Postmortem analysis of coronary atherosclerosis among youth dying of unnatural causes.

Abstract

Background: Cardiovascular diseases (CVDs) are the most common causes of non-communicable diseases (NCDs) in Kenya with atherosclerosis contributing a major portion. There is a steady increase in its prevalence in the youth with commencement appreciated as early as infancy. Predisposing factors to atherosclerotic lesions such as alcohol consumption and smoking are on the rise among the youth. There is paucity of data on prevalence and patterns of atherosclerosis among this age group in our setting. Postmortem provides the gold standard for assessing atherosclerosis. Objective: To evaluate through postmortem the presence and histologic type of coronary atherosclerosis among youth who have died from unnatural causes and to assess the correlation between coronary atherosclerosis and known risk factors. Study Design: Descriptive cross-sectional study Study Area: Kenyatta National Hospital (KNH) Mortuary and City Mortuary, Kenya. Tissue processing was done at the University of Nairobi Histopathology Laboratory. Study Population: Decedents from unnatural deaths aged between 18 and 35 years. Materials and Methods: Study was conducted on 95 decedents. Data on risk factors was obtained from the next of kin of the decedent using a structured questionnaire. Anthropometric measures were recorded. Postmortems were done and the hearts excised, weighed and fixed in formalin for one week. The 3 coronary arteries were systematically dissected to check for gross changes and excised. They were processed and stained with H&E (Haematoxylin and Eosin) and MT (Masson’s Trichrome) and evaluated for atherosclerotic lesions which were graded according to the American Heart Association (AHA) classification of atherosclerosis. Results: The study included 79 male decedents and 16 female decedents. Amongst them 51(53.7%) had presence of coronary atherosclerosis. Of these cases, 82.4% (n=51) were males and 17.6% (n=51) were females. There was no statistically significant relationship between atherosclerosis and the assessed risk factors. Left xv circumflex artery was the most affected with a prevalence of 41.1% (n=95). The most common type of atherosclerosis was Type 2 followed by Type 3. Single vessel atherosclerosis was the most prevalent at 32.6% (n=95) of the cases. Conclusions: There is presence of coronary atherosclerotic lesions in young decedents in our setting with a high prevalence noted. There was no significant relationship determined between the risk factors assessed and coronary atherosclerosis. Recommendations: Future studies that target a wider study population that incorporate epidemiologic data, detailed medical records and cardiovascular biomarkers could be done to further aid in analysis of atherosclerosis in the young adults in our setting.