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Khat chewing and cardiovascular risk profile in a cohort of Yemeni patients with angiographically documented coronary artery disease

Heart Asia, 12/07/2012

Shujaa AK et al. – The authors sought to explore the prevalence of khat chewing and cardiovascular risk profile in a cohort of Yemeni patients with angiographically documented coronary artery disease (CAD). In Yemeni patients undergoing elective coronary angiography, khat use was highly prevalent, whereas several classic risk factors were relatively infrequent. None of the risk factors or khat use differed substantially with the extent of CAD.

Dr Wail Nammas (12/10/2012) comments:

It is estimated that 20,000,000 people are using khat worldwide [1]. The problem of khat is not rare in Western countries. It was reported that 7 metric tons of khat pass through the Heathrow airport in London weekly [2]. In the United States, East African and Yemeni independent dealers are distributing khat [3]. In order to preserve its efficacy for a longer period of time, several synthetic forms were developed, including hagigat, mephedrone, and graba. Hagigat (capsules containing 200 mg of cathinone) is labeled as a natural stimulant in Israel [4]. Cathinone, the prime active substance in khat, acts as an indirect sympathomimetic alkaloid inducing the release of catecholamines from central dopaminergic and serotonergic synapses, as well as from peripheral norepinephrine storage sites [5-7]. Khat use was reported an independent risk factor for myocardial infarction [8]. Khat users presenting with acute coronary syndrome had worse in-hospital and one-year outcome, as compared with non-users [9].
We sought to explore any possible relationship between khat use and the extent of coronary artery disease (CAD) - in terms of the number of vessels affected by significant coronary stenosis (?50%) - in stable patients undergoing elective coronary angiography. We enrolled 100 consecutive Yemeni patients who underwent elective coronary catheterization. Patients were classified into 2 groups: khat users and non-users, and were assigned according to the number of affected coronary arteries as having single-vessel, two-vessel, or multi-vessel disease. The distribution of single- two-vessel and multi-vessel disease was matched between the two groups (p >0.05). We concluded that in patients with stable angina pectoris undergoing elective coronary angiography, the extent of CAD was matched between khat users and non-users.
1. Corkery JM, Schifano F, Oyefeso S, et al. “Bundle of fun” or “bunch of problems”? Case series of khat-related deaths in the UK. Drugs: Education, Prevention, and Policy 2011;18:408-25.
2. Griffiths P. Qat use in London. A study of qat use among a sample of Somalis living in London. Home Office Drug Prevention Initiative. London: Home Office 1998.
3. Hansel J. Mayo Clinic studies Khat chewing. PostBulletin Journal. chewing.html. Accessed July 16, 2012.
4. Bentur Y, Bloom-Krasik A, Raikhlin-Eisenkraft B. Illicit cathinone (“Hagigat”) poisoning. Clin Toxicol (Phila). 2008;46:206-10.
5. Pehek EA, Schechter MD, Yamamoto BK. Effects of cathinone and amphetamine on the neurochemistry of dopamine in vivo. Neuropharmacology 1990;29:1171-6.
6. Kalix P. The pharmacology of khat. Gen Pharmacol 1984;15:179-87.
7. Kalix P. Effects of the alkaloid cathinone on the release of radioactivity from rabbit atria prelabelled with 3H-norepinehrine. Life Sci 1983;32:801-7.
8. Al-Motarreb A, Briancon S, Al-Jaber N, et al. Khat chewing is a risk factor for acute myocardial infarction: a case-control study. Br J Clin Pharmacol. 2005;59:574-81.
9. Ali WM, Al Habib KF, Al-Motarreb A, et al. Acute coronary syndrome and khat herbal amphetamine use: an observational report. Circulation. 2011;124:2681-9.

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