Half of heart attack patients in Pakistan under 49, reveals NICVD study

Cardiologists at the National Institute of Cardiovascular Diseases (NICVD) have revealed that nearly 50 per cent of heart attack patients in the country are younger than 49 years, and between 12 per cent to 15 per cent are under 40.

Experts warn that this trend — fuelled by diabetes, hypertension, obesity, smoking and unhealthy lifestyles — is making Pakistan one of the world’s worst-hit countries for early-age heart attacks.

The data was shared during a symposium in Karachi on Saturday where NICVD researchers in collaboration with local pharmaceutical firm Pharmevo presented the results of the country’s largest clinical trial comparing two anticoagulants for treating acute left ventricular thrombus (LVT) — a dangerous blood clot that can form in the heart after a severe heart attack and cause stroke or other embolic complications.

The trial, known as RIVAWAR, was designed and conducted independently by the NICVD’s cardiology team and ran from June 7, 2021, till December 31, 2023. It enrolled 261 post–heart attack patients, randomising them to receive either rivaroxaban — a newer direct oral anticoagulant — or warfarin, the decades-old standard treatment.

All participants had confirmed LVT within seven days of their heart attack, with most suffering severe ST-segment elevation myocardial infarction (STEMI) and reduced heart pumping capacity.

According to principal investigator Dr Jehangir Ali Shah, rivaroxaban achieved faster clot resolution in the early phase — 20 per cent at four weeks versus 8.3 per cent with warfarin — while both drugs had similar high success rates at 12 weeks. He noted that about 16 per cent of heart attack patients previously faced a significant stroke risk due to LVT, but this was eliminated in the trial cohort.

“This is the largest randomised trial to date in acute LVT, and the results show rivaroxaban to be a safe, effective alternative to warfarin,” he said, adding that 15 per cent of the participants were under 40 years old.

Dr Shah said the study was significant not only for its clinical findings but also as an example of high-quality investigator-led research conducted in Pakistan and published in the Journal of the American College of Cardiology: Advances.

NICVD’s Director of Cath Lab Dr Abdul Hakeem spoke on the public health urgency with respect to cardiac diseases. “Pakistan has the highest rate of young heart attack patients globally. Every third adult has diabetes, 40 per cent have high blood pressure, obesity is common, and smoking rates remain high. Many patients don’t know they’re at risk because, in our culture, loose clothing hides weight gain. After the age of 30, everyone should get a cardiac check-up,” he said.

He added that common misconceptions — such as assuming a heart attack always causes severe chest pain — can delay treatment.

“Nine out of 10 of our patients had no pain, only heaviness in the chest or acidity-like discomfort. If you feel chest heaviness while walking or climbing stairs, get an ECG immediately,” he advised.

Dr Hakeem warned that the most dangerous anterior heart attack could damage up to 60 per cent of the heart muscle and often caused a clot that appeared four to eight weeks later, increasing stroke risk.

NICVD Executive Director Dr Tahir Saghir said the institute was now moving into further advanced research, including trials on drug-coated balloons that did not require stents — a development that could reduce future artery blockages. “We already have international funding for this work, and the direct beneficiaries will be our patients,” he said.

Senior cardiologist Dr Nadeem Rizvi emphasised the importance of locally conducted clinical research, saying results based on Pakistan’s environment and health care system are more practical and applicable.

Dow Institute of Cardiology Director Dr Tariq Furman said genetic, socioeconomic and physical differences between Pakistani and Western populations required tailored treatment guidelines.

“We need our own data. Sometimes their recommended high doses aren’t suitable for our patients,” he said.

Pharmevo’s Abdul Samad said the company’s support for RIVAWAR was part of its commitment to advance evidence-based care.

“These results will help guide treatment choices for post–heart attack clots. We will continue to support medical research in Pakistan so that effective medicines are available locally,” he said.