Association Between Serum Syndecan 1 Levels and Metabolic Syndrome Parameters: A Comparative Cross‐Sectional Study

Background and Aims: The prevalence of cardiovascular diseases (CVD) are on the increase worldwide and more in the developing countries. Coronary artery disease (CAD) constitutes the major brunt of CVD. Despite the increasing morbidity and mortality, Bangladesh has a few published data on CAD in rural population. This study addressed the prevalence of CAD and its risk factors in rural population of Bangladesh.Study methods: Sixteen villages were purposively selected in a rural area. A population census was conducted in the selected area. The census yielded eligible participants, who reached at least eighteen years of age. Those who willingly consented to participate were enlisted. Each participant was interviewed regarding CAD risk (age, sex, social class, occupation, illness, family history). Anthropometry (height, weight, waist- and hip-girth) was recorded. Resting blood pressure (BP) was measured. Blood sample was collected for fasting blood glucose (FBG), total cholesterol (Chol), triglycerides (Tg), low density lipoproteins (LDL), very low density lipoproteins (VLDL) and high density (HDL). All participants having FBG>5.5mmol/l or systolic (SBP) ?135 or diastolic BP (DBP) ?85mmHg underwent electrocardiography (ECG). A team of cardiologists selected and accomplished exercise tolerance test (ETT) and echocardiography (Echo).Results: The prevalence of CAD was 4.5% (95% CI: 3.85 – 5.15). Compared with the female (3.5%, CI, 2.76 – 4.24) the male participants had significantly higher prevalence of CAD (6.0%, CI, 4.83 – 7.13). Comparison of characteristics between participants with and without CAD showed that age, SBP, DBP and FBG were significantly higher in CAD group. Bivariate analysis showed that age, sex, social class, glycemic status, metabolic syndrome (MetS) and smoking were significantly related to CAD. Stepwise logistic regression proved only male sex, rich social class, hypertension and diabetes had independent risk of CAD; whereas, age, obesity and dyslipidemia were proved not significant.Conclusions: The study concludes that the prevalence of CAD in a Bangladeshi rural population is comparable to other developed countries. The male sex, rich social class, hypertension and diabetes were proved to have excess risk of CAD. Neither obesity nor dyslipidemia were found significant for CAD. The younger people had similar risk as the aged ones, which necessitate primordial and primary prevention of CAD. Further study may be undertaken, which should include and consider physical activity and diet; and if possible, Creactive protein, Vitamin D and homocysteine level.IMC J Med Sci 2017; 11(2): 61-69

An Evidence-Based Review of Exercise and Metabolic Syndrome

A relationship between carotid stenosis and coronary arterial disease (CAD) is widely accepted; however, data on the exact prevalence of coronary disease in patients with severe carotid stenosis are lacking. Information on the prevalence and predictors of CAD among these patients could impact diagnostic and treatment approaches. The primary aim of this study was to determine the prevalence of significant CAD among patients referred for carotid artery revascularization. The secondary objectives included characterizing the association between the level of advancement of carotid stenosis and the presence of CAD, and between atherosclerotic risk factors and the presence of CAD in patients with carotid stenosis, and also to determine whether there was a difference in the prevalence of CAD between patients with symptomatic versus asymptomatic carotid stenosis. We included 200 patients with severe carotid stenosis, of whom 77 (38.5%) had symptomatic stenosis. All patients underwent coronary angiography no more than 6 months before the scheduled carotid revascularization. Of the 200 total of patients, 192 underwent carotid stenting, six underwent carotid endarterectomy, and two were treated conservatively. CAD was defined as stenosis of at least 50% on recent coronary angiography or a history of previous percutaneous coronary intervention and/or coronary aortic bypass graft; the prevalence was 77.5% among our patients. There was no statistically significant difference in the prevalence of CAD between patients with unilateral versus bilateral carotid stenosis or contralateral carotid occlusion. The difference in the severity of coronary disease, which was given by the SYNTAX score, was not significant between these groups. Factors associated with the presence of CAD were male sex, a history of smoking, and global or regional wall motion disorder on echocardiography. We did not find any significant difference in the prevalence of CAD between patients with symptomatic versus asymptomatic carotid stenosis. We observed a very high prevalence of concomitant CAD in patients with severe carotid stenosis. The results of our study suggest that routine preprocedural screening for CAD in patients with carotid artery stenosis could identify a large proportion of patients with silent CAD; whether treatment for CAD before carotid revascularization can prevent periprocedural myocardial infarction should be addressed in a randomized-controlled trial.

Epidemiological studies have established a strong association between hypertension and coronary artery disease (CAD). Hypertension is a major independent risk factor for the development of CAD, stroke, and renal failure. The optimal choice of antihypertensive agents remains controversial, and there are only partial answers to important questions in the treatment of hypertension in the prevention and management of ischemic heart disease (IHD), such as: ● What are the appropriate systolic blood pressure (SBP) and diastolic blood pressure (DBP) targets in patients at high risk of developing CAD or in those with established CAD? ● Are the beneficial effects of treatment simply a function of blood pressure (BP) lowering, or do particular classes of drugs have uniquely protective actions in addition to lowering BP? ● Are there antihypertensive drugs that have shown particular efficacy in the primary and secondary prevention of IHD? ● Which antihypertensive drugs should be used in patients who have established CAD with stable or unstable angina pectoris, in those with non–ST-elevation myocardial infarction (NSTEMI), and in those with ST-elevation myocardial infarction (STEMI)?

Epidemiological studies have established a strong association between hypertension and coronary artery disease (CAD). Hypertension is a major independent risk factor for the development of CAD, stroke, and renal failure. The optimal choice of antihypertensive agents remains controversial, and there are only partial answers to important questions in the treatment of hypertension in the prevention and management of ischemic heart disease (IHD), such as: This scientific statement summarizes the published data relating to the treatment of hypertension in the context of CAD prevention and management and attempts, on the basis of the best available evidence, to develop recommendations that will be appropriate for both BP reduction and the management of CAD in its various manifestations. Where data are meager or lacking, the writing group has proposed consensus recommendations, with all of the reservations that that term implies and with the hope that large gaps in our knowledge base will be filled in the near future by data from well-designed prospective clinical trials. All of the discussion and recommendations refer to adults. The writing committee has not addressed hypertension or IHD in the pediatric age group. Also, there is no discussion of the different …

Background and aim: Metabolic syndrome (MetS) includes an assembly of conditions; the most important of which is obesity. The pandemic prevalence of obesity worldwide increased the awareness of MetS. Mesenteric fat thickness is linked to higher risk of coronary artery disease (CAD) complications which may lead to death. Although many studies were done on patients with MetS worldwide, studies on Egyptian patients are limited. Thus, here we examined the relationship between mesenteric fat thickness and the severity and prevalence of CAD among Egyptian patients with MetS. Methods: Sixty-four patients with MetS were recruited in this prospective cohort study. We assessed the mesenteric fat, and carotid intima media thickness using ultrasonography. Moreover, we evaluated the coronary arteries using myocardial perfusion imaging, MSCT, and/or coronary angiography. Results: Twenty-three patients had a mesenteric fat thickness less than 10 mm, while 41 patients had a mesenteric fat thickness equal to 10 mm or more. Severity and prevalence of CAD were significantly higher in patients with a mesenteric fat thickness of 10 mm or more (P<0.001, and 0.007). Moreover, there was a significant positive correlation between carotid intima media thickness and a number of diseased vessels in patients with CAD. Conclusion: Our results suggest that mesenteric fat thickness and carotid intima media thickness are good indicators of the prevalence and severity of CAD in patients with MetS. More studies on a large number of the population are required to define MetS in Egyptian patients with MetS, especially in those with a higher risk of CAD.

Prevalence and Impact of Coronary Artery Disease in Patients With Pulmonary Arterial Hypertension

Objectives: to evaluate the prevalence of significant coronary artery disease (CAD) in patients referred for open heart surgery for various valvular and non valvular etiologies.Methods and materials: a total of 160 patients (73 males and 87 females) were included in this study: old age, male gender, hypertension (HT), diabetes mellitus (DM), hyperlipidemia, smoking and left ventricular (LV) systolic dysfunction are recorded as risk factors for CAD. Of the 160 patients: 143 (89.4 %) have valvular disease (VHD) and 17 (10.6%) have non valvular disease. Patients with VHD were classified according to valve lesions into: mitral stenosis (MS), mitral regurgitation (MR), aortic stenosis (AS), aortic regurgitation (AR), tricuspid regurgitation (TR) and mixed valvular disease. Correlation between various types of valve diseases and CAD are assessed.Results: CAD were detected in 26.9% (43) of patients. Old age, HT, DM, hyperlipidemia and smoking were significantly correlated with CAD. CAD were more common in patients with VHD than non VHD. 25(50%) patients with AS have significant CAD (P value= 0.0001), in patients with MR: 8(12.7%) have significant CAD, while patients with MS and AR were have CAD in 15.1% and 25% respectively. Among patients with non valvular heart disease (17 patients): 13 patients have atrial septal defect and 4 patients have atrial myxoma. 3 patients (6.1%) have significant CAD (P value=0.2), one of them had HT, DM and smoker man presented with chest pain on exertion.Conclusion: Obstructive CAD were more common in patients with AS and MR and higher in patients with risk factors for CAD.

<h3>Background</h3> The changing demographics of waitlisted liver transplantation (LT) patients and shift in etiology of liver disease result in increasing prevalence of coronary artery disease (CAD), which can impact post-LT outcomes. This study aims to evaluate the prevalence of CAD among potential LT recipients, describe the risk factors of CAD and investigate the impact of pre-LT CAD on post-LT outcomes. <h3>Methods</h3> Two electronic databases, MEDLINE and EMBASE, were searched for articles describing the CAD in pre-LT patients. Articles that describe the prevalence, risk factors and outcomes of pre-LT patients diagnosed with CAD were included. Generalized linear mixed model (GLMM) and Clopper-Pearson intervals to stabilize the variance were used to tabulate the prevalence of CAD in pre-LT patients and outcomes post-LT. The prevalence of CAD in pre-LT patients was stratified across different regions and countries of varying income levels. Risk factors of CAD and outcomes were analyzed with regression or pairwise analysis. <h3>Results</h3> Total of 39 articles were included. The pooled prevalence of 15,880 patients from 34 studies diagnosed with CAD before LT was 15.88% (CI: 9.81% - 24.69%, IDDF2021-ABS-0095 Figure 1. Screening Method of CAD before Liver Transplant). LT candidates in high-income countries had markedly higher odds of CAD (OR: 10.5; CI: 8.12 – 13.7; p &lt; 0.0001) compared to patients in middle-income countries. Age, male, presence of diabetes, hypertension, hyperlipidemia, smoking, non-alcoholic steatohepatitis, hepatitis B and hepatocellular carcinoma were significantly associated with CAD. CAD diagnosis prior to LT was a significant risk factor for overall mortality (OR: 1.42; CI: 1.40 – 1.43; p = 0.0140) and cardiac-related mortality (OR: 1.18; CI: 1.10 – 1.27; p = 0.0347) post-LT. North America had the highest pooled prevalence of CAD in pre-LT patients at 23.61% (CI: 14.07% - 36.83%) amongst South America, Europe, Middle east, Asia and Oceania. 69% of the included studies utilized non-invasive stress tests and invasive coronary angiograms in their pre-LT cardiac assessment (IDDF2021-ABS-0095 Figure 2. Global Prevalence of CAD before Liver Transplant). <h3>Conclusions</h3> This meta-analysis and systematic review demonstrate the high prevalence of CAD in pre-LT patients, the associated risk factors and outcomes. More studies are required to determine the optimal screening methodology for CAD in pre-LT patients.

‘Hypertension’ and ‘microalbuminuria’: The bell tolls for thee

This study was conducted to determine and compare the prevalence of coronary artery disease and coronary risk factors in both a rural and an urban population of Moradabad in north India. A cross-sectional survey of two randomly selected villages from the Moradabad district and 20 randomly selected streets in the city of Moradabad. The 3575 subjects were between 25 and 64 years old; 1769 (894 men and 875 women) lived in the countryside and 1806 (904 men and 902 women) lived in the city. The survey methods were questionnaires, physical examination and electrocardiography. The overall prevalence of coronary artery disease, based on a clinical diagnosis and an electrocardiogram, was 9.0% in the urban and 3.3% in the rural population. The prevalences were significantly (P < 0.001) higher in the men compared with the women in both urban (11.0 vs 6.9%) and rural (3.9 vs 2.6%) populations, respectively. The prevalence of symptomatic coronary artery disease (known coronary disease and Rose questionnaire-positive angina) was 2.3% in the men (n = 19) and 1.5% in the women (n = 13) in the rural subjects, and 8.5% in the men (n = 77) and 3.4% in the women (n = 31) in the urban population. When diagnosed on the basis of electrocardiographic changes alone, the prevalences were 1.5% (n = 26) in the rural population and 3.0% (n = 55) in the urban. Coronary risk factors were two- or three-fold more common among urban subjects compared to the rural population in both sexes. Central obesity was four times more common in the urban population compared to the rural in both sexes. Sedentary lifestyle and alcohol intake were significantly (P < 0.01) higher in the urban population compared to the rural subjects. There was a significant association between coronary disease and age, hypercholesterolaemia, hypertension and central obesity in both sexes. Smoking was a significant risk factor of coronary disease in men. Coronary artery disease and coronary risk factors were two or three times higher among the urban compared with the rural subjects, which may be due to greater sedentary behaviour and alcohol intake among urbans. It is possible that some Indian populations can benefit by reducing serum cholesterol, blood pressure and central obesity and increasing physical activity.

Coronary Computed Tomographic Angiographic Findings in Asymptomatic Patients With Heterozygous Familial Hypercholesterolemia and Null Allele Low-Density Lipoprotein Receptor Mutations

1. Relationship Between Hypertension and CAD e437 2. Prevention of Cardiovascular Events in Patients With Hypertension and CAD e443 3. BP Goals e445 4. Management of Hypertension in Patients With CAD and Stable Angina e449 5. Management of Hypertension in Patients With ACS e451

BackgroundThere are no recent data on prevalence of coronary artery disease (CAD) in Indians. The last community based study from Kerala, the most advanced Indian state in epidemiological transition, was in 1993 that reported 1.4 % definite CAD prevalence. We studied the prevalence of CAD and its risk factors among adults in Kerala.MethodsIn a community-based cross sectional study, we selected 5167 adults (mean age 51 years, men 40.1 %) using a multistage cluster sampling method. Information on socio-demographics, smoking, alcohol use, physical activity, dietary habits and personal history of hypertension, diabetes, and CAD was collected using a structured interview schedule. Anthropometry, blood pressure, electrocardiogram, and biochemical investigations were done using standard protocols. CAD and its risk factors were defined using standard criteria. Comparisons of age adjusted prevalence were done using two tailed proportion tests.ResultsThe overall age-adjusted prevalence of definite CAD was 3.5 %: men 4.8 %, women 2.6 % (p < 0.001). Prevalence of any CAD was 12.5 %: men 9.8 %, women 14.3 % (p < 0.001). There was no difference in definite CAD between urban and rural population. Physical inactivity was reported by 17.5 and 18 % reported family history of CAD. Other CAD risk factors detected in the study were: overweight or obese 59 %, abdominal obesity 57 %, hypertension 28 %, diabetes 15 %, high total cholesterol 52 % and low level of high density lipoprotein cholesterol 39 %. Current smoking was reported only be men (28 %).ConclusionThe prevalence of definite CAD in Kerala increased nearly three times since 1993 without any difference in urban and rural areas. Most risk factors of CAD were highly prevalent in the state. Both population and individual level approaches are warranted to address the high level of CAD risk factors to reduce the increasing prevalence of CAD in this population.

Coronary evaluation in patients with stroke: Recognizing the risk