Asseaament of Carotid Arteries in Yemenis Khat Chewers Usine Medical Duplex Ultrasonography

Abstract

Chewing Khat is considered as a major deep-rooted sociocultural habit in Yemen. it has been established to cause various health problems. The main objective of this study was to assess the changes of carotid arteries intima media thickness, flow velocities, and Doppler indices of in Yemenis Khat chewers using medical duplex ultrasound. This prospective cross sectional study was achieved from July 2017 to July 2018 with 205 Subjects 108 (52.7%) as chewers and 97(47.3%) non-chewers, 10 subjects are excluded according to restricted sampling criteria. The mean age in two groups was 28.29 ± 7.0 years. In all cases, the carotid duplex ultrasound scanning protocol, based on the standard of American institute of ultrasound in medicine, was performed to get measurement of intima media thickness, peak systolic velocity, end diastolic velocity, resistivity index, and pulsatility index. The Khat chewing information of participants were obtained by standardized questionnaire. The SPSS was used for results analysis and p-value ≥ 0.05 was considered significant. There was no statistically significant difference in the mean values of RT CCA-IMT and LT CCA-IMT between khat chewers and non-khat chewers. The CCA-MIT was significantly higher among male khat chewers compared to male non-chewers (P = 0.004). However, there was no statistically significant difference between khat chewers and non-chewers with respect to the age of 20 years or older (P = 0.301) and BMI of 18.5 kg/m2 or higher (P = 0.888). Age showed a significant positive correlation with RT CCA-IMT (r = 0.380; P < 0.001) and LT CCA-IMT (r = 0.458; P < 0.001) in Khat chewers. In contrast, age showed a significant positive correlation with LT CCA-IMT only in non-khat chewers (r = 0.236; P = 0.024). On the other hand, BMI showed a significant positive correlation with LT CCA-IMT (r = 0.254; P = 0.010) among khat chewers, but no significant correlation was found in CCA-IMT of both sides among non-khat chewers. Among khat chewers, there was a significant positive correlation with RT CCA-IMT (r = 0.273; P = 0.005) and LT CCA-IMT(r = 0.194; P = 0.049). This study showed the differences between Khat and non-Khat chewers regarding Doppler parameters. A significantly decreased RI and PI was observed in all CAs of the Khat chewers’ group compared to those of the non-Khat chewers, except for bilateral ICA (p = .701, and .178) for RT and LT respectively. A decreased PSV was also observed in all bilateral CAs of the Khat chewers’ group compared to those of the non-Khat chewers, but these were statistically significant only in the RT CCA (p < 0.001) and RT ICA (p = 0.042). In the Khat chewers group, the PSV had a significantly negative correlation with the period of chewing only in the RT CCA (p = 0.01), left CCA (LT CCA) (p < 0.001) and ECA (p = 0.005). There was no significant difference in Doppler parameters between genders in the Khat Chewers group. Moreover, higher carotid flow velocities in males compared to females were observed in the control non-Khat chewers group. But this trend did not reach statistical significance except that of RT CCA PSV (p < 0.001). Doppler indices had a significantly negative correlation with the period of chewing in the bilateral CAs, except in the RT ICA RI (p = .117) and LT CCA PI (p = .055), in the Khat chewers’ group. Therefore, the study concluded that chronic Khat chewing may slightly affect the CCA-IMT. And the age has a significant positive correlation with CCA-IMT in khat chewers and LT CCA-IMT in non-khat chewers, which could help to determine the contribution of different predisposing factors to atherosclerosis. And this study may provide an interpretation of high prevalence and mechanism of hemorrhagic stroke among Yemeni population in their middle age, and the correlation of chronic chewing Khat to this type of stroke more than ischemic one. More studies are recommended to confirm this finding using the transcranial Doppler technique