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The incidence of coronary artery disease in Singapore has shown a rapid rise in recent years, however, there is a subjective impression that the prevalence of atherosclerotic peripheral artery diseases, although sharing common aetiological factors with coronary artery disease, has not shown a similar rise. We set out to determine the incidence of occlusive peripheral artery diseases of the lower limb in a selected population of Asian patients using a non-invasive test and we analysed the risk factors. The overall prevalence of peripheral artery disease of the subjects as determined by an abnormal ankle brachial index less than 0.9 in at least one limb was 19.1%. Increasing age, hypercholesterolemia and smoking were risk factors. In patients with proven coronary artery disease, abnormal ankle brachial indices were present in 21.3% of patients with angiographic evidence of coronary artery disease but in only 13.0% of those without. In this study, the incidence of peripheral artery disease in this selected Asian population was high. With the increasing availability of vascular laboratories and awareness of the diseases, we can expect to see increasing numbers of patients presenting with these problems.

Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long-term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty-nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with perioperative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow-up ranged from 3 to 54 months. There were no late deaths. It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal.(ABSTRACT TRUNCATED AT 250 WORDS)

Over the last 10 years, there has been a reduction of surgical mortality in coronary bypass grafting for left main coronary artery disease. Most of the available literature reports are of Caucasian populations. We report our experience of the surgical treatment of this disease in a predominantly Oriental population. From 1 January 1987 to 30 June 1991, 86 consecutive patients had coronary artery bypass surgery for left main stenosis. There were 65 men and 21 women with an age range of 34 to 80 years (mean age: 58 years SD +/- 8.63). There were no operative deaths and 1 hospital death (1.2%) from a non-cardiac cause. The perioperative myocardial infarction rate was 3.5% (3/86). These results are better than some earlier series in which hospital mortality was reported as high as 12.6% and the preoperative myocardial infarction rate 11.8%. In this series where the patients are predominantly Oriental, the results are comparable if not better than in series reported in centres where the population is predominantly Caucasian.