ArticlePDF Available

Assessment of Risk Factors in Patients With Myocardial Infarction

Authors:

Abstract and Figures

Background: Coronary artery diseases (CAD) are one of the important health problems in the world, although considerable progresses have been made to decrease the mortality, they are still the first cause of death in many countries. Hence, the necessity of examining effective factors and risk factors on CAD can be one of the most important health priorities in many countries like Iran. Objective: This study was performed to assess the risk factors in patients with myocardial infarction (MI) in Zahedan. Materials & methods: This is a cross sectional study in which 213 patients were examined. They had been diagnosed to have heart failure. Data gathering took 18 months. Data gathering tool was a designed checklist which was filled up by an experienced nurse during interview. Obtained results were recorded in files and analyzed in SPSS 21. Results: Results showed that 70% of patients were women and only 30% were men. 48% of them were illiterate and patients mean age was 58.3. SD had been 12.6. The mean of pain onset time till referring to hospital was 11 hours with SD of 2.1. 17% of patients (coronary artery diseases history), 25.5% (hypertension history), 26% (diabetes history), 15.5% (cholesterol history), 13% (smoking) and 3% have reported CABG history. The majority of people who referred had inferior MI (40.4%). 67.1% normal rhythm, 2.8% atrial fibrillation and 16% had ventricular tachycardia. Statistical tests showed a significant correlation between sex and the mean of referring time (p<0.05) but the relation between age and referring time was not significant. Conclusion: Effective risk factors on MI were recognized in this study. Some of them such as age, sex and education cannot be modified but many are controllable such as hypertension, diabetes, cholesterol, and smoking and on time referring after pain onset. Having considered the results of this study health promotion for society and especially vulnerable people can be provided by omitting or reducing risk factors.
Content may be subject to copyright.
Global Journal of Health Science; Vol. 8, No. 1; 2016
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
255
Assessment of Risk Factors in Patients With Myocardial Infarction
Fatemeh Kiani1, Nasrin Hesabi1 & Azizollah Arbabisarjou1
1 Health Promotion Research Center, Zahedan University of Medical Sciences Zahedan, IR, Iran
Correspondence: Nasrin Hesabi, Health Promotion Research Center, Zahedan University of Medical Sciences
Zahedan, IR, Iran. E-mail: Nasrin 215@yahoo.com
Received: December 24, 2014 Accepted: March 4, 2015 Online Published: May 28, 2015
doi:10.5539/gjhs.v8n1p255 URL: http://dx.doi.org/10.5539/gjhs.v8n1p255
Abstract
Background: Coronary artery diseases (CAD) are one of the important health problems in the world, although
considerable progresses have been made to decrease the mortality, they are still the first cause of death in many
countries. Hence, the necessity of examining effective factors and risk factors on CAD can be one of the most
important health priorities in many countries like Iran.
Objective: This study was performed to assess the risk factors in patients with myocardial infarction (MI) in
Zahedan.
Materials and Methods: This is a cross sectional study in which 213 patients were examined. They had been
diagnosed to have heart failure. Data gathering took 18 months. Data gathering tool was a designed checklist
which was filled up by an experienced nurse during interview. Obtained results were recorded in files and
analyzed in SPSS 21.
Results: Results showed that 70% of patients were women and only 30% were men. 48% of them were illiterate
and patients mean age was 58.3. SD had been 12.6. The mean of pain onset time till referring to hospital was 11
hours with SD of 2.1. 17% of patients (coronary artery diseases history), 25.5% (hypertension history), 26%
(diabetes history), 15.5% (cholesterol history), 13% (smoking) and 3% have reported CABG history. The
majority of people who referred had inferior MI (40.4%). 67.1% normal rhythm, 2.8% atrial fibrillation and 16%
had ventricular tachycardia. Statistical tests showed a significant correlation between sex and the mean of
referring time (p<0.05) but the relation between age and referring time was not significant.
Conclusion: Effective risk factors on MI were recognized in this study. Some of them such as age, sex and
education cannot be modified but many are controllable such as hypertension, diabetes, cholesterol, and smoking
and on time referring after pain onset. Having considered the results of this study health promotion for society
and especially vulnerable people can be provided by omitting or reducing risk factors.
Keywords: risk factors, myocardial infarction
1. Background
Coronary heart disease (CHD) is the most common serious disease in industrialized communities and a fast
developing health problem in developing countries. These diseases have caused mortality in developed countries
more than other diseases and impose numerous social and economic costs. These diseases are now seen in
countries with low or average income which also have the majority of population. These diseases will probably
turn into the most common cause of death in world till 2020 (Fauci et al., 2008).
During recent decades developed countries have been able to decline the coronary heart diseases mortalities
significantly by preventive actions. They have passed the outbreak stage of this epidemic and the disease
mortality has dramatically declined in them (Rossignol et al., 2012).
It seems that the mortality of these diseases will increase in developing countries due to lack of familiarity with
coronary heart diseases risk factors and failure to comply preventive principles. Based on health ministry
statistics mortality of these diseases is progressing in Iran so that 70 per cent of death in Iran is due to heart
diseases and also 15 to 17 million in the world annually (Akbari, Mohammadzadeh, Rajabpoor, & Azim Poor,
2009).
One of the diagnosis methods is examining the affected patients (Sezavar, Valizadeh, Moradi Lakeh, & Rahbar,
2010). Some of the risk factors of coronary heart disease are uncontrollable like senility, being male and history
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 1; 2016
256
of atherosclerosis that are considered uncontrollable as risk factors but many of them can be modified like
hypertension, hyperlipidemia , mellitus diabetes and smoking cigarette which are commutable risk factors of
coronary artery disease (Andreoli, Carpenter, Griggs, & Benjamin, 2007). Studies results shows that CAD is not
incidental and affected people can be found by clinical symptoms (Kwak, Myung, Lee, & Seo, 2012). Cigarette
is the most preventive risk factor. The effect of smoking cessation in smokers with coronary artery stenosis
equals to that of surgery (Sivaraman, Hausenloy, Wynne, & Yellon, 2010). The relationship between nutritious
factors and blood lipids levels has also been examined in human groups in randomized studies (Ellingsen,
Hjerkinn, & Arnesen, 2006; Baxter, Coyne, & McClintock, 2006). Now even the positive effect of cholesterol
decline in healthy people who have normal cholesterol level has been proved (Sivaraman et al., 2010).
Clinically cigarette decreases high density lipoproteins (useful lipids) and increases low density lipoproteins
(harmful lipids) and blood glucose. Reduce in serum cholesterol average and hypertension after CAD has been
proved (Kathleen, Zubair, & Belgin, 2006; Yarnell, Christopher, & Hugh, 2005). Clinically cardiac enzymes and
ECG can be one of ways of diagnosing heart failure. Cardiac enzymes changes can be observable in ECG of
myocardial infarction patients (Zipes, Bonow, & Braunwalds, 2006).
Prevalence of cardiovascular diseases is high in our society. Preventive measurements can be done by precise
recognition of patients. Other studies have only mentioned specific aspect of disease. The purpose of the study
was to assess risk factors in MI patients and determine clinical criteria for patients with MI who referred to
Khatm-Al Anbia-hospital affiliated to Zahedan University of Medical Sciences, Iran during 2013-2014. This
hospital is the oldest hospital in Zahedan and one of the largest hospitals that have CCU wards. It is possible to
provide more accurate information for health authorities by determining risk factors.
2. Materials and Methods
This cross-sectional study was done using interview with MI patients and their records (based on WHO/AHA
criteria). Diagnosing severe MI requires the followings based on WHO/AHA criterions.
1. Increase or decrease of biochemical typical markers of myocardial necrosis with at least one of the
following: signs of ischemia, pathologic Q wave rise in ECG changes in ECG that is indicative of
ischemia (rise or fall of ST segment).
2. Pathologic factors of one AMI (Libby, Bonow, Mann, & Zipes, 2008).
The study was done through interviews and patients’ records. 213 patients with acute MI who referred to Khatam
Al Anbia hospital in Zahedan filled out checklists during 18 months. Patients with definitive diagnosis of MI
were hospitalized and examined in CCU wards of Khatam hospital.An experienced and trained nurse gathered
the data.
The used checklist was consisted of four parts. The first part included demographic data like age, sex, education
and residence. The second part included pain onset time, emergency hospitalization time, CCU hospitalization
time. The third part included questions related to coronary artery disease history and its duration, hypertension
history and its duration, diabetes history and its duration, cholesterol and its duration, history of smoking
cigarette and its duration, CABG history and its duration, receiving thromboembolism kinase drug, laboratory
tests such as Troponin T,I; CKMB; rhythm type, hospital discharge status and drugs taken ( anticoagulant, nitrite,
Clonidine, Statins, diuretics and beta-blockers) finally patients information and kinds of MI have been completed.
Kinds of MI, the most common observed dysrhythmia, and drugs taken have been mentioned in the fourth part.
The data were entered to the SPSS21. Significance level index was 0.05.
3. Results
There were 70% (149) male participants and 30% (64) females. The mean of participants age 58.3, SD 12.62,
minimum age 29 and maximum age was 100. 48.4% of participants were illiterate. 24.9% had elementary
education, 16.4% diploma, and 26.7% university degree. 10.3% of those with MI had university degree. 88.3%
of participants resided in Zahedan and others resided in Sistan and Balouchestan province towns or out of
province. Pain onset time had been 14% (in most cases) between 8 and 9 o’clock, and totally 33.5 % of patients
have stated pain onset time between 9 and 12 in the noon. 36.6% of them have reported the pain between 13 till
20 and 25.9% between 21 and 6 o’clock.
The mean of pain onset time duration until emergency reception was 11 hours with SD of 21. Referring time was
at least 15 minutes and at most 169 hours. The time interval between emergency receptions until CCU had been
at least 10 minutes and at most 2 days.
Frequency of other diseases history of patients are the following:
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 1; 2016
257
22% history coronary artery disease, 25.5% history of hypertension, 26% history of diabetes, 15.5% cholesterol
history, 13% history of smoking cigarette, and 3% have reported CABG history (Table 1).
Table 1. Assessment of risk factors in patients with MI
Risk factor Number percent
CAD history 36 17
Diabetes 56 26
Hypertention 54 25.5
CABG 7 3
Cholesterol 32 15.5
Smoking cigarette 28 13
Total 213 100
Different kinds of reported MI
The findings showed different kinds of MI as following:
Inferior lateral MI (4.7%), inferior MI (40.4%), anterior MI 25.5%, anteseptal MI 9.4% and 20% had been other
MIs (Table 2). Regarding ST segment changes, ST segment elevation was observed in most cases (90%).
Table 2. Different kinds of reported MI in Patients
Kind of MI Number Percent
Inferior lateral 10 4.7
inferior 85 40
Anterior 55 25.5
Ant septal 20 9.4
Other MI 43 20
Total 213 100
A statistically significant correlation was observed between pain onset time until referring to hospital with sex so
that the mean of referring time was 9 hours for men and 17 hours for women. 67.1% of Patients had normal
rhythm. 2.8% atrial fibrillation, 16% ventricular tachycardia, 3.1% right and left bundle branch block, 2.8%
Mobitz type 2, 1% CHB and 0.5% had junctional rhythms.
The mean of participants’ age was 58.3+-12.6. (Minimum 29 and maximum 100). This study is very similar to
that of Sezavar & et al; they have reported the mean of age of patients with MI 59 which is more than that of
south Asia and Middle-East patients (14). Youngest population of patients with the first AMI resided in south
Asia (age mean 53 years old) and Middle East (51 years old). The oldest population had been residents of
Western Europe, China and Hong Kong (63 years old).
70% of participants were men in our study which has been mentioned 84% versus 16% in other studies, this ratio
had been more for men than women in other studies for example these have been proved in studies of Yousef et
al. (2004) and Ismail et al. (2004). 20% of all MI receptions have been MI less than 55 for men and less than 65
for women in U.K (Chow, Pell, Walker, O'Dowd, Dominiczak, & Pell, 2007).
Regarding ST segment changes, ST segment elevation was observed in most cases (90%). A statistically
significant correlation was observed between pain onset time until referring to hospital with sex so that the mean
of referring time was nine hours for men and 17 hours for women. Patients (67.1%) had normal rhythm. atrial
fibrillation(2.8%), ventricular tachycardia (16% ), right and left bundle branch block (3.1%), Mobitz type 2
(2.8% ) , CHB (1% ) and 0.5% had junctional rhythms.
The mean of participants’ age was 58.3+-12.6. (Minimum 29 and maximum 100). This study is very similar to
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 1; 2016
258
that of Sezavar & et al. In their study, they have reported the mean of patients age with MI 59 which is more than
that of south Asia and Middle East patients (Yusuf et al., 2004).Youngest population of patients with the first
AMI resided in south Asia(age mean 53 years old) and Middle East (51 years old). The oldest population had
been residents of Western Europe, China and Hong Kong (63 years old). Participants (70%) were men in our
study which has been mentioned 84% versus 16% in other studies. This ratio had been more for men than
women in other studies for example these have been proved in study of Esmaeel & Yousef (Fred, 2010; Ismail et
al., 2004; Yusuf et al., 2004). 20% of all MI receptions have been in England; MI less than 55 for men and less
than 65 for women (Chow et al., 2007; Ismail et al., 2004).
Clinical assessment sciences institute in Canada carried out a study on 4403 patients in Ontario Canada. They all
had heart attack records which showed that mean of their age (67.3 years) and 33.7% were women. Statistics
showed that numbers of married men who have been taken to hospital after heart attack faster were more than
single ones, but in contrast there has been no relationship between marital statuses of women with arrival speed
to hospital after experiencing chest pain related to heart attack which indicates that women take care of their
husbands better (Chow et al., 2007; “Iranian Students' News Agency - ISNA,” 1998-2013). 48.4% of participants
were illiterate in the present study. Results of a study showed that the majority of patients 79.1% did not have
any information about the initial symptoms of MI (Akbari et al., 2009). Illiteracy lead to ignorance and
uneducated people certainly have lower level of health behaviors and preventive behaviors. Providing
information by mass media and correct planning by health centers is needed for secondary prevention. It is
recommended to provide necessary information for public education and also training and counseling for older
patients with higher risk of heart disease.
23.5% of patients have reported the pain onset time between 12:00 till 6:00 in the morning. Results of the study
of Goff et al. (Goff et al., 2007) showed that analysis of patients with MI diagnosis indicated that circadian cycle
for MI had been between 6:00 am and 12:00 pm (Ellingsen et al., 2005). Most MI occurrence time had been in
the morning, preventing it needs planning for public awareness in societies which are more prone to acute MI.
The mean of pain onset time duration until emergency reception is eleven hours. Another study which was
carried out in Uremia. It was mentioned 80 hours and 36 minutes (Akbari et al., 2009). Streptokinase drug which
is recommended as a fibrinolytic drug for patients with chest pain, its highest effect is the first 30 minutes after
MI ("Iranian Students' News Agency - ISNA," 1998-2013; Janszky et al., 2012; Khan et al., 2007). Other
resources have mentioned that drug effectiveness rate for revascularization (by tromboliza , angioplasty or both)
depends on the interval of coronary artery obstruction beginning and reperfusion (Herman & Walsh, 2011;
Janszky et al., 2012; Taghadosi, Seyedi, & Mosavi, 2007).pain onset time had been 11 hours in our study while
results of Mirzaei’s study which was carried out in Kerman showed that it lasts 2 hours from chest pain
beginning till referring to health centers that is much different from our study (Bagherian Sararoodi, Saneei, &
Bahrami Ehsan, 2010; Mirzaei, Mohammad, & Bagherian, 2005).what reasons have caused this delay? It seems
that we can divide delay time from beginning till hospitalization at CCU ward in the following three stages:
(1). Time needed for patients to make decisions, state their illness and ask help.
(2). Moving the patient from the place of pain onset to emergency or health centers.
(3). Delay time between hospital emergency to hospitalization at CCU ward, but in these all three stages other
factors are also important.
The second part has not been attended in our study; in fact the first and the third stages are combined in our study.
It was recognized in this study that most of the delay time had been related to patient decision making for asking
help and other stages were less important regarding wasting time. Results of the study of Taghadosi et al.
(examining the reasons and amount of MI patients referring delay to Shahid Beheshti hospital of Kashan in 1383
showed that 89% of patients had more than 8 hours delay in referring to emergency (Anand et al., 2008;
Taghadosi et al., 2007). Lokker has stated pain beginning time till reaching to hospital 110 minutes and African
women had the most delay (Lokker et al., 2015). Women had more delay than men in our study. The reason of
this delay may be higher pain tolerance threshold in women or more MI prevalence in men. Women do not
attribute chest pain to heart and its diseases and do not do anything to reduce it (Afzal, Korniyenko, & Haq,
2015). Women suffer from MI when they are older which may decrease pain for them and make them more
tolerable (Taghadosi et al., 2007). 30.5% of patients had hypertension history in this study. The role of
hypertension in heart complications and its outcomes in MI patients is not unknown to anyone. Probably patients
after MI with hypertension expect more MI unpleasant outcomes and consider their illness less controllable and
curable compared to patients without hypertension (Bagherian Sararoodi et al., 2010; Gaziano, 2005).
Hypertension risk factors and diabetes had more relation to MI in women than men in study of Anand et al.
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 1; 2016
259
(Anand et al., 2008; Kazemy & Sharifzadeh, 2010). Tobacco smoking has been under the influence of cultural
and historical backgrounds of societies; women smoked less than men in most societies which clearly explains
low MI rate in young women compared to men. Molarris et al. recognized in their study that among attributed
risk factors to MI patients, smoking cigarette and hypercholesterolemia is more in young individuals and
hypertension, diabetes and CAD is more in older ones (Morillas et al., 2002). Studies have demonstared that
heavy smoking is the most important factor of early MI (Gaziano, 2005). Our study does not conform to other
studies in this background. Diabetes 26%, hypertension 25.5%, CAD history 17%, high cholesterol history
15.5% CABG 3% and smoking 13% had been the most important risk factors in the aforementioned patients
respectively.
It was recognized in other studies that annual mortality had been 26% in diabetic patients and 14% in
non-diabetic ones. The mortality of diabetic patients with MI had also been higher than non-diabetic ones
(Akbari et al., 2009; Erlinge et al., 2014; Kazemy & Sharifzadeh, 2010; Lee & Chou, 2003). This ratio rises if
hypertension and diabetes are both existent (Kazemy & Sharifzadeh, 2010). Anatomically the most prevalent
kind of MI is respectively inferior 40.4%, anterior 25.8%, anteseptal 9.4% and the least is lateral MI. It is 53%
inferior and 40% anterior in Soltani et al. study (Kazemy & Sharifzadeh, 2010; Soltani MH, 2005). Infarction
section is a prognosis factor and anterior infraction has a more severe prognosis (Perkins-Porras, Whitehead,
Strike, & Steptoe, 2009).It was recognized in Soltani’s study that patients with wide anterior infarction have had
more intra hospital and annual death compared to the other infractions. Anterior infarction causes 31% of death
compared to the 15% of inferior infraction (Soltani MH, 2005; Z, 2004).
It was recognized in our study that 90% of patients show ST segment rise while other resources have emphasized
that early thrombolytic treatment reduces mortality especially that of MI with rise of ST segment and lethal
rhythms. Since thrombolytic treatment depends on time, treatment beginning less than one hour is important for
these patients (Banks & Dracup, 2006; Perkins-Porras et al., 2009; Svensson et al., 2003).
Age, sex and marital status are variables which have always been under the influence of delay time in referring
to hospital, although this study did not show a significant correlation among referring delay variables and these
variables. Other various studies have stated aging in direct relation with referring delay time to hospital as an
effective factor (Banks & Dracup, 2006; Gartner, Walz, Bauernschmitt, & Ladwig, 2008; Gharakhani, Naghsh
Tabrizi, Emami, & Seif Rabiee, 2007; Goff et al., 2007; Khan et al., 2007; Leila Javadi, Masood Pezeshkian,
Abbas Afrasiabi, Alireza Garjani PhD, & Zahra Golmohammadi, 2010; Nguyen, Saczynski, Gore, & Goldberg,
2010; Perkins-Porras et al., 2009; Rezaey, Kohestany, Baghcheghy, & Yazdan Khah Fard, 2006; Sarı et al., 2008;
Svensson et al., 2003; Taghadosi et al., 2007; Z, 2004). The results of a study in province of Sistan and
Balouchestan (Iran) demonstrated that there was a significant relationship between hypertension, hyperlipidemia,
diabetes mellitus, obesity and gender (Pishkarmofrad et al., 2012).
In some studies increase of referring delay time had been effective along aging (33-35). It was recognized in our
study that referring delay time variables had been longer in women than men, which is similar to other studies
(Nguyen et al., 2010; Perkins-Porras et al., 2009; Rezaey et al., 2006; Taghadosi et al., 2007). Patients’sex has
not been related to referring delay time in some studies (Akbari et al., 2009; Gharakhani et al., 2007; Leila Javadi
et al., 2010; Rezaey et al., 2006; Sarı et al., 2008; Svensson et al., 2003). The best effect of drug is at the first
half of chest pain, highest mortalities also occur at first hours after MI and many factors have roles in creating
them. The need for attending this issue, public training of society, coping with chest pain, recognizing risk
factors and controlling them is felt more than past.
Acknowledgments
We want to express our thanks to Mr. Vahedi clinical nurse specialist in CCU of the khatam Al-Anbia hospital
who gathered the data and warmly cooperated.
Authors’ Contribution
Fatemeh kiani carried out the design, coordinated the study and prepared the manuscript. Nasrin, Hesabi edited
the manuscript and collected data. Azizollah, Arbabisarjou revised, re-edited and submitted it to this journal. All
authors’ have read and approved the content of the manuscript.
Financial Disclosure
None declared.
Finding SUpport
Personnel of Khatam-Al- Anbia hospital collaborated and provided patients records.
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 1; 2016
260
References
Afzal, A., Korniyenko, A., & Haq, S. (2015). A Bridge to a Woman's Heart as the Cause of Recurrent Chest Pain:
A Case on Myocardial Bridge. Am J Ther. http://dx.doi.org/10.1097/MJT.0000000000000215
Akbari, M., Mohammadzadeh, M., Rajabpoor, M., & AzimPoor, A. (2009). Agents connection with awareness
and act of patients that caused acute myocardial infarction encountering with clinical symptoms them to
stay in urmia hospitals. Journal of Urmia Nursing And Midwifery Faculty, 7(2), 73-80.
Anand, S. S., Islam, S., Rosengren, A., Franzosi, M. G., Steyn, K., Yusufali, A. H., . . . Yusuf, S. (2008). Risk
factors for myocardial infarction in women and men: insights from the INTERHEART study. European
heart journal, 29(7), 932-940. http://dx.doi.org/10.1093/eurheartj/ehn018
Andreoli, T. E., Benjamin, I., Griggs, R. C., Wing, E. J., & Fitz, J. G. (2010). Andreoli and Carpenter's Cecil
essentials of medicine. Elsevier Health Sciences.
Azer, S. A. (2014). Mechanisms in cardiovascular diseases: how useful are medical textbooks, eMedicine, and
Yo uT ub e ? Advances in physiology education, 38(2), 124-134. http://dx.doi.org/10.1152/advan.00149.2013
Bagherian Sararoodi, R., Saneei, H., & Bahrami Ehsan, H. (2010). The Relationship of History of Hypertension
and Illness Cognitive Representation in Post-Myocardial Infarction. Journal of Isfahan Medical School,
27(101), 710-716.
Banks, A. D., & Dracup, K. (2006). Factors associated with prolonged prehospital delay of African Americans
with acute myocardial infarction. American Journal of Critical Care, 15(2), 149-157.
Baxter, A. J., Coyne, T., & McClintock, C. (2006). Dietary patterns and metabolic syndrome-a review of
epidemiologic evidence. Asia Pacific journal of clinical nutrition, 15(2), 134.
Bennett, K., Kabir, Z., Unal, B., Shelley, E., Critchley, J., Perry, I., . . . Capewell, S. (2006). Explaining the
recent decrease in coronary heart disease mortality rates in Ireland, 1985–2000. Journal of epidemiology
and community health, 60(4), 322-327. http://dx.doi.org/10.1136/jech.2005.038638
Chow, C., Pell, A., Walker, A., O'Dowd, C., Dominiczak, A., & Pell, J. (2007). Families of patients with
premature coronary heart disease: an obvious but neglected target for primary prevention. BMJ, 335(7618),
481-485. http://dx.doi.org/10.1136/bmj.39253.577859.BE
Ellingsen, I., Hjerkinn, E., Arnesen, H., Seljeflot, I., Hjermann, I., & Tonstad, S. (2005). Follow-up of diet and
cardiovascular risk factors 20 years after cessation of intervention in the Oslo Diet and Antismoking Study.
European journal of clinical nutrition, 60(3), 378-385. http://dx.doi.org/10.1038/sj.ejcn.1602327
Erlinge, D., Gotberg, M., Lang, I., Holzer, M., Noc, M., Clemmensen, P., . . . Olivecrona, G. K. (2014). Rapid
endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary
intervention for the treatment of acute myocardial infarction. The CHILL-MI trial: A randomized controlled
study of the use of central venous catheter core cooling combined with cold saline as an adjunct to
percutaneous coronary intervention for the treatment of acute myocardial infarction. J Am Coll Cardiol,
63(18), 1857-1865. http://dx.doi.org/10.1016/j.jacc.2013.12.027
Fred, H. L. (2010). Pericardial fat necrosis: A review and update. Texas Heart Institute Journal, 37(1), 82.
Gartner, C., Walz, L., Bauernschmitt, E., & Ladwig, K. (2008). The causes of prehospital delay in myocardial
infarction. DEUTSCHES ARZTEBLATT-KOLN, 105(15), 286.
Gaziano, T. A. (2005). Cardiovascular disease in the developing world and its cost-effective management.
Circulation, 112(23), 3547-3553. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.591792
Gharakhani, M., Naghsh Tabrizi, B., Emami, F., & Seif Rabiee, M. (2007). Evaluation of the time interval
between the beginning of acute chest pain in the patients with acute myocardial infarction and admission of
them at coronary care unit and the related factors. Scientific Journal of Hamadan University of Medical
Sciences and Health Services, 14(2), 51-55.
Goff, D. C., Brass, L., Braun, L. T., Croft, J. B., Flesch, J. D., Fowkes, F. G., . . . Jencks, S. F. (2007). Essential
Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke
A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention,
Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and
Outcomes Research and Atherosclerotic Peripheral Vascular Disease. Circulation, 115(1), 127-155.
http://dx.doi.org/10.1161/CIRCULATIONAHA.106.179904
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 1; 2016
261
Herman, P. M., & Walsh, M. E. (2011). Hospital admissions for acute myocardial infarction, angina, stroke, and
asthma after implementation of Arizona's comprehensive statewide smoking ban. Journal Information,
101(3). http://dx.doi.org/10.2105/ajph.2009.179572
Iranian Students' News Agency - ISNA. (1998-2013). Retrieved from http://isna.ir/fa/news/9004-18549
Ismail, J., Jafar, T., Jafary, F., White, F., Faruqui, A., & Chaturvedi, N. (2004). Risk factors for non-fatal
myocardial infarction in young South Asian adults. Heart, 90(3), 259-263.
http://dx.doi.org/10.1136/hrt.2003.013631
Janszky, I., Ahnve, S., Ljung, R., Mukamal, K. J., Gautam, S., Wallentin, L., & Stenestrand, U. (2012). Daylight
saving time shifts and incidence of acute myocardial infarction–Swedish Register of Information and
Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Sleep medicine, 13(3), 237-242.
http://dx.doi.org/10.1016/j.sleep.2011.07.019
Kazemy, T., & Sharifzadeh, G. R. (2010). Comparisons of acute myocardial infarction (AMI) among women and
men. Modern Care Journal, 7(1), 5-11.
Khan, M. S., Jafary, F. H., Faruqui, A. M., Rasool, S. I., Hatcher, J., Chaturvedi, N., & Jafar, T. H. (2007). High
prevalence of lack of knowledge of symptoms of acute myocardial infarction inPakistan and its contribution
to delayed presentationto the hospital. BMC Public Health, 7(1), 284.
http://dx.doi.org/10.1186/1471-2458-7-284
Kwak, S. M., Myung, S.-K., Lee, Y. J., Seo, H. G., & Group, K. M.-a. S. (2012). Efficacy of omega-3 fatty acid
supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of
cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Archives of
internal medicine, 172(9), 686-694. http://dx.doi.org/10.1001/archinternmed.2012.262
Lee, T.-M., & Chou, T.-F. (2003). Impairment of myocardial protection in type 2 diabetic patients. The Journal
of Clinical Endocrinology & Metabolism, 88(2), 531-537. http://dx.doi.org/10.1210/jc.2002-020904
LeGrand, S. B., Leskuski, D., & Zama, I. (2008). Narrative review: furosemide for hypercalcemia: an unproven
yet common practice. Annals of internal medicine, 149(4), 259-263.
http://dx.doi.org/10.7326/0003-4819-149-4-200808190-00007
Leila Javadi, M., Masood Pezeshkian, M., Abbas Afrasiabi, M., Alireza Garjani PhD, L. R. P., & Zahra
Golmohammadi, M. (2010). Erythropoietin Prevention effect on Induced Apoptosis by
Ischemia-Reperfusion in Myocytes of Rat. J Cardiovasc Thorac Res, 2(1), 1-7.
Lokker, M. E., Gwyther, L., Riley, J. P., van Zuylen, L., van der Heide, A., & Harding, R. (2015). The Prevalence
and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure
Attending a South African Medical Center. J Cardiovasc Nurs.
http://dx.doi.org/10.1097/JCN.0000000000000256
Mirzaei, S., S, Mohammad, A. S., & Bagherian, F. (2005). Paper: Comparison of signs and symptoms of
myocardial infarction and unstable angina in male and female hospitalized patients in coronary care units of
kerman medical university hospital, 2004-2005.
Morillas, P. J., Cabadés, A., Bertomeu, V., Echanove, I., Colomina, F., Cebrián, J., . . . Sanz, J. C. (2002). Acute
myocardial infarction in patients under 45 years. Revista espanola de cardiologia, 55(11), 1124-1131.
http://dx.doi.org/10.1016/S0300-8932(02)76774-2
Nguyen, H. L., Saczynski, J. S., Gore, J. M., & Goldberg, R. J. (2010). Age and sex differences in duration of
prehospital delay in patients with acute myocardial infarction a systematic review. Circulation:
Cardiovascular Quality and Outcomes, 3(1), 82-92. http://dx.doi.org/10.1161/circoutcomes.109.884361
Pishkarmofrad, Z., Arbabisarjou, Hamed, S., Ebrahim, E., Masoud, R., & Mehrdad, H. (2012). Coronary
ArteryDisease in critical patients of Iran. CoronaryArtery Disease. J Pak Med Assoc, (12), 1282-5.
Perkins-Porras, L., Whitehead, D. L., Strike, P. C., & Steptoe, A. (2009). Pre-hospital delay in patients with acute
coronary syndrome: factors associated with patient decision time and home-to-hospital delay. European
Journal of Cardiovascular Nursing, 8(1), 26-33. http://dx.doi.org/10.1016/j.ejcnurse.2008.05.001
Rezaey, K., Kohestany, H., Baghcheghy, N., & Yazdan Khah Fard, M. (2006). Evaluation of the time Interval
between the onset of symptoms to hospitalization in acute myocardial infarction cases admitted. Bushehr
port in, 67-75.
Rossignol, P., Cleland, J. G., Bhandari, S., Tala, S., Gustafsson, F., Fay, R., . . . Zannad, F. (2012). Determinants
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 8, No. 1; 2016
262
and Consequences of Renal Function Variations With Aldosterone Blocker Therapy in Heart Failure
Patients After Myocardial Infarction Insights From the Eplerenone Post–Acute Myocardial Infarction Heart
Failure Efficacy and Survival Study. Circulation, 125(2), 271-279.
http://dx.doi.org/10.1161/CIRCULATIONAHA.111.028282
Sarı, İ., Acar, Z., Özer, O., Erer, B., Tekbaş, E., Üçer, E., . . . Aksoy, M. (2008). Factors associated with
prolonged prehospital delay in patients with acute myocardial infarction. Türk Kardiyol Dern Arş-Arch Turk
Soc Cardiol, 36(3), 156-162.
Sezavar, S. H., Valizadeh, M., Moradi Lakeh, M., & Rahbar, M. H. (2010). Early myocardial infarction and its
risk factors in patients admitted in Rasul-e-Akram Hospital. 2, 14(2), 156-163.
Sivaraman, V., Hausenloy, D. J., Wynne, A. M., & Yellon, D. M. (2010). Preconditioning the diabetic human
myocardium. Journal of cellular and molecular medicine, 14(6b), 1740-1746.
http://dx.doi.org/10.1111/j.1582-4934.2009.00796.x
Soltani MH, A. M. (2005). Svrvyval one-year review of patients with acute myocardial infarction. Journal of
Shaeed Sdoughi University of Medical Sciences Yazd, 1, 18.
Svensson, L., Karlsson, T., Nordlander, R., Wahlin, M., Zedigh, C., & Herlitz, J. (2003). Safety and delay time in
prehospital thrombolysis of acute myocardial infarction in urban and rural areas in Sweden. The American
journal of emergency medicine, 21(4), 263-270. http://dx.doi.org/10.1016/S0735-6757(03)00040-8
Taghadosi, M., Seyedi, S. M., & Mosavi, S. G. A. (2007). Assesment of delayed treatment in patients with acute
myocardial infarction at Kashan Shaheed Beheshtee Hospital during 2003-2005. Feyz Journals of Kashan
University of Medical Sciences, 11(3).
Wasilewski, J., Mirota, K., Wilczek, K., Głowacki, J., & Poloński, L. (2012). Calcific aortic valve damage as a
risk factor for cardiovascular events. Polish Journal of Radiology, 77(4), 30.
http://dx.doi.org/10.12659/PJR.883626
Yarnell, J. W., Patterson, C. C., Thomas, H. F., & Sweetnam, P. M. (2000). Comparison of weight in middle age,
weight at 18 years, and weight change between, in predicting subsequent 14 year mortality and coronary
events: Caerphilly Prospective Study. Journal of epidemiology and community health, 54(5), 344-348.
http://dx.doi.org/10.1136/jech.54.5.344
Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., . . . Varigos, J. (2004). Effect of potentially
modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study):
case-control study. The Lancet, 364(9438), 937-952. http://dx.doi.org/10.1016/S0140-6736(04)17018-9
Z, S. M. D. F. A. (2004). Determined from the onset of myocardial infarction and streptokinase. Journal of
shahid sadooghi yazd University of Medical Sciences, 2, 25.
Copyrights
Copyright for this article is retained by the author(s), with first publication rights granted to the journal.
This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution
license (http://creativecommons.org/licenses/by/3.0/).
... The risk factors (RF) -arterial hypertension (AH), physical inactivity, and alcohol consumption are significantly higher in women than men. Metabolic risk factors greatly increase the risk of AMI, regardless of sex [24,25]. ...
... The presence of advanced age, smoking, AH, diabetes mellitus, peripheral arterial disease, cardiovascular disease, CKD, COPD, hepatic insufficiency, and cancer increases the all-cause mortality in persons who experienced STEMI/NSTE-ACS [10,21]. Swedish data from the meta-analysis of 97 254 has demonstrated 18.3% mortality in the first year [11,24]. The high risk of cardiovascular events after the first year implies continuous monitoring and secondary prevention, and continuous double anti-thrombosis therapy (DAPT) after the first year after AMI prevents vascular incidents [22]. ...
Article
Full-text available
Cardiovascular diseases (CVD) are the leading cause of invalidity and death in developed countries. Among them, the main cause of death is coronary artery disease. In this retrospective study, 172 patients with acute coronary syndrome (STEMI, NSTEMI, UA) are included. They had been hospitalized on an emergency basis in the Cardiology Department, Invasive Sector of Prof. Dr. St. Kirkovich Hospital in Stara Zagora, and the Cardiology Hospital -Yambol between January 2009 and February 2010. We found a significant difference in the age at acute coronary syndrome (ACS) occurrence by sex: earlier manifestation was observed in men (p=0.018). The univariant regression analysis showed that elderly age (p=0.005, OR 1.024), glomerular filtration <90 ml/h (p=0.006, OR 0.964), GRACE-score > 140 pt (p<0.001, OR 1.045), HF (Killip class ≥ II) (p=0.002, OR 15.6) and EF<40% (p=0.003, OR 1) were factors for adverse prognosis in the first, fifth and ninth year. Only GRACE-score was an independent predictor of death obtained by multivariate regression analysis in the study (p=0.002, OR 1.052). The factors influencing long-term survival adversely after ACS are age, smoking, chronic kidney disease, previously experienced myocardial infarction, diabetes mellitus, three-vessel coronary disease, and decreased systolic function of the left ventricle, and GRACE > 140 p.
... Moreover, studies on the risk factors of myocardial infarction (MI) and CVDs have touched upon the participants' sex as a critical and determinant indicator (7). It has been identified that women experience their first MI about 10 years later than men, while this difference appears to attenuate after menopause (8). ...
... Of the 100 participants included in this study, (range: 4-11) days, that in the ICU was 3.6 ± 0.9 (range: 2-7) days, and that of the intubation period proved to be 5.01 ± 0.60 (range: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] hr. ...
Article
Full-text available
Background: Due to the controversy over the effect of serum testosterone levels on coronary artery diseases, this survey explores the serum levels of free testosterone, luteinizing hormone, and follicle-stimulating hormone in candidates for coronary artery bypass graft compared with an age-matched control group and evaluates the associated factors in these participants. Objective: To determine the testosterone level in elective coronary artery bypass grafting participants. Materials and Methods: In this cross-sectional study, all male patients aged > 40 yr as candidates for elective coronary artery bypass grafting, who were referred to the Afshar Hospital, Yazd, Iran, from March 2018 to March 2019, were included. In total, 100 men were enrolled (50 cases and 50 controls). Their serum levels of free and total testosterone, luteinizing hormone, and follicle-stimulating hormone were measured and the results were compared. Results: The findings indicated a significant difference between the two groups in total and free testosterone (both p < 0.001); they were lower in the case group. There was also a significant difference in the total testosterone of the participants with diabetes mellitus compared with no-diabetic individuals (p = 0.007). Free testosterone of diabetic subjects taking insulin was lower compared with those taking no insulin (p = 0.04). There was also an association between the body mass index and free testosterone, left ventricular ejection fraction and total testosterone, and a significant and negative relation between the duration of hospital admissions and free testosterone (p < 0.05). Conclusion: This study illustrates that participants with coronary artery disease bear a significantly low testosterone level in comparison with the healthy control group.
... Scientific research conducted over the years into predictive factors for AMI have shown that age and gender are two of the main predictors [7][8][9][10]. In their study into demographic risk factors related to the occurrence of myocardial infarction, Duan et al. [7] showed that myocardial infarction is more prevalent among men than women, and that this risk increases considerably above the age of 50. ...
... The odds ratios (OR) were calculated for the following, which are also considered to be AMI predictors: GCS 9-12 points OR=3.442 (CI 95%) and swelling OR=3.572 (CI 95%). Kiani et al. [10] analyzed risk factors for patients with myocardial infarction treated in hospital. They demonstrated a statistically significant dependency for sinus rhythm, atrial fibrillation, ventricular tachycardia atrioventricular blocks. ...
Preprint
Full-text available
Background: Identifying predictive factors based on procedures carried out by emergency medical teams may speed up the diagnosis of AMI. By shortening the time between the onset of the pain and the initiation of coronary reperfusion, patient prognosis can be improved Methods: The study was conducted on residents of the Bielsko-Biała district, served by state ambulance service Medical Response Teams (MRT). The patients were assigned to the following groups: Group A (n = 338) - patients with chest pain in whom infarction with elevation of the ST segment (ST-ACS) was diagnosed on the basis of an ECG, Group B (n=300) - patients with chest pain in whom an infarction was not diagnosed. A factor structural test for the studied parameters was used to determine their significance. An odds ratio (OR) was established for statistically significant parameters, and multi-dimensional logistic regression analysis was conducted. The significance of the odds ratios (OR) was estimated for individual risk factors based on 95% confidence intervals (CI). Results: It can be stated with 95% probability that the significant parameters: Male (p=0.00001), Age 51-70(p=0.00307), Breathing rate less than 12/min(p=0.02711), Pulse below 60 min (p=0.00165), Edemas (p=0.00075), Moist skin(p<0.01), Sinus rhythm (p=0.00004), Additional ventricular beats(p=0.00133) increase the risk of myocardial infraction. Conclusion: Identifying the predictors of myocardial infarction specific to pre-hospital emergency care is essential for improving the detection of AMI and shortening the time between calls to the MRT and the initiation of coronary reperfusion.
... Patients will require hospital admission and urgent coronary revascularization in the case of ST elevation myocardial infarction [3]. The prevalence of the disease increases with age and is associated with traditional risk factors such as hypertension and diabetes [4]. Patients with this condition should receive antiplatelets medications in addition to lipid lowering drugs [5]. ...
Preprint
Full-text available
Background: There is a well-established relationship between myocardial infarction and infection. Multiple articles describe the increased risk of myocardial infarction, both type 1 and 2, following an infectious process. However few articles have described the relation between concomitant myocardial infarction and infections on same admission mortality and complications. Methods: The aim is to assess the effect of an acquired or concomitant infection on complications and mortality during hospitalized cases of myocardial infarction. 1197 patients of different types of myocardial infarction were studied in correlation to infectious processes. Cultures from different sites were collected and isolation of various bacterial agents were studied. Mortality and various complications were compared between infected and non-infected subjects. Pearson's chi squared test was used to compare percentages (or the Fisher exact test when expected values were lower than 5). Moreover, means were compared through ANOVA, after checking data normality and homoscedasticity. A likelihood ratio backward stepwise method was used to conduct dichotomous logistic regressions, taking dichotomous outcomes as dependent variables, and sociodemographic and biological characteristics as independent variables (potential confounders). Results: Wound, sputum, blood and urine infections were associated with increased same admission mortality and complications. Microorganisms were then studied alone regardless of the site of infection and it was shown that Escherichia Coli, Escherichia Coli ESBL, Candida Albicans, Pseudomonas Aeruginosa and Staphylococcus of any type were significantly associated with same admission complications when associated with myocardial infarction. Length of stay was significantly elevated in patients with concomitant infection and it increased with the addition of positive cultures from different sites. Conclusion: Concomitant infections with myocardial infarction significantly increase the risk of same admission complications, mortality and length of stay regardless of the site of infection and type of microorganisms.
... [6] the prevalence ofhypercholesterolaemia, hypertriglyceridaemia and elevated LDL cholesterol was observed to be higher in the middle income group compared to the low income group [7]. As compared to a previous study in the early 1900s in a similar population, there is a significant increase in the number of people with obesity, diabetes and dyslipidemias [8]. ...
Article
Background: Cardiovascular disease is becoming a major burden in developing countries, It is considered as important public health problem not only in the developed countries but also in developing countries like India. It has emerged as a major health burden worldwide. It contributed to 15.3 million deaths in 1996 of which 5.5 million was from developed countries and 9077 million from developing countries. A rise in the prevalence decline in the latter half have been well documented in the industrialized countries. However, the scenario is reversed in developing countries especially India with a steady escalation in prevalence of Cardio Vascular disease Aims and Objectives: The purpose of this study was to assess contributing factors among Myocardial Infarction,to find out the association between contributing factors of myocardial infarction with their demographic variable and to identify contributing factors of myocardial infarction. Methods and Mateials: A descriptive study was carried out on 100 myocardial infarction patients who were admitted to the Intensive coronary care unit of selected cardiology ward in selected hospital, Vadodara. Patients were selected by Non- Probability convenient Sampling technique. The collected data was analyzed though SPSS software. Results: The majority contributing level of Myocardial infarction 42(42%) were mild, 32(32%) of the patients were moderate, 26(26%) of the patients were severe. There was no significant association was found between contributing factors of myocardial infarction with their demographic variables. Conclusion: Result revealed that most of the patients (42%) were having mild contributing factors and were having moderate contributing factors (32%) and least percentage (26%) were having severe contributing factors among myocardial infarction patients.
... The INTERHEART-South Asia study identified eight coronary risk factors: abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, low fruit and vegetable consumption, and lack of physical activity, which accounted for 89% of all acute MI cases in Indians. [5,27] Similar to our study, diabetes mellitus followed by hypertension and hyperlipidemia were found to be the common risk factors by Kiani et al. [29] In another cross-sectional study in India involving 100 STEMI patients, diabetes (33%), hypertension (40%), and smoking (30%) were noted to be the most common risk factors. [30] The high prevalence of comorbid risk factors in Indian CAD patients could be the rationale for STEMI presentation at a young age. ...
Article
Full-text available
Background: A detailed analysis of electrocardiogram (ECG) patterns may help in the identification of the precise site and location of coronary artery occlusions and guide the selection of an appropriate clinical therapeutic strategy in patients with myocardial infarction (MI). Aim: This study was conducted to evaluate the sensitivity and specificity of prespecified ECG criteria in localizing the culprit artery in acute ST‑segment elevation myocardial infarction (STEMI) and to correlate the ECG findings with coronary angiogram. Methods: Patients with acute STEMI aged ≥l8 years, diagnosed by ECG and who underwent angiography, were included for analysis. The infarct‑related artery was identified with prespecified ECG criteria and the measure of agreement kappa was calculated to find the correlation between ECG findings and coronary angiogram. Results: Of 118 patients, anterior wall myocardial infarction (AWMI) was more common than inferior wall myocardial infarction (IWMI) (56% vs. 46%). In AWMI, ST‑elevation ≥2.5 mm in V1 and ST‑elevation in augmented Vector Left (aVL) had high sensitivity for detecting occlusion proximal to S1 and D1. High correlation with the angiogram was observed with ST‑elevation in aVL, V1 for occlusion proximal to S1 and D1 (κ = 0.531; P = 0.000). In IWMI, ST‑elevation in lead III > II and ST‑elevation ≥1 mm in II, III, augmented Vector Foot (aVF) had maximum sensitivity in detecting occlusion in proximal and distal right coronary artery (RCA). High correlation with the angiogram was observed with ST‑elevation in lead III > II (κ = 0.438; P = 0.000) and ST‑coving without ST‑elevation in RV4 (sensitivity = 79%, κ = 0.402; P = 0.002) for occlusion in the RCA. Ratio of S:R waves amplitude in aVL ≤3 and ST‑depression ≥0.5 mm V1‑V3 were 100% sensitive for occlusion in the left circumflex (LCx). Strong correlation with the angiogram was observed with ST‑elevation ≥0.5 mm V7–V9 for occlusion in LCx (sensitivity = 94%, κ = 0.743; P = 0.000). Conclusion: ECG in patients with STEMI is valuable and can reliably predict the culprit artery in these patients prior to angiography.
... Without early intervention, 70% of pre-diabetes cases will progress to diabetes within 10 years [2,3]. Complications of diabetes represent a significant public health burden and can be either: (a) microvascular complications such as neuropathy, nephropathy, and ocular damage; or (b) macrovascular complications such as cardiovascular disease [4][5][6][7][8][9]. ...
Article
Full-text available
Background: Diabetes is a leading cause of death and disability in the United States, and its precursor, pre-diabetes, is estimated to occur in one-third of American adults. Understanding the geographic disparities in the distribution of these conditions and identifying high-prevalence areas is critical to guiding control and prevention programs. Therefore, the objective of this study was to investigate clusters of pre-diabetes and diabetes risk in Florida and identify significant predictors of the conditions. Methods: Data from the 2013 Behavioral Risk Factor Surveillance System were obtained from the Florida Department of Health. Spatial scan statistics were used to identify and locate significant high-prevalence local clusters. The county prevalence proportions of pre-diabetes and diabetes and the identified significant clusters were displayed in maps. Logistic regression was used to identify significant predictors of the two conditions for individuals living within and outside high-prevalence clusters. Results: The study included a total of 34,186 respondents. The overall prevalence of pre-diabetes and diabetes were 8.2 and 11.5%, respectively. Three significant (p < 0.05) local, high-prevalence spatial clusters were detected for pre-diabetes, while five were detected for diabetes. The counties within the high-prevalence clusters had prevalence ratios ranging from 1.29 to 1.85. There were differences in the predictors of the conditions based on whether respondents lived within or outside high-prevalence clusters. Predictors of both pre-diabetes and diabetes regardless of region or place of residence were obesity/overweight, hypertension, and hypercholesterolemia. Income and physical activity level were significant predictors of diabetes but not pre-diabetes. Arthritis, sex, and marital status were significant predictors of diabetes only among residents of high-prevalence clusters, while educational attainment and smoking were significant predictors of diabetes only among residents of non-cluster counties. Conclusions: Geographic disparities of pre-diabetes and diabetes exist in Florida. Information from this study is useful for guiding resource allocation and targeting of intervention programs focusing on identified modifiable predictors of pre-diabetes and diabetes so as to reduce health disparities and improve the health of all Floridians.
... Acute coronary syndrome (ACS) has been established to represent a consequence of atherosclerosis, with preventable and non-preventable risk factors that have been identified to lead to the onset of acute myocardial infarction (1,2). Atherosclerosis is a chronic inflammatory process in the middle arterial intima for which the Creactive protein (CRP), an acute-phase protein secreted during the inflammatory stimulus, has been shown to be an independent predictor of coronary artery disease (CAD) (3). ...
Article
Full-text available
Background: The aim of this study was to investigate whether the C-reactive protein (CRP) is associated with ejection fraction of left ventricle (EFLV) in the early phase of ST-elevation myocardial infarction (STEMI), treated with the primary percutaneous intervention (pPCI), and to establish whether there exists a relationship between its values and the presence of major adverse cardiovascular events (MACE) within six months of pPCI. Methods: Research had a prospective character and included 357 patients who were diagnosed with STEMI and who underwent pPCI within 24 hours of pain onset. The following were monitored and recorded: 1) CRP values, which were measured between 24 and 48 hours of pPCI, 2) EFLV values, which were measured five days after the pPCI, and 3) MACE, which was established within six months of pPCI. Results: The EFLV values measured five days after the pPCI were significantly lower with increasing CRP values (rho = - 0.384, p < 0.0001). There was a significant difference in CRP values between patients who had MACE and those without it (38.35 [98.10] vs. 12.97 [23.80], p = 0.0001). In addition, CRP values were significantly increased in patients who died during the first six months after the pPCI compared with those who survived (115.00 [202.80] vs. 15.84 [31.5], p = 0.001). Conclusion: The CRP values in patients with STEMI who were treated with the pPCI are related to systolic function in the early phase of STEMI as well as MACE during the first six months of follow-up. Keywords: C-Reactive Protein, Myocardial Infarction, Prognosis.
Article
Full-text available
To identify the risk factors for Coronary Artery Diseases such as Hypertension
Article
Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.
Article
Although primary hyperparathyroidism is the most common cause of hypercalcemia, cancer is the most common cause requiring inpatient intervention. An estimated 10% to 20% of all patients with cancer have hypercalcemia at some point in their disease trajectory, particularly in advanced disease. Aggressive saline hydration and varying doses of furosemide continue to be the standard of care for emergency management. However, a review of the evidence for the use of furosemide in the medical management of hypercalcemia yields only case reports published before the introduction of bisphosphonates, in contrast to multiple randomized, controlled trials supporting the use of bisphosphonates. The use of furosemide in the management of hypercalcemia should no longer be recommended.
Article
Myocardial bridge is a congenital structural variant of the coronary arteries where a segment of the epicardial vessel is surrounded by the myocardium. It is an uncommon entity that may go unnoticed in patients with recurrent chest pain. We present a case on a 36-year-old woman with recurrent chest pain. Initial workup revealed normal routine laboratory test results, cardiac biomarkers, electrocardiogram, and an echocardiogram showing preserved ejection fraction with no valvulopathies. A dobutamine myocardial perfusion stress test was performed; this induced chest pain in the patient with electrocardiogram changes evident for 1-mm ST segment elevation in lead V5 and V6 consistent with myocardial ischemia. Perfusion imaging revealed a small fixed myocardial perfusion defect of the apical inferior wall. A cardiac catheterization revealed moderate-to-severe myocardial bridging involving the middle left anterior descending artery. Treatment with metoprolol and ranolazine resolved her symptoms. This case portrays the importance of recognizing myocardial bridge as the potential cause of recurrent chest pain and its ability to cause myocardial ischemia under stress.