Study of Aortic Valve Sclerosis as A Marker of Atherosclerosis in Acute Coronary Syndromes

According to the World Health Report 2002, Cardio Vascular Diseases (CVD) will be the largest cause of death and disability in India by 2020 [1].World Health Statistics 2016 claimed 17.5 million lives in 2012 (46% of all Non Communicable Disease deaths) -6 million of which were under age 70.Of the 17.5 million deaths, 7.4 million were due to coronary heart disease and 6.7 million to stroke [2].Aortic sclerosis is associated with increased incidence of myocardial infarction and cardiovascular death [3,4].Detection of an ejection systolic murmur in the aortic valve region often corresponds to a diagnosis of aortic sclerosis or aortic stenosis.Ejection systolic murmur even though regarded as harmless, may also be found in patients with significant aortic valve obstruction and associated with increased cardiovascular events [5].The epidemiological risk factors of calcific aortic valve disease resemble those of atherosclerosis and include age, male gender, hypertension, smoking, elevated levels of serum Low-Density Lipoprotein (LDL) cholesterol and diabetes [6,7].In spite of the high incidence of myocardial infarction in our scenario, there is a lack of understanding of its association with the common finding of aortic valve sclerosis in our setup.Having an understanding of an association between the two, may help to understand better the complex patho-physiological aspects involved in acute coronary syndromes. MAtErIALS And MEtHOdSThis prospective case control study was conducted in the medical Intensive Coronary Care Unit of North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, between 1 st Jan 2015 to 31 st Dec 2015.A total of 60 patients diagnosed with acute coronary syndromes were randomly selected and studied after obtaining the Institute ethics committee clearance.They were compared with 60 age and sex matched individuals admitted to In Patient Department for reasons other than acute coronary syndromes.The formula that was used for calculating sample size was:standard normal variate at 5% type 1 error (p<0.05) it is 1.96 was used in the formula.p = Expected proportion in population based on previous studies or pilot studies.d = Absolute error or precision (has to be decided by the researcher).According to the study of Kearney K et al., the proportion of people having aortic sclerosis was ~ 4 [8].The precision/absolute error was kept at 5% and type 1 error was kept at 5%.So, if the above values are put in the formula above= Sample size= (1.96) 2 x 0.04(1-0.04)= 60.(0.05) 2 Inclusion criteria1) History of acute new onset chest pain within the previous 24 hours.2) 12 lead electrocardiogram with changes suggestive of acute coronary syndromes.