Acute myocardial infarction continues to be one of the foremost causes of morbidity and mortality worldwide, responsible for around three million deaths annually. Despite significant progress in cardiac care, myocardial ischemia remains a growing concern, particularly in developing nations. Rapid urbanization, sedentary behavior, changing food habits, and psychosocial stress have led to a rise in cardiovascular disease incidence. The World Health Organization predicts that by 2030, cardiovascular diseases will account for 23.6 million deaths globally

In India, the prevalence of ischemic heart disease has nearly doubled in the past two decades, shifting from older adults to younger working populations. Patients face challenges in achieving sustained risk reduction due to lifestyle limitations and lack of awareness. Furthermore, psychosocial stressors following cardiac events affect rehabilitation and quality of life, making it vital to examine both medical and social dimensions of myocardial ischemia.

AIMS AND OBJECTIVES

Primary Aim

To evaluate and analyze both traditional and emerging risk factors contributing to myocardial ischemia among patients presenting to the emergency department of a tertiary care hospital, and to assess the impact of myocardial ischemia on family and social well-being.

Specific Objectives

1. To identify the demographic and clinical characteristics of patients presenting with myocardial ischemia, including age distribution, gender ratio, occupation, and socioeconomic background.
2. To determine the prevalence of conventional cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol consumption, and obesity among the study population.
3. To assess emerging risk factors including psychosocial stress, prolonged screen exposure, social media addiction, sedentary lifestyle, and use of anabolic or protein supplements.
4. To evaluate lifestyle and dietary patterns (vegetarian/non-vegetarian diet, frequency of processed food intake, and physical activity level) and their correlation with the occurrence of myocardial ischemia.
5. To analyze the psychosocial consequences of myocardial ischemia on patients’ family dynamics, social interactions, and emotional health following the cardiac event.

To provide recommendations for preventive strategies emphasizing lifestyle modification, public awareness, and early screening for high-risk individuals.

Study Design:

This investigation was a prospective, single-centre, observational cohort study conducted in the Emergency Medicine Department of KLE’s Dr. Prabhakar Kore Hospital, Belagavi. The study period spanned 1 October 2023 to 31 March 2024. Consecutive adult patients presenting with symptoms and ECG changes suggestive of myocardial ischemia were screened and enrolled according to prespecified eligibility criteria. The study was designed to describe risk-factor distributions, quantify emerging lifestyle contributors, and evaluate short-term clinical and psychosocial outcomes in a real-world emergency care setting.

Sampling and sample size :

A consecutive sampling strategy was used: every eligible patient who presented during the study window and provided informed consent was included. Because the study’s primary aim was descriptive (characterize risk factors and psychosocial impact) and exploratory for emerging exposures (screen time, supplement use), a convenience sample of all eligible presentations during the 6-month period was used. This yielded 7,564 analyzable patients after exclusions. Where inferential comparisons were performed (e.g., sedentary versus active groups), post-hoc power estimates were generated to assess the sensitivity of key comparisons.

Data collection schedule and procedures:

Data collection was prospective and contemporaneous with clinical care. Trained investigators completed a structured case record form (CRF) at presentation documenting demographics, history, physical examination, ECG and initial laboratory results, comorbidities, and lifestyle exposures (diet, physical activity, screen time, supplement use). Psychosocial data (stress level, family support) were captured by short structured interviews during admission and again at discharge when feasible to document early post-event impact. Imaging, therapy (including reperfusion), ICU admission and in-hospital outcomes were also recorded.

Inclusion Criteria:

• Age ≥18 years, irrespective of gender.
• Patients presenting to the Emergency Medicine Department of KLE’s Dr. Prabhakar Kore Hospital with clinical features suggestive of myocardial ischemia, including chest pain, dyspnea, diaphoresis, or syncope.
• Electrocardiographic (ECG) changes indicative of myocardial ischemia, such as ST-segment elevation, depression, or T-wave inversions, consistent with acute coronary syndrome.
• Patients willing to provide informed consent to participate in the study, either personally or through a legal guardian (in cases of unstable or critically ill individuals).
• Patients with adequate medical records allowing for accurate data extraction on risk factors, lifestyle habits, and clinical outcomes.

Exclusion Criteria:

• Patients with pre-existing neurological disorders such as cerebrovascular accidents (stroke) that could confound symptom interpretation.
• Individuals diagnosed with chronic kidney disease (CKD) or on long-term dialysis, due to overlapping symptoms and altered biochemical markers that may interfere with accurate ischemia assessment.
• Patients with chronic liver disease (CLD) or hepatic dysfunction, as these conditions may independently affect metabolic and cardiovascular profiles.
• Patients with trauma, sepsis, or non-cardiac causes of chest pain such as pulmonary embolism, aortic dissection, or pericarditis.
• Pregnant women, due to altered hemodynamic and metabolic states that may mimic or modify ischemic presentations.
• Patients who refused consent or were discharged against medical advice before complete evaluation.

Data Collection: Data collection was carried out prospectively from October 1, 2023, to March 31, 2024, at the Emergency Medicine Department of KLE’s Dr. Prabhakar Kore Hospital, a tertiary care teaching hospital affiliated with Jawaharlal Nehru Medical College, Belagavi. The process followed a systematic and structured approach to ensure accuracy, reproducibility, and compliance with ethical standards.

A prevalidated structured case record form (CRF) was used to capture all relevant information from patients presenting with symptoms and electrocardiographic (ECG) changes suggestive of myocardial ischemia. Each case was evaluated by an attending emergency physician, and the data were verified by a cardiology consultant prior to inclusion.

Demographic and Clinical Variables

Demographic details such as age, sex, residential background (urban/rural), occupation, socioeconomic status, and education level were recorded. Clinical parameters included presenting symptoms, duration of chest pain, presence of dyspnea, radiation of pain, and associated autonomic symptoms such as diaphoresis or syncope.

Baseline vital parameters—heart rate, blood pressure, oxygen saturation (SpO₂), and respiratory rate—were noted at admission. Initial ECG findings were documented, including ST-segment elevation, depression, or T-wave inversions. Laboratory investigations (complete blood count, renal function, lipid profile, cardiac enzymes including troponin-I and CK-MB) were recorded when available.

Comorbidities and Lifestyle Factors

The presence of established cardiovascular risk factors was systematically assessed, including hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking or alcohol use. In addition to traditional risk factors, newer lifestyle-related factors were explored. Data on dietary habits (vegetarian or mixed diet, frequency of fast-food intake, consumption of processed and reheated foods) and physical activity level were collected using a standardized questionnaire.

Digital and Behavioral Determinants

Given the growing influence of digital habits on health, detailed information was collected regarding screen time exposure, defined as the average daily duration of mobile phone, television, or computer use. Particular emphasis was placed on social media engagement, online gaming, and late-night screen exposure. These variables were correlated with sleep duration and quality, physical inactivity, and stress perception.

Gym and Supplement Use

Among younger and middle-aged adults, specific questions were asked regarding gym attendance, use of anabolic steroids, protein supplements, or energy drinks. The duration, frequency, and brand type were noted where possible, and participants were questioned about concurrent substance use (e.g., pre-workout stimulants or caffeine-based products).

Psychosocial and Family Data

To assess the broader impact of myocardial ischemia on personal and family dynamics, data regarding psychological stress, occupational strain, family support, and post-event social adjustment were gathered through direct interviews with patients or attendants. Patients were categorized based on self-reported levels of stress (low, moderate, severe) using a simple Likert scale. Family members were also asked about changes in the patient’s behavior, emotional well-being, and daily functioning after the cardiac event.

Data Quality and Verification

Each form was reviewed by an independent investigator to ensure completeness. Inconsistent or missing entries were cross-checked with medical records or verified through direct communication with patients. To maintain accuracy, the collected data were double-entered into a secured digital database using Microsoft Excel and later analyzed statistically using SPSS (version 25.0).

Ethical Considerations

Ethical clearance for the study was obtained from the Institutional Ethics Committee prior to data collection. Written informed consent was obtained from all participants or their legal guardians. Confidentiality of patient data was maintained throughout, with all identifying information anonymized prior to analysis.

During the study period from October 2023 to March 2024, a total of 7,714 patients presented to the Emergency Medicine Department of KLE’s Dr. Prabhakar Kore Hospital with symptoms suggestive of myocardial ischemia. Of these, 7,564 patients met the inclusion criteria and were enrolled for final analysis after excluding those with chronic kidney disease, chronic liver disease, cerebrovascular accidents, and incomplete records. The overall mortality rate observed during the study period was 1.9% (150 deaths).

Demographic Distribution

Among the total study population, 3,757 were male (49.7%) and 3,807 were female (50.3%), resulting in a male-to-female ratio of 0.98:1.
The age of participants ranged from 18 to 85 years, with the mean age being 52.4 ± 10.7 years. The majority of cases (46%) belonged to the 41–60 years age group, followed by 28% in the 61–75 years range, reflecting the predominance of middle-aged and older adults. Notably, 14% of cases were below 40 years, highlighting the increasing trend of ischemic heart disease among younger adults.

Dietary and Lifestyle Characteristics

Dietary assessment revealed that 64.4% of participants were vegetarians while 35.6% followed a mixed or non-vegetarian diet. Among vegetarians, 71% reported frequent consumption of processed or reheated foods, while 29% adhered to freshly prepared meals.
Regarding physical activity, 68.9% of male and 65.6% of female patients were involved in moderate to heavy work, whereas 31% of males and 34.3% of females had sedentary occupations such as office-based or home-based work. The sedentary lifestyle group demonstrated a higher prevalence of obesity, hypertension, and dyslipidemia compared to those engaged in active professions (p < 0.05).

Comorbidities and Traditional Risk Factors

Among enrolled patients, hypertension was the most prevalent comorbidity, affecting 61% of the cohort, followed by diabetes mellitus (54%), dyslipidemia (47%), and obesity (36%). A significant proportion of males (29%) and females (8%) were active smokers, while alcohol consumption was reported in 24% of males and 3% of females.
A family history of premature ischemic heart disease was present in 17% of cases. These findings confirm that traditional cardiovascular risk factors continue to play a major role in the development of myocardial ischemia within this population.

Emerging Risk Factors

Emerging behavioral and lifestyle risk factors were strongly represented in the study cohort.

• Digital exposure: Nearly 72% of patients reported daily screen time exceeding 5 hours, primarily for social media use or entertainment. Among younger participants (<40 years), this figure rose to 84%.
• Sleep disturbance:57% reported irregular sleep cycles or sleep duration of less than 6 hours per night.
• Psychological stress:68% of participants experienced moderate to severe occupational or emotional stress. Stress levels were significantly higher among the sedentary and digitally active groups (p < 0.01).
• Supplement use: Among males aged 20–45 years, 12% admitted to using protein or anabolic supplements regularly. These individuals also had higher rates of elevated LDL cholesterol and early-onset ischemic changes.

These findings suggest a notable contribution of modern lifestyle habits—particularly stress, poor sleep hygiene, and digit al overuse—to the burden of myocardial ischemia.

Religious and Sociocultural Distribution

The religious distribution was as follows: Hindus (60.5%), Muslims (29.5%), and Christians (10%). There was no statistically significant difference in ischemic burden between religious groups (p > 0.05), though diet and occupation patterns differed modestly across groups. The socioeconomic analysis revealed that 58% of participants belonged to the middle-income group, followed by 28% low-income and 14% high-income categories.

Hospitalization and Outcomes

The mean hospital stay among survivors was 4.2 ± 1.8 days. Of the 7,564 patients, 1,246 (16.5%) required Intensive Care Unit (ICU) admission for hemodynamic instability or arrhythmias.
Reperfusion therapy (thrombolysis or primary PCI) was successfully performed in 42% of eligible cases, with an in-hospital recovery rate of 98.1%. Mortality was mainly associated with delayed presentation (>12 hours after symptom onset), uncontrolled diabetes, and multi-vessel coronary disease.

Psychosocial and Family Impact

The psychosocial component revealed significant post-event consequences:

• 61% of patients reported reduced participation in social or recreational activities following discharge.
• 58% experienced moderate to severe anxiety or depressive symptoms, particularly within the first three months post-event.
• 42% of family members reported increased emotional and financial stress due to the cost of treatment and rehabilitation.
• Marital and occupational adjustment difficulties were noted in 37% of younger male patients (<45 years).

These findings underscore the dual burden of myocardial ischemia—not only as a medical emergency but also as a chronic psychosocial challenge affecting patients and their families.

Summary of Key Findings

• Total enrolled: 7,714; Analyzed: 7,564.
• Mortality: 1.9%.
• Gender ratio: 0.98:1 (M:F).
• Predominant age group: 41–60 years (46%).
• Vegetarians: 64.4%.
• Sedentary lifestyle: 32% overall.
• Hypertension (61%) and diabetes (54%) were leading comorbidities.
• High screen time (>5 hrs/day): 72%.
• Stress prevalence: 68%.
• Protein/anabolic supplement use: 12% among young males.
• Psychosocial impact: 61% reported impaired family or social function.

The present study demonstrates that myocardial ischemia is not solely driven by conventional risk factors but also by evolving lifestyle and psychosocial determinants. The findings correspond to those of Yusuf et al. (2020), who highlighted modifiable behavioral risks as major contributors to CVD worldwide. Similarly, Garcia et al. (2021) observed that psychological distress significantly increased the risk of recurrent cardiac events in young survivors of myocardial infarction.

Prolonged exposure to mobile screens and social media contributes to sedentary behavior, disrupted sleep, and stress—all linked to increased cardiovascular risk. A similar trend was documented by Qiu et al. (2024), establishing screen time as an independent risk factor for developing cardiovascular diseases. Our study also confirms the impact of unhealthy dietary patterns and the growing misuse of performance-enhancing supplements among youth, consistent with Kayapinar et al. (2018). These results highlight the necessity of public health interventions promoting balanced diet, mental well-being, and moderation in technology use.

Beyond clinical implications, the psychosocial aftermath is significant. Post-ischemic patients frequently experience anxiety, depression, and reduced family compatibility. The economic burden of treatment further compounds the problem, affecting both individual livelihood and household stability. Therefore, comprehensive management of myocardial ischemia must include psychosocial counseling, lifestyle modification, and family education.

The present study emphasizes that myocardial ischemia remains a major public health challenge, not only due to its high morbidity and mortality but also because of its growing prevalence among younger adults. The findings demonstrate that while traditional cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, and obesity continue to dominate, emerging lifestyle-related and psychosocial determinants are rapidly gaining significance in contemporary clinical practice.

The increasing influence of digital screen exposure, sedentary behavior, psychological stress, and unhealthy dietary habits underscores the evolving nature of myocardial ischemia in the modern era. The misuse of anabolic steroids and protein supplements among young individuals pursuing body enhancement trends adds a new dimension of concern. These lifestyle and behavioral patterns, when coupled with preexisting risk factors, potentiate early-onset ischemia and contribute to recurrent cardiac events.

Beyond the clinical burden, this study highlights the psychosocial and economic repercussions of myocardial ischemia. Post-event depression, anxiety, occupational challenges, and family strain substantially affect the patient’s recovery and reintegration into daily life. The disease, therefore, extends its impact from an individual’s physiology to the broader social fabric—reducing productivity, increasing healthcare expenditure, and affecting family well-being.

Given these multifactorial contributors, the cornerstone of addressing myocardial ischemia lies in primordial and primary prevention. Early identification of at-risk individuals, community-based screening programs, and lifestyle modification should be prioritized at both individual and policy levels. Encouraging regular physical activity, balanced nutrition, adequate sleep, stress management, and digital discipline can effectively reduce the onset of ischemic events. Health education initiatives targeting schools, workplaces, and digital platforms can play a pivotal role in reshaping public awareness toward cardiovascular wellness.

From a healthcare systems perspective, it is imperative to strengthen preventive cardiology units and integrate psychosocial counseling within cardiac rehabilitation programs. Family-centered education should be emphasized to foster emotional resilience and social support for recovering patients. Policies promoting affordable cardiac care, workplace wellness programs, and digital health literacy will further enhance long-term outcomes.

In summary, myocardial ischemia represents not only a cardiovascular disorder but a multifaceted lifestyle and societal challenge. A combined approach encompassing medical management, preventive strategies, and psychosocial rehabilitation is essential for reducing disease burden. Through comprehensive, multidisciplinary efforts involving clinicians, policymakers, and the community, it is possible to mitigate the rising incidence of ischemic heart disease and improve both clinical and social outcomes for affected individuals and their families

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