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Aim The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan. Subjects Cardiovascular diseases (CVDs) are the leading cause of sudden death. CVDs are a major health problem in Pakistan, and the number of patients is increasing daily. Aim The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan. Method A cross-sectional study was conducted to investigate the prevalence of cardiovascular diseases in the local population of 53 cities in Punjab, Pakistan. A total of 6351 individuals were contacted to collect data using a questionnaire from October 2014 to September 2015. Data were collected directly by meeting the participants or indirectly through relatives and friends. Results Of the participants, 49.2% (3127/6351) were male and 50.8% (3224/6351) female. The data showed that 17.5% (1109/6351) of the population had CVDs with 16.6% (519/3127) being male and 18.3% (590/3224) female. Conclusion This study concluded that CVDs are a serious problem for both genders and affected 17.5% of the studied population. Diseases are more common in females than males with young age of onset. An inactive lifestyle, low level of activity and family history of disease could be disease risk factors in the study area.
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Prevalence of cardiovascular diseases in Punjab, Pakistan:
a cross-sectional study
Faiza Zubair
&Syed Kashif Nawaz
&Ammara Nawaz
&Hasnain Nangyal
&Naila Amjad
&Muhammad Saleem Khan
Received: 9 November 2017 /Accepted: 4 January 2018 /Published online: 31 January 2018
#Springer-Verlag GmbH Germany, part of Springer Nature 2018
Aim The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize
people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan.
Subjects Cardiovascular diseases (CVDs) are the leading cause of sudden death. CVDs are a major health problem in Pakistan,
and the number of patients is increasing daily.
Aim The purpose of the present study was to measure the frequency of CVDs and some of the risk factors and to familiarize
people with information on the high rates of mortality and morbidity due to CVDs in the studied areas of Punjab, Pakistan.
Method A cross-sectionalstudy was conducted to investigate the prevalence of cardiovascular diseasesin the local population of
53 cities in Punjab, Pakistan. A total of 6351 individuals were contacted to collect data using a questionnaire from October 2014
to September 2015. Data were collected directly by meeting the participants or indirectly through relatives and friends.
Results Of the participants, 49.2% (3127/6351) were male and 50.8% (3224/6351) female. The data showed that 17.5%
(1109/6351) of the population had CVDs with 16.6% (519/3127) being male and 18.3% (590/3224) female.
Conclusion This study concluded thatCVDs are a serious problem for both genders and affected 17.5% of the studied population.
Diseases are more common in females than males with young age of onset. An inactive lifestyle, low level of activity and family
history of disease could be disease risk factors in the study area.
Keywords Cardiovascular disease .Cohort study .Onset age .Sargodha .Punjab .Pakistan
A disease related to the circulatory system in humans is
known as a cardiovascular disease (CVD). CVDs are a major
health problem in Pakistan, and the number of patients is
increasing daily. CVDs caused about 16.7 million deaths in
2000 and 17 million in 2008, with more casualties in females
(Rosamond et al. 2008;WHO2011). This disease causes 25%
of the total deaths in developed and 80% in middle- and low-
income countries (Yarmohammadian et al. 2012). CVD also
causes 85% of the global disabilities (Alwan et al. 2011). In
the USA, 250,000 women die from CVDs annually (Hosseini
et al. 2011). On the Asian subcontinent, people are highly
susceptible to CADs, which cause many deaths (Joshi et al.
2007). Females are at higher risk of CVDs than males in
developing countries (Mosca et al. 2011).
The risk factors associated with CVD are smoking, poor
diet, high blood cholesterol levels, obesity, insufficient phys-
ical activity, physiosocial stress, diabetes and ethnicity
(Finucane et al. 2011; Mosca et al. 2011; Ueshima et al.
2008). In Asian women, high cholesterol levels and increased
systolic blood pressure cause CVDs (Barzi et al. 2007). Due to
westernized lifestyles, the number of young CVD patients is
increasing daily in Iran.
There are various differences in the mortality and mor-
bidity rates according to gender, age, socioeconomic sta-
tus, geographical location and ethnicity. The mortality rate
due to CVDs is higher at younger ages. Its prevalence is
higher in socioeconomically poor compared with wealthy
*Muhammad Saleem Khan
Department of Zoology, University Of Sargodha, Sargodha, Pakistan
Department of Zoology, University of Lahore, Sargodha
Campus, Punjab, Pakistan
Department of Botany, Hazara University, Mansehra, Pakistan
Department of Zoology, Government College University,
Faisalabad, Pakistan
Journal of Public Health (2018) 26:523529
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... A cross-sectional study conducted among the local population of 53 cities in Punjab, Pakistan, reported that CVDs impacted 17.5% of the population, with females having a higher incidence rate than males and start occurring at a younger age. An inactive lifestyle, low level of activity and family history of disease could be disease risk factors (26). CVDs are also responsible for 40% and 37% of deaths in Egypt and Saudi Arabia, respectively. ...
... In EMR, the total number of fatalities due to diabetes was 186,841 thousand in 2019. Pakistan recorded the highest number (80,976) followed by Egypt (26,844), Iran (157,018) then Morocco (17,947) (6) ( Table 1). According to the 2019 Global Burden of Disease Study, diabetes is the second cause of death in two countries (Bahrain and Jordan) and the third reason for death in three countries (Iraq, Palestine, and Qatar) in the region. ...
... Hypertension Hypertension or raised blood pressure is defined as systolic and/or diastolic blood pressure greater than, or equal to, 140/90 FIGURE 4 | Correlation between the prevalence of obesity, diabetes, and cumulative cancer risk among adults in EMR (6,26). mmHg. ...
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There are 22 countries in the Eastern Mediterranean Region (EMR) expanding from Morocco in the west to Pakistan and Afghanistan in the east, containing a population of 725,721 million in 2020. In the previous 30 years, the illness burden in the EMR has transmitted from communicable diseases to non-communicable diseases such as diabetes, cardiovascular diseases, and cancer. In 2019, cardiovascular mortality in the EMR was mostly attributed to ischemic heart disease, the first reason for mortality in 19 countries in the region. Stroke was the second reason for death in nine countries followed by diabetes, which was ranked as the second reason for death in two countries. The prominent nutrition-related NCDs risk factors in EMR include obesity, hypertension, high fasting plasma glucose, and upregulated unhealthy diet consumption. Most of the EMR population are unaware of their NCDs risk factor status. These risk factors, even if treated, are often poorly controlled, therefore, inhibiting their existence by changing the lifestyle to proper dietary habits and sufficient physical activity is mandatory. In this review, the epidemiology and nutrition-related risk factors of NCDs in the EMR will be discussed and illustrated, aiming to scale up action and support decision-makers in implementing cost effective strategies to address obesity and NCDs prevention and management in the region.
... Risk factors being observed in this study were the sedentary life style and the genetic cause or history of family related to disease. 6 Longer intensive care unit (ICU) stay can cause difficulty in returning to preoperative conditions and even can lead to readmission to hospital. 7 Physiotherapy in ICU was recently incorporated and starting working on the concept of early mobilization, as well as its importance in the practice of early mobilization. ...
... Functional independence according to FIM tool was compared between both groups. The median (IQ) FIM at Day 1 was 31.00 (8) in experimental group compared to 32.00 (6) in the controls, this difference was statistically not significant (P Value 0.097). Similarly, the median (IQ) FIM at Day 7 was 110.0 (4) in experimental and 76 (31) in control group implying that Function independence was statistically significantly different (P Value 0.000). ...
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Objective: To compare the effectiveness of Phase 1 cardiac rehabilitation with lower limb paddling, with phase 1 cardiac rehabilitation without lower limb paddling. Study Design: Randomized clinical Trail Place and Duration of Study: Department of Cardiology, Rawal General and Dental Hospital Islamabad from 1st January 2020 to 31st December 2020. Methodology: Fifty four patients, 27 in each group were determined using general self-efficacy before intervention readings. Inclusion was made on post elective Sternotomy surgery, post extubation, both genders, age between 35 and 60 years, body mass index (BMI) between 20 and 30 kg/m2, hemodynamic stability, absence of arrhythmias. Results: The mean SF-36 at day 1 was 37.74±1.45 and at Day 7 was 90.42±11.8 in experimental group and 37.22±1.45 at Day 1 and 76.81±2.58 at day 7 for control group respectively. The mean FIM at day 1 was 31.48±5.07 and on day 7 it was 109.03±5.97 in experimental group compared to 33.66±5.34 on day 1, and 82.44±13.35 on day 7 for controls. The mean for self-efficacy at day 1 was 19.11±2.5 and at day 7 it was 62.59±3.17 in experimental compared to 21.11±3.59 on day 1, and 61.74±6.32 on day 7 in the controls. The mean EF was same at day 1 and day 7, in experimental group it was 53.11±4.8 whereas for control group it was 53.85±3.76 one day 1 and day 7. The mean ABGs at day 1 were 7.41±0.05 and at Day 7 it was 7.42±0.04 in experimental group whereas in the controls it was 7.39±0.39 at Day 1 and 7.44±0.01 at day 7. Conclusion: Phase 1 cardiac rehabilitation with and without paddling have similar effects according to ABGs and Ejection fraction. However, the quality of life was found significantly improved using paddling intervention during Phase 1 Cardiac rehabilitation compared to those without paddling. Hence it is implied that it is safe to incorporate paddling with phase 1 cardiac rehabilitation in post CABG patients. Keywords: Coronary artery disease, Cardiac rehabilitation, CABG, Ergometer
... Prevalence of CAD was 17.48%. A study that was also conducted in Pakistan reported similar finding with CAD prevalence of 17.50% [18]. After noting quantitative variables, we observed that CAD was more common among females as compared to males. ...
... After noting quantitative variables, we observed that CAD was more common among females as compared to males. This finding of study was supported by a study that was conducted in Pakistan as well [18]. Another study showed that CAD incidence are higher among males while more severe in females [6]. ...
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Coronary artery disease (CAD) is a very ordinary health problem around the globe. CAD is affected by various factors like diabetes, obesity, smoking, gender, and diet. However, the association of CAD with diet is understudied in our region that’s why our study was aimed to evaluate the effect of diet on CAD incidence. This cross-sectional study was completed among local population of Rawalpindi, Pakistan in almost6 months from November 2020 to April 2021. People were taken in our study via set criteria. Data was collected by self-structured proforma. Data analysis was performed by applying IBM SPSS version 25. Descriptive statistics were applied for quantitative variables. Statistical tests like Chi-square test and Spearman correlation analysis were applied to know the association, direction,and strength of study variables. Our current study displays overall high prevalence CAD (17.48%) among study population. Mean value of age for study participants was 45.42 with SD of ±8.01years. Prevalence of CAD was more common among females, faster food eaters and fresh fruit and raw vegetables non-eaters.Gender, fast food, and fresh fruits and vegetables were associated with CHD significantly with p-values 0.030, 0.0007, and 0.0006 respectively. Strength and direction for fast food and CAD association was very strong and positive while for association between fresh fruits and raw vegetables and CAD was very strong and negative with correlation coefficient +0.812 and -0.831 respectively.In a nutshell, current study indicates high prevalence of CAD especially among females, fast food eaters and fresh fruits and raw vegetables non-eaters. Higher consumption of fast foods leads to higher incidence of CAD and vice versa while higher consumption of fresh fruits and raw vegetables bring down the incidence of CAD incidence and vice versa. So, we need to create awareness among people about the impact of food on CAD and gender specific interventions for each gender to lower down the CAD incidence.
... Unfortunately, with an estimated prevalence of 17.5%, Pakistan is a high burden CVD country where 29% of allcause mortality is attributed to CVD [17]. Very few studies have evaluated the frequency, severity and risk factors associated with pDDIs among CVD patients in Pakistan. ...
... In this study, all the 300 patients (100%) had ≥ 1 pDDI. A total of 2787 pDDIs were observed with a median of 8.50 pDDIs per patient (range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Out of 2787 pDDIs, 2064 (74.06%) were of moderate severity followed 483 (17.33%) major and 240 (8.61%) minor pDDIs. ...
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Background Patients with cardiovascular diseases (CVD) are at high risk of experiencing drug–drug interactions (DDIs). The objective of this study was to evaluate the frequency, level and risk factors associated with potential-DDIs (pDDIs) in hospitalized CVD patients at cardiology departments of two tertiary care hospitals in Quetta, Pakistan. Methods In the current prospective observational study, a total of 300 eligible CVD inpatients were evaluated for pDDIs using Lexicomp Interact®. The pDDIs were classified into class A (no known interaction); B (no action needed); C (monitor therapy: it is documented that the benefits of an interaction outweigh the risk, appropriately monitor therapy in order to avoid potential adverse outcomes); D (consider therapy modification: it is documented that proper actions must be taken to reduce the toxicity resulting from an interaction); X (avoid combination: the risk of an interaction outweighs the benefits and are usually contraindicated). Multivariate binary logistic regression analysis was used to find factors associated with the presence of Class-D and/or X pDDIs. A p -value < 0.05 was considered statistically significant. Results With a median of 8.50 pDDIs per patient, all patients (100%) had ≥ 1 pDDIs. Out of total 2787 pDDIs observed, 74.06% ( n = 2064) were of moderate and ( n = 483) 17.33% of major severity. Class C pDDIs were most common ( n = 1971, 70.72%) followed by D ( n = 582, 20.88%), B ( n = 204, 7.32%) and X ( n = 30, 1.08%). Suffering from cardiovascular diseases other than myocardial infarction (OR 0.053, p -value < 0.001) and receiving > 12 drugs (OR 4.187, p -value = 0.009) had statistical significant association with the presence of class D and/or X pDDIs. Conclusion In the current study, pDDIs were highly prevalent. The inclusion of DDI screening tools, availability of clinical pharmacists and paying special attention to the high-risk patients may reduce the frequency of pDDIs at the study sites.
... 5 Pakistan is currently facing a near epidemic of CVDs, validated by about a quarter (25%) of its middle-aged adults exposed to CVD risk factors. 6 Cardiovascular diseases are a group of chronic and systemic inflammatory diseases with multiplex etiology. Myocardial infarction has been defined as the death of cardiac cells, largely due to disruption of the atherosclerotic plaque. ...
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Objectives: This study aimed to assess the association of periodontitis and Myocardial Infarction (MI) and contributes as a potential risk factor for its incidence. Methodology: This multi-centre, case-control study enrolled 125 participants. Case group comprising of Acute Myocardial Infarction (AMI) = 55, control group consisting of non – AMI = 70. Both groups were assessed for presence of periodontitis along with specific risk factors that were recorded in a modified proforma comprising of questions pertaining to demographics, oral hygiene practices and oral eating habits. Chi-square test was used to assess association and p-value was considered significant at ≤0.05. Results: Periodontitis was found to be prevalent in 71% of Myocardial Infarction (MI) patients with an OR 4.125 (95% CI, 1.934 - 8.797) as compared to 37% in Control (non-Myocardial Infarct). Increasing age, male gender, illiteracy, unemployment/retirement, low socio-economic status, being overweight, no dental visits, and smoking (both duration & frequency) were found to be statistically significantly associated with occurrence of periodontitis and myocardial infarction in the study. Conclusion: Periodontitis was found to be prevalent among the MI patients suggesting a causal link between these two conditions that can be reduced by adopting a healthy lifestyle, refraining from smoking, good oral hygiene and visiting a dentist for regular check-up.
... These newly derived age groups are consistent with local Pakistani studies. For example, a recent cross-sectional study reported that, unlike developed countries, the Pakistani population had a greater risk of CVDs over the age of 40 years [46]. Another study showed that South Asian countries (including Pakistan) reported the onset of CVDs 10 years earlier than other countries [47]. ...
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Criticism of the implementation of existing risk prediction models (RPMs) for cardiovascular diseases (CVDs) in new populations motivates researchers to develop regional models. The predominant usage of laboratory features in these RPMs is also causing reproducibility issues in low–middle-income countries (LMICs). Further, conventional logistic regression analysis (LRA) does not consider non-linear associations and interaction terms in developing these RPMs, which might oversimplify the phenomenon. This study aims to develop alternative machine learning (ML)-based RPMs that may perform better at predicting CVD status using nonlaboratory features in comparison to conventional RPMs. The data was based on a case–control study conducted at the Punjab Institute of Cardiology, Pakistan. Data from 460 subjects, aged between 30 and 76 years, with (1:1) gender-based matching, was collected. We tested various ML models to identify the best model/models considering LRA as a baseline RPM. An artificial neural network and a linear support vector machine outperformed the conventional RPM in the majority of performance matrices. The predictive accuracies of the best performed ML-based RPMs were between 80.86 and 81.09% and were found to be higher than 79.56% for the baseline RPM. The discriminating capabilities of the ML-based RPMs were also comparable to baseline RPMs. Further, ML-based RPMs identified substantially different orders of features as compared to baseline RPM. This study concludes that nonlaboratory feature-based RPMs can be a good choice for early risk assessment of CVDs in LMICs. ML-based RPMs can identify better order of features as compared to the conventional approach, which subsequently provided models with improved prognostic capabilities.
... 7 However, an alarming increase in CVD cases has been observed in Pakistan in 2019, and WHO found a whopping increase of 29% of total deaths, which is almost 406,870 per year and expected to increase to 22.2 million by 2030. 2,8 Several epidemiological reports have exhibited that lower-and middle-income countries mostly become a target of CVSDs due to a lack of an appropriate healthcare system. 9 In addition, the WHO states that 75% of cardiovascular diseases can be prevented by addressing "behavioral risk factors" such as tobacco use, physical inactivity, unhealthy diet, obesity, lifeless attitude, stress, alcohol abuse, and obesity. ...
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Polyphenols have long been recognized as health-promoting entities, including beneficial effects on cardiovascular disease, but their reputation has been boosted recently following a number of encouraging clinical studies in multiple chronic pathologies, that seem to validate efficacy. Health benefits of polyphenols have been linked to their well-established powerful antioxidant activity. This review aims to provide comprehensive and up-to-date knowledge on the current therapeutic status of polyphenols having sufficient heed towards the treatment of cardiovascular diseases. Furthermore, data about the safety profile of highly efficacious polyphenols has also been investigated to further enhance their role in cardiac abnormalities. Evidence is presented to support the action of phenolic derivatives against cardiovascular pathologies by following receptors and signaling pathways which ultimately cause changes in endogenous antioxidant, antiplatelet, vasodilatory, and anti-inflammatory activities. In addition, in vitro antioxidant and pre-clinical and clinical experiments on anti-inflammatory as well as immunomodulatory attributes of polyphenols have revealed their role as cardioprotective agents. However, an obvious shortage of in vivo studies related to dose selection and toxicity of polyphenols makes these compounds a suitable target for clinical investigations. Further studies are needed for the development of safe and potent herbal products against cardiovascular diseases. The novelty of this review is to provide comprehensive knowledge on polyphenols safety and their health claims. It will help researchers to identify those moieties which likely exert protective and therapeutic effects towards cardiovascular diseases.
Early diagnosis of coronary artery disease (CAD) in patients with chest pain is a challenge. Currently diagnosis of CAD is confirmed by coronary angiography, which is invasive and not easily available in developing countries. Therefore, it is imperative to establish noninvasive biomarker for early diagnosis of CAD in patients with angina and determine the diagnostic accuracy of inflammatory biomarkers of atherosclerosis in comparison to angiography and correlate with severity of CAD in patients with angina. Diagnostic accuracy study was carried out in tertiary care hospitals, Rawalpindi, Pakistan. Total of 58 patients aged 55.24 ± 11.61 years, with chest pain and troponin-I -ve, having coronary artery stenosis ≥50% were included as cases of CAD and 55 subjects having stenosis <50% were included as controls. Nuclear factor kappa-B (NF-κB), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were analyzed on immunoassay analyzers. The receiver operating characteristic curve analysis revealed significant (P < 0.05) high area under curve (95% confidence interval) with sensitivity and specificity of NF-κB 0.76 (0.65-0.85), 73% and 65%; TNF-α 0.72 (0.61-0.81), 71% and 69%; IL-6 0.62 (0.52-0.71), 64% and 53% and hs-CRP 0.62 (0.52-0.71), and 53% and 56% in CAD patients compared to controls. There was significant positive correlation between NF-κB (r = 0.44), TNF-α (r = 0.37), IL-6 (r = 0.23), and hs-CRP (r = 0.23) with severity of CAD by Gensini score. The inflammatory biomarkers, especially NF-κB and TNF-α, have highest diagnostic accuracy and indicate severity of atherosclerosis in patients with angina. These markers may be used as noninvasive biomarkers to exclude healthy individuals before undergoing angiography.
Mulberry (Morus spp., Moracecae) is a notable medicinal and multi-functional plant. Distinct mulberry types are spread in subtropical, temperate and tropical areas all over the world. Mulberry leaves carry a number of bioactive compounds with it along with various pharmacological effects. It is a magnificent origin of nutrients, phytochemical and is been proven as nutraceutical. Mulberry leaves have a wide range of pharmacological effects having bacteriostatic, anti-hyperlipidemia, lowering blood glucose, anti-hypertensive, and antiviral properties. Mulberry leaves caloric content was determined as of carbohydrate (CHO), protein, fat, fiber, moisture and ash. Mulberry leaves contained the uppermost amount of carbohydrate (28.37%) in T1 and the lowermost amount of moisture (5.2%) in T1. The mineral content of macro-elements and micro-elements were determined from chromium (Cr), manganese (Mn), iron (Fe), zinc (Zn), magnesium (Mg), phosphorus (P), calcium (Ca), potassium (K) and sodium (Na). The content of minerals in mulberry leaves contained the highest amount of manganese (34.7) in T1 and the lowest sodium in T1. The content of vitamins in mulberry leaves contained the fat-soluble and water-soluble vitamins β-carotene, C, B3 and B2 were determined. Amongst the vitamins, mulberry leaves contained the uppermost value of β-carotene (14.0mg) and the lowermost value of vitamin B3(0.04). Bioactive compounds of mulberry leaves were determined are rutin, catechins, alkaloids and quercetin. Among the bioactive compounds in mulberry leaves contained the uppermost value of quercetin (763mg). The total phenolic content was (0.42–0.80 mg) Conclusively, mulberry leaves is enriched with nutritional values. So, it can be used in the treatment of various disease
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Objective: Due to devastating consequences of coronary artery disease (CAD) in young population, this study was designed to evaluate the prevalence of preventable risk factors and severity of atherosclerosis for Iranian young adults (≤45 years) diagnosed with premature CAD. Method: A cross sectional, descriptive study comprised 1093 consecutive patients (≤45 years), with a diagnosis of CAD, who underwent percutaneous intervention (PCI) or coronary bypass graft (CABG) from 2010 to 2012. Data on demographic features, cardiovascular risk factors, and angiographic findings were studied. Result: There were 1093 young patients (234 females, 859 males) with proven CAD; the mean age of 39 ± 3 years and the mean BMI were 28 ± 4.7 kg/m 2. According to the treatment plan, patients were classified into two groups: PCI and CABG groups (n = 898,195 respectively). Obesity was the most prevalent risk factor (73.6%). In the risk factor assessment, it was noticed: 27% with diabetes mellitus, 37% with hypertension, 38% with family history, 39% with hyperlipidimia, and 54% smokers. Angiographic study revealed that 10 (1%) had left main coronary disease, 747 (68%) patients had single vessel disease, 181 (17%) had two-vessel disease and that 155 (14%) had three-vessel disease. The most common anatomical involvement was the anterior wall territory. Conclusion: Young CAD patients from Iran have different risk profile. Although atherosclerosis of the coronary arteries is less prominent in young patients, more often it is accompanied by decreased left ventricular function. There is a need for prevention plan to control obesity by targeting young adults in the population.
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This is a historical review of the contribution of the Framingham Heart Study to our understanding of the epidemiology of blood pressure (BP) and cardiovascular disease (CVD). Framingham investigators initially explored the epidemiological relationship of various BP components to coronary heart disease in men and women and how this risk is further modified by age, that is, how diastolic blood pressure (DBP) is the stronger predictor of coronary heart disease risk in young people versus systolic blood pressure (SBP) in middle-aged and elderly people. Framingham investigators then examined the natural history of various BP components over a 30-year follow-up in normotensive and untreated hypertensive individuals and showed how this provides hemodynamic insights into the importance of pulse pressure as a marker of large artery stiffness in middle-aged and elderly people. Importantly, pulse pressure was also found to be superior to SBP or DBP as a predictor of coronary heart disease in a middle-aged and elderly Framingham population. Lastly, dual models of SBP with DBP and pulse pressure with mean arterial pressure were superior to single BP component models for predicting CVD events; thus, increases in both peripheral vascular resistance and central large artery stiffness contribute to CVD in varying proportions depending on age. Furthermore, the Framingham Heart Study provided evidence that DBP <70 mm Hg with SBP ≥120 mm Hg was associated with a CVD risk equivalent to approximately 20 mm Hg of additional elevation in SBP, thus further supporting the importance of large artery stiffness as a CVD risk factor in elderly people. These original Framingham studies have contributed greatly to BP risk classification tables for the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" and for the European Society for Hypertension. Moreover, Framingham originally brought attention to hypertension, which is now the leading cause of mortality globally. Copyright © 2013 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.
DOI: Bangladesh Med J. 2013 Jan; 42 (1): 34-37
Peripheral arterial disease (PAD) is a manifestation of the atherosclerotic process and is associated with an increased risk of cerebrovascular disease, cardiovascular disease, and death. Clinicians should consider screening both asymptomatic and symptomatic patients with the ankle-brachial index, a test with a high sensitivity and specificity. For those patients with PAD, atherosclerotic risk factors (such as smoking, dyslipidemia, hypertension, and diabetes mellitus) should be aggressively treated. In addition to exercise therapy, there is evidence available to support the use of aspirin, clopidogrel, lipid-lowering agents, pentoxifylline, and cilostazol.
Background: To determine the frequency of congenital heart diseases in neonates Methods: In this descriptive study, echocardiography was performed in all 459 suspected cases of congenital heart diseases. Results: In 162 confirmed cases, the frequency of congenital heart disease was 2.86%. Male outnumbered female (100vs 62). Acyanotic lesions were more common than cyanotic lesions (127vs 35). Ventricular Septal Defect was the most common acyanotic lesion while Transposition of Greater Arteries was the most common cyanotic lesion Conclusion: Congenital heart diseases, being one of the commonest problem in newborns, requires early diagnosis, so that the affected child can get maximum medical support and benefit
Background: We sought to determine the frequency of the risk factors for congestive cardiac failure (CCF) in a tertiary care hospital in Peshawar, Pakistan. Methods: This retrospective, observational study was conducted in the department of cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2005 to September 2007. Relevant information regarding the risk factors of CCF was recorded on questionnaires, devised in accordance with the objectives of the study. Results: This study recruited 1019 patients with an established diagnosis of CCF on the basis of clinical findings and pertinent investigations. The study population comprised 583 (57.12%) men and 436 (42.78%) women. The patients’ age ranged from 6 years to 82 years with a mean age of 48.5 years and a mode of age of 45 years. The distribution of the causative factors of CCF was as follows: ischemic heart disease in 38.56%; hypertension in 26.30%; dilated cardiomyopathies in 10.10%; obstructive and restrictive cardiomyopathies in 5.39%; valvular heart diseases in 9.32%; congenital heart diseases like ventricular septal defects and atrial septal defects in 4.41% and 0.58%, respectively; constrictive pericarditis in 1.07%; pericardial effusion in 0.68%; chronic obstructive pulmonary disease and pulmonary hypertension in 1.47%; thyrotoxicosis in 0.68%; complete heart block in 0.29%; and Paget’s disease in 0.09% of the cases. Conclusion: Ischemic heart disease, hypertension, cardiomyopathy, valvular heart disease, and congenital heart disease were the major contributors to CCF in our patients.
Background: There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation (AF) in non-white populations is scarce. Objectives: To document the clinical epidemiology of AF among hospital admissions to two teaching hospitals in Karachi, Pakistan, over a two-month period and to describe the clinical features and management of these patients. Subjects: 3,766 acute medical admissions, of whom 245 (6.5%) had AF. Results: Of 245 patients with AF, clinical notes of 24 were lost in the system. Of the remaining 221 patients with AF (107 males; mean age 66 years), 22% were Afghani Muslims, 3% Indians, 1% white and the rest were Pakistani with unknown country of origin. The most common associated medical conditions were hypertension (54%), valvular heart disease (54%) and ischaemic heart disease (IHD, 47%). The most common presenting complaints in female patients were palpitations (51%) and anxiety (35%). In males, the most common symptoms were palpitations (46%), chest pain (35%) and anxiety (27%). Among male patients, 100% had an electrocardiogram (ECG), 93% an X-ray, 89% echocardiography and 49% thyroid function testing. Direct current (DC) cardioversion was attempted in 8%. Of the male admissions with AF, 64% were taking aspirin, while 75% were anticoagulated in hospital and 40% of patients were discharged on anticoagulants with cessation documented in 14%. Beta blockers and amiodarone were prescribed in 74% and 19% of male cases respectively. In females, 100% had an ECG, 76% chest X-rays and 81% had echocardiography proposed. Thyroid function tests were done in 46% of cases, and DC cardioversion was attempted in 11%. Of the female AF patients, 70% were anticoagulated in hospital and 48% went home on anticoagulants. Cessation of warfarin was documented in 27% of female patients, and beta blockers and amiodarone were prescribed in 80% and 26% respectively. Conclusion: Among acute medical admissions to hospital in Pakistan the prevalence of AF was 6.5%. Consistent with previous similar surveys in mainly Western (Caucasian) populations, standard investigations in this cohort were inadequate and there was underuse of anticoagulation (with a high cessation rate).
Objective: To determine the frequency of diabetic cardiomyopathy among patients with type-2 diabetes presenting with overt heart failure. Study design: Case series. Place and duration of study: Department of Cardiology, Mayo Hospital, Lahore, from April 2008 to July 2009. Methodology: One hundred patients with type-2 diabetes mellitus having symptoms and signs of heart failure were enrolled. Anthropometric parameters were recorded and all patients had investigations including complete blood count, blood glucose (fasting and random), serum creatinine, fasting lipid profile, haemoglobin A1c, chest X-ray, electrocardiogram and Doppler echocardiography. After stabilization, every patient underwent coronary angiography. The data was entered in a structured proforma. Results: Sixty (60%) patients were males and 40 (40%) were females. Duration of diabetes was > 10 years in all. Eighty (80%) were on oral hypoglycemic and 20 (20%) were on insulin. Diabetic cardiomyopathy was found in 40 patients (40%) of the total study patients. Forty percent (40%) patients had marked left ventricular (LV) systolic dysfunction (ejection fraction < 30%). Three (5%) patients died during hospitalization. Conclusion: Diabetic cardiomyopathy is a fairly common cause of heart failure in the native population with type-2 diabetes mellitus and results in high morbidity and mortality.