European Journal of Cardiovascular Medicine

Coronary artery disease (CAD) is a major global health burden and remains the leading cause of morbidity and mortality worldwide [1]. CAD occurs due to the narrowing or blockage of coronary arteries, primarily as a result of atherosclerosis, which leads to reduced blood supply to the heart muscle. This condition can manifest as stable angina, acute coronary syndrome, myocardial infarction, or sudden cardiac death [2]. The prevalence of CAD varies across different populations, influenced by genetic predisposition, lifestyle factors, and the presence of comorbid conditions such as hypertension, diabetes mellitus, dyslipidemia, and obesity [3].

In South Asia, including Bangladesh, CAD presents a significant public health challenge due to the rising prevalence of cardiovascular risk factors. Studies suggest that South Asians develop CAD at a younger age and with more severe manifestations compared to Western populations [4, 5]. Unhealthy dietary habits, sedentary lifestyles, smoking, and inadequate healthcare access contribute to the increasing burden of CAD in Bangladesh [6]. Despite advancements in diagnostic and therapeutic approaches, the prevalence of CAD continues to rise, necessitating early detection and effective management strategies [7, 8].

Hospital-based studies play a crucial role in understanding the burden and pattern of CAD in specific populations. Coronary angiography is a gold-standard diagnostic tool that helps in assessing the extent of coronary artery involvement, including single-vessel disease (SVD), double-vessel disease (DVD), and triple-vessel disease (TVD) [9, 10]. Identifying the most commonly affected arteries, such as the left anterior descending (LAD), right coronary artery (RCA), and left circumflex artery (LCX), provides valuable insights into disease patterns [11]. Such findings can guide clinicians in optimizing treatment plans, including medical management, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) [12].

Despite the increasing prevalence of CAD in Bangladesh, there is limited data on its pattern and distribution among hospitalized patients. Understanding the demographic characteristics, risk factor distribution, and angiographic findings in Bangladeshi patients can aid in early intervention and policy formulation. This study aimed to determine the prevalence and pattern of CAD among patients admitted to the Department of Cardiology at Mymensingh Medical College Hospital (MMCH). The findings will provide essential epidemiological insights into CAD in Bangladesh and help in developing targeted prevention and management strategies for at-risk populations.

This hospital-based cross-sectional study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital (MMCH), from November 2023 to December 2024. The study aimed to assess the prevalence and pattern of coronary artery disease (CAD) among hospitalized patients undergoing diagnostic evaluation. A total of 107 patients admitted with suspected CAD were included using a consecutive sampling technique. Patients were selected based on clinical presentation and referral for coronary angiography. Those with a history of prior coronary interventions, such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), and patients with incomplete medical records were excluded.

Data collection was carried out through structured questionnaires, clinical examinations, and medical record reviews. Demographic variables, including age, gender, and socioeconomic status, were recorded. Risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, and family history of CAD were documented. Laboratory investigations, including lipid profiles, fasting blood sugar, and renal function tests, were analyzed to assess metabolic and renal status.

Coronary angiography was performed using standard catheterization techniques to evaluate the pattern and severity of CAD. The presence of CAD was confirmed based on angiographic findings, and patients were categorized into single-vessel disease, double-vessel disease, or triple-vessel disease. The most commonly affected arteries, including the left anterior descending, right coronary artery, and left circumflex artery, were identified.

Treatment strategies were determined based on the severity of CAD and clinical presentation. Patients with significant obstructive lesions underwent PCI, while those with severe multi-vessel disease were recommended for CABG. Patients with non-severe or stable disease were managed with optimal medical therapy alone.

All collected data were entered and analyzed using SPSS version 25. Descriptive statistics, including mean, standard deviation, frequency, and percentage, were used to summarize demographic characteristics, risk factors, CAD severity, and treatment modalities.

Table 1: Patient Demographics (N = 107)

Table 1 presents the demographic characteristics of the study population (N = 107). The majority of patients were male (76.6%), while females accounted for 23.4%. The mean age of the participants was 51.7 ± 11.3 years, indicating a middle-aged population commonly affected by coronary artery disease.

Table 2: Distribution of Risk Factors

Table 2 summarizes the distribution of major cardiovascular risk factors among the study participants. Hypertension was the most prevalent risk factor, affecting 38.3% of patients, followed by smoking (33.6%) and diabetes mellitus (22.4%). Obesity was observed in 22.4%, while 16.8% had a family history of coronary artery disease (CAD).

Table 3: CAD Severity

Table 3 presents the severity of coronary artery disease (CAD) among the study participants. Single-vessel disease (SVD) was the most common form, affecting 30.8% of patients, followed by triple-vessel disease (TVD) in 22.4% and double-vessel disease (DVD) in 18.7%. Overall, 72.0% of patients had angiographically confirmed CAD, indicating a significant disease burden in the study population.

Table 4: Treatments

Table 4 summarizes the treatment approaches recommended for the study participants. Percutaneous coronary intervention (PCI) was performed in 23.4% of cases, while 7.5% were advised to undergo coronary artery bypass grafting (CABG). Optimal medical therapy (OMT) alone was the chosen management strategy for 21.5% of patients, reflecting a varied approach to CAD treatment based on disease severity and patient condition.

Coronary artery disease (CAD) remains a major health burden in Bangladesh, contributing significantly to morbidity and mortality. Our study, conducted at the Department of Cardiology, MMCH, analyzed the prevalence, pattern, and management of CAD in 107 patients, providing valuable insights into the demographic distribution, risk factors, severity of disease, and treatment approaches. These findings align with previous studies conducted in Bangladesh and South Asia, reinforcing the need for early detection and aggressive management of CAD to improve outcomes.

In our study, 76.6% of patients were male, while 23.4% were female, indicating a clear male predominance. This aligns with findings from Khatun et al. and Islam et al., who also reported a higher prevalence of CAD in men [13, 14]. The mean age of our study population was 51.7 ± 11.3 years, reinforcing the observation that South Asians develop CAD at a younger age compared to Western populations. Chowdhury et al., highlighted that genetic susceptibility and a high burden of metabolic risk factors contribute to this early onset of CAD in Bangladeshis [15].

Among the traditional risk factors, hypertension was the most prevalent (38.3%), followed by smoking (33.6%) and diabetes mellitus (22.4%). These findings are consistent with previous studies, including Rahman et al., who reported similar prevalence rates of hypertension and smoking in Bangladeshi CAD patients [16]. The significant proportion of smokers in our study reflects the ongoing public health challenge posed by tobacco use, which has been strongly linked to premature CAD in South Asian populations. Additionally, obesity was present in 22.4% of cases, and 16.8% of patients had a family history of CAD, reinforcing the combined influence of lifestyle factors and genetic predisposition in the development of CAD.

Regarding disease severity, 72.0% of the total study population had obstructive CAD. Among them, single-vessel disease (SVD) was the most common pattern (30.8%), followed by triple-vessel disease (TVD) (22.4%) and double-vessel disease (DVD) (18.7%). These findings align with previous studies, such as those by Ezhumalai and Jayaraman and Khan et al., who reported a similar distribution of CAD severity in South Asian patients [17, 18]. Notably, the high prevalence of multi-vessel disease (DVD and TVD combined: 41.1%) highlights the significant burden of advanced CAD in our population. This suggests that a considerable proportion of patients present with more severe forms of the disease, potentially due to delayed diagnosis and inadequate risk factor control.

In terms of treatment strategies, percutaneous coronary intervention (PCI) was performed in 23.4% of cases, while 7.5% of patients were recommended for coronary artery bypass grafting (CABG). This reflects the growing preference for minimally invasive procedures in managing CAD. However, 21.5% of patients were managed with optimal medical therapy (OMT) alone, suggesting that a substantial proportion of cases were either stable CAD or had contraindications to invasive procedures. Our findings are consistent with Pieris et al. and Hosseini et al., who also noted a high proportion of CAD patients receiving medical therapy in similar settings [19, 20].

These findings emphasize the urgent need for targeted prevention strategies to reduce the CAD burden in Bangladesh. The high prevalence of modifiable risk factors, such as hypertension, smoking, and obesity, suggests that aggressive lifestyle interventions, early screening programs, and effective pharmacological management are essential. Previous research has shown that South Asians exhibit a unique risk profile for CAD, with a greater likelihood of developing metabolic syndrome and early-onset cardiovascular disease compared to Western populations [21]. Given that multi-vessel disease is common, more efforts should be directed toward improving adherence to preventive strategies, ensuring timely diagnosis, and expanding access to interventional procedures where necessary.

Limitations of the study

Although our study provides important insights into CAD prevalence and patterns, it has some limitations. It was a single-center study, which may not fully represent the broader Bangladeshi population. Additionally, long-term follow-up data were not available to assess patient outcomes after treatment. Future multicenter studies with larger sample sizes and long-term follow-ups are needed to better understand the evolving trends in CAD prevalence and management in Bangladesh.

This study highlights the significant burden of coronary artery disease in Bangladeshi patients, with a predominance in middle-aged men. Hypertension, smoking, and diabetes mellitus emerged as the most common risk factors, emphasizing the role of both modifiable lifestyle factors and genetic predisposition. A substantial proportion of patients had obstructive coronary artery disease, with single-vessel involvement being the most frequent pattern, followed by multi-vessel disease. While percutaneous coronary intervention was the preferred treatment, many patients were managed with optimal medical therapy, reflecting a diverse approach based on disease severity. These findings underscore the need for early screening, targeted prevention strategies, and comprehensive management plans to reduce the impact of coronary artery disease in Bangladesh.

Financial support and sponsorship: No funding sources.

Conflicts of interest: There are no conflicts of interest.

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