Karachi: Cardiologists at the National Institute of Cardiovascular Diseases (NICVD) have revealed that nearly 50% of heart attack patients in Pakistan are younger than 49, while 12–15% are under 40. Experts warn this alarming trend — driven by diabetes, hypertension, obesity, smoking, and poor lifestyles — makes Pakistan one of the worst-hit countries globally for early-age heart attacks.
The figures were shared at a Karachi symposium on Saturday, where NICVD researchers, in collaboration with local pharmaceutical firm Pharmevo, unveiled results from the country’s largest clinical trial comparing two anticoagulants for treating acute left ventricular thrombus (LVT) — a dangerous clot that can form in the heart after a severe heart attack and trigger stroke or other embolic complications.
The trial, RIVAWAR, was independently designed and run by NICVD’s cardiology team between June 7, 2021, and December 31, 2023, enrolling 261 patients within seven days of a heart attack. Most had severe ST-segment elevation myocardial infarction (STEMI) and reduced heart function. Participants were randomly assigned either rivaroxaban — a newer direct oral anticoagulant — or warfarin, the long-standing standard.
Principal investigator Dr Jehangir Ali Shah said rivaroxaban produced faster early results, with 20% clot resolution at four weeks versus 8.3% for warfarin. At 12 weeks, success rates were equally high — 95.8% and 96.6%, respectively. “Around 16% of heart attack patients previously faced a major stroke risk due to LVT, but this was eliminated in our trial cohort,” he said. Fifteen per cent of participants were under 40.
Dr Shah called the study, published in the Journal of the American College of Cardiology: Advances, the largest randomised trial in acute LVT worldwide, and an example of high-quality, investigator-led research in Pakistan.
Dr Abdul Hakeem, Director of Cath Lab, said Pakistan’s rate of young heart attack patients is unmatched globally. “Every third adult has diabetes, 40% have high blood pressure, obesity is common, and smoking rates are high. Many don’t know they’re at risk because loose clothing hides weight gain. After 30, everyone should get a cardiac check-up,” he advised.
He added that nine out of ten patients don’t experience sharp chest pain during a heart attack, only heaviness or acidity-like discomfort. “If you feel heaviness while walking or climbing stairs, get an ECG immediately,” he warned, noting that the most dangerous anterior heart attack can damage up to 60% of the heart and often causes a clot four to eight weeks later.
NICVD Executive Director Dr Tahir Saghir announced new research, including trials on drug-coated balloons without stents, to reduce future artery blockages, with international funding already secured.
Senior cardiologist Dr Nadeem Rizvi stressed the importance of local research, while Dow Institute of Cardiology Director Dr Tariq Furman said Pakistan needs its own data because genetic, socioeconomic, and physical differences mean Western treatment guidelines may not always apply.
Pharmevo’s Abdul Samad said the company’s backing for RIVAWAR reflected its commitment to evidence-based care. “These results will guide treatment choices for post–heart attack clots, and we will continue supporting local medicine production,” he said.
The trial used a locally manufactured rivaroxaban, eliminating the frequent blood monitoring required for warfarin — a potential cost-saving in a resource-limited health system. Researchers say early detection and treatment of LVT could prevent thousands of strokes among Pakistani heart patients each year.
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