Half of heart attack patients in Pakistan under 49, NICVD study finds new drug as effective as standard therapy
KARACHI: Nearly half of Pakistan’s heart attack patients are younger than 49, with up to 15% under 40, according to new data from the National Institute of Cardiovascular Diseases (NICVD). Cardiologists warn that rising rates of diabetes, hypertension, obesity, smoking, and sedentary lifestyles are pushing Pakistan into the global lead for early-age heart attacks.
The findings were shared at a symposium in Karachi, where NICVD researchers presented results from the RIVAWAR trial — the largest randomized study to date comparing two anticoagulants for acute left ventricular thrombus (LVT), a dangerous blood clot that forms in the heart after a severe heart attack and can cause stroke.
RIVAWAR Trial — Largest study of its kind in Pakistan
Conducted independently by NICVD’s cardiology team from June 7, 2021, to December 31, 2023, the RIVAWAR trial enrolled 261 post–heart attack patients with confirmed LVT within seven days of their heart attack. Most had severe ST-segment elevation myocardial infarction (STEMI) and reduced heart pumping capacity.
Patients were randomly assigned to receive either rivaroxaban, a newer direct oral anticoagulant, or warfarin, the decades-old standard therapy.
Principal investigator Dr Jehangir Ali Shah reported that rivaroxaban achieved faster clot resolution in the early phase — 20% at four weeks compared to 8.3% with warfarin — while both drugs had similar high success rates by 12 weeks. Importantly, no strokes occurred among participants during the trial.
“This is the largest randomized trial in acute LVT to date, and the results show rivaroxaban to be a safe, effective alternative to warfarin,” Dr Shah said. He noted that 15% of participants were under 40 years old.
Public health warning on young heart attacks
NICVD’s Director of Cath Lab, Dr Abdul Hakeem, stressed that Pakistan has the world’s highest rate of young heart attack patients. “Every third adult has diabetes, 40% have high blood pressure, obesity is common, and smoking rates remain high. Many patients don’t realize they’re at risk because loose clothing hides weight gain,” he said.
He added that nine out of ten patients had no severe chest pain, but rather chest heaviness or acidity-like discomfort — symptoms often ignored until it’s too late. “If you feel chest heaviness while walking or climbing stairs, get an ECG immediately,” he urged.
Reducing stroke risk after heart attack
Dr Hakeem warned that the most dangerous anterior heart attack can damage up to 60% of heart muscle and often leads to LVT formation within 4–8 weeks, significantly increasing stroke risk.
NICVD Executive Director Dr Tahir Saghir announced upcoming trials on drug-coated balloons that could reduce future artery blockages without stents — research already supported by international funding.
Senior cardiologist Dr Nadeem Rizvi and Dow Institute of Cardiology Director Dr Tariq Furman stressed the importance of locally generated data for treatment guidelines, noting that Western dosing recommendations often do not suit Pakistani patients due to genetic and physiological differences.
Locally made drug, lower costs
The trial used a locally manufactured version of rivaroxaban, eliminating the need for frequent blood monitoring required with warfarin — a potential cost-saving advantage in Pakistan’s resource-limited healthcare system.
Pharmevo’s Abdul Samad said supporting RIVAWAR reflected the company’s commitment to advancing evidence-based care. “These results will help guide treatment choices for post–heart attack clots, and we will continue supporting medical research so effective medicines are available locally,” he said.
Researchers believe early LVT diagnosis and treatment could prevent thousands of strokes among Pakistani heart patients every year.
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