/b\u003e and the study complied with the ethical guidelines outlined in the Declaration of Helsinki. All data fully anonymized to ensure patient confidentiality and compliance with ethical standards. No identifiable information was used at any stage of the research process.\u003c/p\u003e \u003cp\u003eDiagnostic CAG was performed by interventional cardiologists through radial or femoral route. A detailed analysis of angiographic images was interpreted by the operator. Elective coronary angiography in multiple (\u0026ge;\u0026thinsp;2) views was performed by standard technique to define both the extent and severity of disease.\u003c/p\u003e \u003cp\u003eSignificant CAD was defined as at least 70% reduction in the diameter of major epicardial coronary arteries i.e. left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) and their branches; or at least 50% luminal narrowing of the left main coronary artery (LMCA). Patients were classified as having single-vessel disease (SVD), double-vessel disease (DVD) or triple vessel disease (TVD) accordingly.\u003c/p\u003e \u003cp\u003eData were processed by SPSS 27.0. For categorical variables, data was described as frequency or percentage. For continuous variables, if they conform to normal distribution, data was presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, otherwise, data was presented as quartiles [median (quartile 25, 75%)]. If continuous data satisfied normality, comparison between two groups or among multiple groups was analyzed by \u003cem\u003et\u003c/em\u003e-test, otherwise, non-parametric test was used. Fisher\u0026rsquo;s exact or Chi-square test was used for comparison of categorical variables. Confidence intervals were given at the 95% level (95% CI) and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken to indicate statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study examined the results of CAD from 81 young patients with coronary artery disease. Most of them were men 60 (74%) with women 21 (26%) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) and the mean age was 33.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 years. The data revealed that smoking was most prevalent risk factor for 55 patients (67. 1%) Followed by Khat use, in 45 patients (55.5%). Dyslipidemia in 10 patients (12.4%). Surprisingly enough, 10 people (12.5%) did not display any risk factors. refer to (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Baseline characteristics of the study group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cimg 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\"\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the clinical presentation, the majority had ST segment elevated infarction (STEMI) accounting for 61%. Others arrived with ST segment elevated myocardial infarction (16%) unstable angina (around 74%) or chronic stable angina (nearly 15%) as shown in Fig. 1.\u003c/p\u003e\n\u003cp\u003eAmong the patients studied in this research, single vessel disease was found to be the most affected with 54 patients (66.67%]. It was observed that the left anterior descending (LAD) artery was the most impacted artery in 50. 5% of instances [see Fig. 2\u0026amp; Table 2].\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cimg 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\"\u003e\u003cbr\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLAD\u003c/strong\u003e: Left anterior Descending, \u003cstrong\u003eLCX\u003c/strong\u003e: Left circumflex, \u003cstrong\u003eRCA\u003c/strong\u003e: right coronary artery.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003eSmoking and sex were found to have a statistically significant association with coronary artery disease in young patients (\u0026chi;\u0026sup2; = 44.33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There is also significant association between Khat chewing and the number of affected coronary vessels, supported by the Fisher-Freeman-Halton Exact Test (p-value\u0026thinsp;=\u0026thinsp;0.044) and the likelihood ratio (p-value\u0026thinsp;=\u0026thinsp;0.043). Conversely, no significant relationship was observed between other traditional risk factors and the number of affected vessels checks (Table 3).\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eStatistical interpretation\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRisk factor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRelated to\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKhat Chewing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of Affected Vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFisher-Freeman-Halton Exact Test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking \u0026amp; Sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary Artery Disease (in young patients)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChi-Square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 44.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKhat Chewing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of Affected Vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLikelihood Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 14.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther Risk Factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of Affected Vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Not Significant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe characteristics of angiographic morphologic features in young patients in Africa are not well documented in the literature. This is one of the few data that are now available for further research on coronary artery disease in young individuals in Sub-Saharan Africa. This cross-sectional, retrospective observational study assessed coronary artery disease in adults under 40 years of age.\u003c/p\u003e \u003cp\u003eWe analyzed the results of 81 scenarios' coronary angiography. Of the 81 cases who were taken into the study, 21 (26%) were female and 60 (74%) were male.\u003c/p\u003e \u003cp\u003eCandidates under 40 had a mean age (SD) of 33.6 years. The mean age was 36 years for Tricot (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) and 35.4 years for Dolder [11]. However, a 14-year-old was the youngest in India to be diagnosed with acute coronary syndrome (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our analysis, smoking was the most significant risk factor for coronary artery disease (67.9%). In line with our research, a sample of 21 young people with acute coronary syndrome from Sub-Saharan Africa revealed that 54% had a smoking risk factor (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This highlights how smoking tobacco is a significant risk factor for coronary artery disease in young individuals in Sub-Saharan Africa. In fact, the majority of researches on the incidence of coronary syndrome among young people show that smoking repeatedly is the primary cause of the disease (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost of the studies, younger people with coronary artery disease are more likely to have normal coronary arteries with only mild narrowing (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Our study\u0026rsquo;s results show a higher incidence of angiographically significant coronary artery disease, which is in contrast to what has been published generally. This study's scope went beyond only elucidating the distinction. The higher frequency of severe coronary artery disease in our study may be explained by the prevalence of tobacco and chat smoking in this cohort, but more research revealing specifics and associations should be pursued. This increased significant incidence is consistent with a Kenyan study (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study's angiographic results, which show an inclination for Left Anterior Descending Artery (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and a preponderance of single vessel disease, accord with earlier studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study highlights the rising incidence of acute coronary syndrome (ACS) among young adults in Somalia, a sub-Saharan country, emphasizing the need for urgent action from healthcare professionals and policymakers. Future research should focus on mortality rates associated with ACS in this demographic, as understanding these factors is crucial for developing effective interventions to reduce mortality and improve health outcomes.\u003c/p\u003e\n\u003ch3\u003eStudy limitations\u003c/h3\u003e\n\u003cp\u003eConcerning the limitations, there are some. The limitation of that study is the small number (n\u0026thinsp;=\u0026thinsp;81) and single-center design. Its retrospective nature opens questions of potential incomplete data, lifestyle factors and medication non-adherence.\u003c/p\u003e \u003cp\u003eInsufficient follow-up data limit observations on longer-term outcomes, and a focus only from young adults could fail to capture differences in coronary artery disease (CAD) related to age. Moreover, given that risk factor analysis provides no information on the intensity and duration of such exposures or socioeconomic factors which can be associated with CAD occurrence.\u003c/p\u003e \u003cp\u003eThirdly, the issue of confounding factors such as medication history and other comorbidities is not adequately taken into account that may in turn affect its final results. Additional, better studies are required to answer these limitations and improve the resolution of CAD in young adults.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe rising incidence of coronary artery disease in young adults is thought to be caused by rapid changes in lifestyle, unhealthy habits like smoking, chat chewing, etc., as well as a larger prevalence of diabetes and hypertension. Overall, young patients with severe CAD had the highest prevalence of SVD. The most often affected coronary arteries are the LAD, RCA, and LCX.\u003c/p\u003e \u003cp\u003eAt the conclusion of this study, we suggest early risk stratification, disease identification, and management to prevent fatal outcomes in many cases, even though extensive survey and clinical research should be carried out to ascertain the various aspects of CAD in Somalia for primary and secondary prevention strategies of CAD in young people.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003eThe study is not associated with a registered clinical trial.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe research protocol was approved by the Ethics Committee of Mogadishu Somali T\u0026uuml;rkiye Training and Research Hospital with the reference\u0026nbsp;\u003cstrong\u003e(MSTH/19892)\u003c/strong\u003e and the study complied with the ethical guidelines outlined in the Declaration of Helsinki.\u003cbr\u003e\u0026nbsp;consent was waived for the retrospective analysis.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The study is retrospective in nature and involves anonymized data.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cbr\u003e\u0026nbsp;The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;No funding was received for this study.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBulto LN, Hendriks JM. The burden of cardiovascular disease in Africa: prevention challenges and opportunities for mitigation. Eur J Cardiovasc Nurs. 2024;23(6):e88\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeates AK, Mocumbi AO, Ntsekhe M, Sliwa K, Stewart S. Cardiovascular disease in Africa: epidemiological profile and challenges. Nat Reviews Cardiol. 2017;14(5):273\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuyun MF, Sliwa K, Kengne AP, Mocumbi AO, Bukhman G. Cardiovascular diseases in sub-Saharan Africa compared to high-income countries: an epidemiological perspective. Global heart. 2020;15(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStower H. A disease transition in sub-Saharan Africa. Nat Med. 2019;25(11):1647.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026ouml;pr\u0026uuml;l\u0026uuml; D, Ahmed SA, Hassan MS, Waberi MM, Abdi IA, Abdi AE, Ali AA, Omar Hassan M. The severity and complexity of coronary artery disease in Khat user somali patients: a study in a PCI-Capable Tertiary Center in Somalia. Research Reports in Clinical Cardiology. Dec. 2023;31:85\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrajapati J, Jain S, Virpariya K, Rawal J, Joshi H, Sharma K, Roy B, Thakkar A. Novel atherosclerotic risk factors and angiographic profile of young Gujarati patients with acute coronary syndrome. J Assoc Physicians India. 2014;62(7):584\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddique MA, Shrestha MP, Salman M, Haque KS, Ahmed MK, Sultan MA, Hoque MH, Zaman SM. Age-related differences of risk profile and angiographic findings in patients with coronary heart disease. Bangabandhu Sheikh Mujib Med Univ J. 2010;3(1):13\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteyn K, Sliwa K, Hawken S, Commerford P, Onen C, Damasceno A, Ounpuu S, Yusuf S. Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study. Circulation. 2005;112(23):3554\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDattoli-Garc\u0026iacute;a CA, Jackson-Pedroza CN, Gallardo-Grajeda AL, Gopar-Nieto R, Araiza-Garygordobil D, Arias-Mendoza A. Acute myocardial infarction: Review on risk factors, etiologies, angiographic characteristics and outcomes in young patients. Arch Cardiol Mex. 2021;91(4):485\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarr M, Ba DM, Ndiaye MB, Bodian M, Jobe M, Kane A, Diao M, Mbaye A, Dia MM, Pessinaba S, Kane A. Acute coronary syndrome in young Sub-Saharan Africans: a prospective study of 21 cases. BMC Cardiovasc Disord. 2013;13:1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDolder MA, Oliver MF. Myocardial infarction in young men. Study of risk factors in nine countries. Heart. 1975;37(5):493\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Khadra AH. Clinical profile of young patients with acute myocardial infarction in Saudi Arabia. Int J Cardiol. 2003;91(1):9\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoussein-Remacle S, Delarche N, Bader H, Lasserre R, Estrade G. Facteurs de risque de l'infarctus du myocarde du sujetjeune: registreprospectif sur un an. InAnnales de cardiologie et d'angeiologie 2006 Aug 1 (Vol. 55, No. 4, pp. 204\u0026ndash;9). Elsevier Masson.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollet JP, Ripoll L, Choussat R, Lison L, Montalescot G. La maladieath\u0026eacute;rothrombotiquecoronaire du sujetjeune: \u0026eacute;tat des lieux. Sang Thrombose Vaiss. 2000;12(4):218\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGurevitz O, Jonas M, Boyko V, Rabinowitz B, Reicher-Reiss H. Clinical profile and long-term prognosis of women\u0026thinsp;\u0026le;\u0026thinsp;50 years of age referred for coronary angiography for evaluation of chest pain. Am J Cardiol. 2000;85(7):806\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSullivan AK, Holdright DR, Wright CA, Sparrow JL, Cunningham D, Fox KM. Chest pain in women: clinical, investigative, and prognostic features. BMJ. 1994;308(6933):883\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKassam N, Ngunga M, Varwani M, Msunza M, Jeilan M. Acute coronary syndrome patterns in the Young: risk factor profile and in-hospital outcomes in a tertiary referral hospital in Kenya. BMC Cardiovasc Disord. 2024;24(1):192.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFournier JA, Sanchez A, Quero J, Fernandez-Cortacero JA, Gonz\u0026aacute;lez‐Barrero A. Myocardial infarction in men aged 40 years or less: A prospective clinical‐angiographic study. Clin Cardiol. 1996;19(8):631\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePorter A, Wurzel M, Ben-Gal T, Sulkes J, Sagie A. Long-term prognosis of 210 patients who underwent coronary angiography before 40 years of age. Am J Cardiol. 1998;81(9):1168\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolfe CM, Vacek JL. Myocardial infarction in the young: angiographic features and risk factor analysis of patients with myocardial infarction at or before the age of 35 years. Chest. 1988;94(5):926\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavia JE, Hallal FJ, Cheitlin MD, Gregoratos G, McCarty R, Foote W. Coronary artery disease in young patients: arteriographic and clinical review of 40 cases aged 35 and under. Am Heart J. 1974;87(6):689\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Coronary Artery Disease, AngiographicPatterns, YoungAdults, Sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-5437995/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5437995/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe objective of this study was to determine the demographic and Coronary Angiographic trends in young adults diagnosed significant coronary artery disease (CAD) at a referral hospital, Somalia. We performed a retrospective cross-sectional study in 81 patients who were 40 years of age or younger and underwent coronary angiography from October 2022 to October 2024.\u003c/p\u003e \u003cp\u003eResults: The analysis showed a majority of male patients (74%) with an average age at 33.6 years. Nearly two thirds of patients (67.1%) had a history of smoking and more than half used Khat (55.6%); No risk factors were identified in 12.5% of the patients. Additionally, other notable risk factors included hypertension (27.2%), diabetes (13.6%), and Dyslipidemia (12.3%), indicating a multifactorial etiology of CAD in this population. The most frequent clinical presentation was ST-segment elevated myocardial infarction (STEMI) observed in 61% of the patients, with single-vessel disease being more common and almost two thirds involving left anterior artery (LAD). Smoking duration was significantly correlated with vessel involvement (r\u0026thinsp;=\u0026thinsp;0.265, p\u0026thinsp;=\u0026thinsp;0.017) and khat use showed an independent association to number of affected vessels (p\u0026thinsp;=\u0026thinsp;0.044).\u003c/p\u003e \u003cp\u003eConclusion \u0026mdash; these findings confirm the increasing burden of CAD among young people in sub-Saharan Africa and support a public health approach to preventive measures.\u003c/p\u003e","manuscriptTitle":"Demographics and Coronary Angiographic Patterns in Young Adults in a Sub-Saharan Referral Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-18 17:36:40","doi":"10.21203/rs.3.rs-5437995/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e560064-d1c1-4a36-835e-beab026e9645","owner":[],"postedDate":"December 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-27T09:38:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-18 17:36:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5437995","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5437995","identity":"rs-5437995","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}