[Show abstract][Hide abstract] ABSTRACT: Western studies have shown that diabetes mellitus and other glucometabolic states are highly prevalent among patients with Acute Coronary Syndrome (ACS), and are associated with worse adverse cardiovascular outcome. Whether this also applies to Middle Eastern patients is largely unknown. We studied the prevalence of glucometabolic states (known diabetes, newly diagnosed diabetes, impaired fasting glucose (IFG), and no diabetes) in 656 ACS patients, who were followed up prospectively for total mortality, and composite events of death, readmission for myocardial infarction, or urgent coronary revascularization for 1 year after admission. Of the whole group, 291 (44.6%) were known diabetics, 69 (10.6%) had newly diagnosed diabetes, 86 (13.2%) had impaired fasting glucose, and 206 (31.6%) were nondiabetics. The overall in-hospital mortality rate was 2.6%, and was not significantly different between the four groups. At 1 year; overall mortality was 7.2%, and was significantly higher (p = 0.002) among diabetics (newly diagnosed; 17.1%, and known diabetics; 7.8%) compared with patients who had IFG (3.4%) and nondiabetics (4.4%). Composite events at 6 months was significantly higher (p = 0.016) in known diabetics (14.7%), compared with newly diagnosed diabetics (7.1%), IFG (9.2%) and nondiabetics (6.3%). At 1 year, composite events occurred in 15.9% of the whole group, and was significantly higher (p = 0.049) in known diabetics (20.1%), compared with newly diagnosed diabetics (10%), IFG (11.5%) and nondiabetics (13.6%). In Middle Eastern ACS patients, 70% have abnormal glucometabolic states. Newly diagnosed diabetics and known diabetics have higher risk of cardiovascular events than patients with impaired fasting glucose and nondiabetics after 1 year of admission.
Full-text · Article · Mar 2012 · International Journal of Diabetes in Developing Countries
[Show abstract][Hide abstract] ABSTRACT: We measured fasting serum total cholesterol (TC), triglycerides (TG), and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) levels in 5000 individuals. Coronary artery disease (CAD) was present in 31%. Compared with women, men had lower mean TC, LDL-C and HDL-C and higher mean TG. Optimal TC level was observed in only 46% of men and 41% of women, and optimal TG in 42% of men and 50% of women. Only 3% of men and 12% of women had HDL-C > 60 mg/dL. Mean TC was not different in CAD patients and those without CAD, but mean TG was significantly higher and mean HDL-C was lower. In all age groups, low HDL-C was more prevalent among men and women who had CAD.
Full-text · Article · Jan 2008 · Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ
[Show abstract][Hide abstract] ABSTRACT: Background and Methods: C-reactive protein (CRP), a key inflammatory marker, is elevated in pa - tients with acute coronary syndrome (ACS) and is a predictor of short and long-term events in such pa- tients. It is largely unknown if this also applies to Middle Eastern patients with ACS. High sensitivity (hs) CRP was measured on admission in 502 consecutive patients with ACS (mean age 56.6±11.1 years, 80% men, 48% smokers, 47% hypertensives and 41% diabetics). ST elevation myocardial infarction (MI) was diagnosed in 157 (31%), non-ST elevation MI in 80 (16%), and unstable angina in 265 (53%). Results: Primary end-point (composite cardiac death and nonfatal MI) was assessed during index hos- pitalization, at 1, 6 and 12 months according to hs-CRP tertiles (lowest tertile: levels 12 mg/L). In-hospital mortality was 3.4%, and the primary endpoint rate occurred in 4%. Primary end-point was significantly higher among patients in the highest tertile vs. lowest tertile (6.6% vs. 1.8%, p=0.027). One-, 6-, and 12-month primary end- points occurred in 5.6%, 7.6%, and 9.4%, respectively. These were significantly higher in patients in the highest tertile compared to the lowest tertile (9.3% vs. 3.0% at 1 month (p=0.017); 13.5% vs. 4.8% (at 6 months) p=0.007; and 17.6% vs. 6.2% (at 12 months) p=0.002). hs-CRP was an independent pre- dictor of 1-year events (odds ratio (OR) for highest tertile 3.35; 95% CI 1.42-7.90; p
Full-text · Article · Jan 2008 · International Journal of Atherosclerosis
[Show abstract][Hide abstract] ABSTRACT: Background: In the West, acute myocardial infarction occurs after exposure to emotional or physical stress in about 20-30% of cases, and circadian variation has an incidence peak in the early morning hours, on Mondays, and during winter months. Whether similar frequency of triggers and circadian variation occurs in middle-eastern patients with acute myocardial infarction is largely unknown. Methods and Results: Consecutive patients (n=962) admitted with acute ST-elevation myocardial infarction were enrolled. Patients were interviewed within 24 h of admission and were asked about exposure to potential emotional or physical triggers prior to the onset of chest pain. Wake-up time, time, and date of pain onset were also recorded. There were 815 men and 147 women (mean ages of 53.8 and 62.7 years, respectively). Among them, there were 31% hypertensives, 36% diabetics, and 60% smokers. Exposure to a triggering event was reported by 411 patients (42.7%), including emotional trigger (25.9%; anger was the most common, 14.7%), physical exertion (10.5%), heavy meal (2%), sexual activity (1.8%), and smoking binge (0.5%). More than half of the patients (55%) had the onset of pain within the first 4 h after waking up. Friday (local weekend) was the day with the highest incidence of infarction with a 34% relative-risk increase (p<0.05) as compared with Sunday, the day with the least incidence. Incidence of infarction during the winter months did not differ significantly from those during the summer months. Conclusions: In this middle-eastern study, more than 40% of the patients admitted with acute myocardial infarction reported exposure to emotional or physical trigger. Anger was the most common trigger. We also observed that peak incidence of myocardial infarction in the early morning hours was similar to that obtained from western data. However, Friday not Monday was the day of peak incidence. Higher incidence was not observed during the winter months. In addition to coronary risk-factor control, stress management and behavioral therapy have a potential impact on the incidence of acute myocardial infarction.
No preview · Article · Jan 2008 · International Journal of Atherosclerosis
[Show abstract][Hide abstract] ABSTRACT: The prevalence of the major conventional cardiovascular risk factors - cigarette smoking, diabetes mellitus, hypertension, and dyslipidemia - among coronary heart disease (CHD) patients in the Middle East has not been studied extensively.
The Jordan Hyperlipidemia And Related Targets Study (JoHARTS) evaluated the prevalence of the 4 conventional risk factors in 5000 individuals including 1692 (34%) women. CHD was present in 1534 (31%) individuals (1202 men and 332 women). Among CHD patients, at least one risk factor was present in the majority of men (95%) and women (96%). Compared with women who had CHD, men had significantly higher prevalence of smoking (45% vs. 11%, p < 0.0001) and low levels of high-density lipoprotein cholesterol (60% vs. 39%, p < 0.0001), and lower prevalence of diabetes (40% vs. 64%, p < 0.0001), hypertension (38% vs. 63%, p < 0.0001), and hypercholesterolemia (19% vs. 27%, p = 0.003). Diabetes was more prevalent among men and women with CHD than men and women without CHD (40% vs. 18% for men, and 64% vs. 24% for women p < 0.0001). Similarly, smoking was more prevalent in men and women with CHD than those without CHD (45% vs. 32% for men, and 11% vs. 7%, p < 0.0001). Low levels of high-density lipoprotein cholesterol were also more prevalent in men with CHD than those without CHD (60% vs. 51%, p < 0.001) and among women with CHD than those without CHD (39% vs. 24%, p = 0.0001). Prevalence rates of hypertension, hypercholesterolemia, and hypertriglyceridemia were not different among individuals with or without CHD.
These results further challenge claims that patients with CHD commonly lack conventional risk factors. The great majority (>95%) of CHD patients studied have at least one risk factor. Detection, evaluation and management of these factors are essential steps to control CHD in the region.
No preview · Article · Jul 2006 · International Journal of Cardiology