Coronary Heart Disease Morbidity Research Articles

Visceral-to-peripheral adiposity ratio: a critical determinant of sex and ethnic differences in cardiovascular risks among Asian Indians and African Creoles in Mauritius.

Coronary heart disease morbidity and mortality are higher in people of South Asian origin than in those of African origin. We investigated whether as young adults without diabetes, people in Mauritius of South Asian descent (Indians) would show a more adverse cardiovascular risk profile that those of predominantly African descent (Creoles), and whether this could be explained by ethnic differences in visceral adiposity or other fat distribution patterns. The study was conducted in 189 young non-physically active adults, with the following measurements conducted after an overnight fast: anthropometry (weight, height, waist circumference), whole-body and regional body composition by dual-energy x-ray absorptiometry, blood pressure, and blood assays for glycemic (glucose and HbA1c) and lipid profile (triglycerides and cholesterols). The results indicate higher serum triglycerides and lower HDL cholesterol in men than in women, and in Indians than in Creoles (p < 0.001). No significant differences due to sex or ethnicity are observed in body mass index and waist circumference, but indices of visceral adiposity (visceral/android, visceral/subcutaneous) and visceral-to-peripheral adiposity ratio (visceral/gynoid, visceral/limb) were significantly higher in men than in women, and in Indians than in Creoles. The significant effects of sex and ethnicity on blood lipid profile were either completely abolished or reduced to a greater extent after adjusting for the ratio of visceral-to-peripheral adiposity than for visceral adiposity per se. In young adults in Mauritius, Indians show a more adverse pattern of body fat distribution and blood lipid risk profile than Creoles. Differences in their fat distribution patterns, however, only partially explain their differential atherogenic lipid risk profile, amid a greater impact of visceral-to-peripheral adiposity ratio than that of visceral adiposity per se on sex and ethnic differences in cardiovascular risks; the former possibly reflecting the ratio of hazardous (visceral) adiposity and protective (peripheral) superficial subcutaneous adiposity.

Peripheral Arterial Disease Detection Efforts with Ankle Brachial Index (ABI) Examination

Peripheral Arterial Disease (PAD) is the third leading cause of atheroskeric vascular morbidity in coronary heart disease. The ankle-brachial index (ABI) is one way to assess peripheral arteries. This activity aims to identify people who are at risk or suffer from PAD. The method used is a medical examination, which includes ABI values, blood pressure, cholesterol levels, blood sugar, and uric acid. This medical examination was conducted on 41 people in RT 02 RW 06 Pasar Ambacang, Padang City. The screening results found that 17.07% of respondents had ABI values higher than 1.3 (severely calcified vessel), and 14.62% had ABI values in the range of 0.71-0.9 (mild obstruction). This activity also found respondents with first-stage hypertension (29.26%), second-stage hypertension (2.44%), high cholesterol levels (56.09%), high blood sugar levels (7.31%), and uric acid levels exceeding normal limits (7.31%). Screening efforts can be a preventive measure.

Heart Disease Knowledge and Awareness in African American and Hispanic Women.

Coronary heart disease (CHD) is the leading cause of morbidity and mortality among US women. Minority women have higher rates of CHD and are more likely to experience adverse outcomes. Because of racial disparities in CHD outcomes, the purpose of this study was to assess CHD knowledge and awareness in African American and Hispanic women. Using a survey research design, a convenience sample of African American and Hispanic women was surveyed in their local communities. CHD knowledge, awareness, and demographic data were collected using an online survey. The survey was administered in English and Spanish using an iPad. CHD knowledge was assessed using a 7-item survey based on the American Heart Association's Life's Simple 7 brochure. CHD awareness was assessed using a 7-item survey adapted from the American Heart Association's Survey of Women's Cardiovascular Disease Awareness. CHD knowledge was scored on a scale of 0 to 7, and awareness was assessed based on responses to each question. The data analysis consisted of cross-tabulations and multivariable repeated measures analysis. We assessed differences in CHD knowledge and awareness based on race/ethnicity. We hypothesized that there would be statistically significant differences in CHD knowledge and awareness based on specific demographic factors (eg, age, income, education, health literacy). A total of 100 African American (n=50) and Hispanic (n = 50) women participated in the study. Results revealed that CHD knowledge and awareness were limited for both groups. Seventy-three percent of participants (African American 66%; Hispanic 80%) did not know that CHD is the leading cause of death in women and 75% (African American 60%; Hispanic 90%) were moderately or not at all informed about CHD. These findings support the need for more research on innovative strategies to improve CHD knowledge and awareness, particularly in African American and Hispanic women who are at highest risk, thereby addressing racial/ethnic and gender disparities in CHD morbidity and mortality.

Smartphone-Based Cardiac Rehabilitation Program Improves Functional Capacity in Coronary Heart Disease Patients: A Systematic Review and Meta-Analysis.

Cardiac rehabilitation (CR) reduces mortality and morbidity in coronary heart disease (CHD); however, patients show a lack of adherence to CR. Alternatively, telehealth interventions have shown promising results for improving target outcomes in CR. This study aimed to review the effect of smartphone-based CR on the functional capacity of CHD patients. A literature search was performed using PubMed, MEDLINE, Embase, and Cochrane Library on 21 March, 2022 to find randomised controlled trials on smartphone usage in CR to improve functional capacity. Outcomes included maximal oxygen consumption (VO2 max), a 6-min walk test (6-MWT), quality of life, smoking cessation, and modifiable risk factors. Eleven trials recruiting CHD patients were reviewed. Wearable devices connected to smartphone- or chat-based applications were commonly used for CR delivery. Most trials managed to provide exercise prescriptions, education on medication adherence and controlling risk factors, and psychosocial counselling through the intervention. Functional capacity improved significantly following smartphone-based CR in CHD patients compared to control groups, as measured by VO2 max and 6-MWT; patients were more likely to quit smoking. Compared to traditional care, smartphones that delivered CR to CHD patients demonstrate superior outcomes regarding increasing functional capacity. There is no significant improvement on lipid profile, blood pressure, HbA1C, body mass index, and quality of life. It can be used either alone or as an adjunct. Ultimately, the patients' preferences and circumstances should be considered.

The ABCB1 C3435T Polymorphism is Associated with Triglyceride Reduction in Atorvastatin-treated Uygur Patients with Coronary Heart Disease and Dyslipidemia: An Observational Study.

The morbidity of coronary heart disease (CHD) and dyslipidemia in the Uygur population of Xinjiang is higher than the national average. Interindividual variability of the response to atorvastatin is a major clinical problem; generally, statins shed less impressive benefits for females than males. Nevertheless, it is unclear whether ABCB1 genes and sex modify the efficacy of atorvastatin in Uygur patients. To determine the impact of ABCB1 gene polymorphisms on the therapeutic response to atorvastatin in a Uygur population with dyslipidemia. Patients with dyslipidemia were treated with 20 mg/d or 40 mg/d atorvastatin for two to six months. TC, LDL-C, HDL-C, TG, APOB, APOE, LP(a), and APOA1 levels were measured before and after atorvastatin administration. We performed genotyping of ABCB1 C3435T and G2677T variants using hybridization sequencing. The association of variants between the percentage of change in TG levels was examined using multiple linear regression analysis. We enrolled 193 Uygur patients. Atorvastatin reduced TG, LDL-C, TC, APOB, and APOE levels (P < 0.05), whereas LP(a) and APOA1 levels increased (P < 0.05). In multiple linear regression analysis, baseline TG level (beta 0.204; 95% confidence interval (CI): 1.980-10.493; P = 0.004) and TT genotype of ABCB1 C3435T (beta 0.162; 95% CI: 2.517-23.406; P = 0.023) predicted TG reduction with atorvastatin therapy in overall patients. Baseline TG level (beta 0.346; 95% CI: 4.374 -13.34; P < 0.001) with the TT genotype of ABCB1 C3435T (beta 0.401; 95% CI: 4.053-28.356; P = 0.021) was associated with a significant reduction in TG levels in men. Only baseline TG level predicted TG reduction within six months of atorvastatin therapy for females (beta 0.61; 95% CI: 3.204-20.557; P = 0.041). In patients with the ABCB1 C3435T TT genotype, atorvastatin more effectively lowered TG than other polymorphisms. This investigation may provide insights into effective individualized therapies for CHD and dyslipidemia in the Uygur population.

Smoking and diabetes: sex and gender aspects and their impact on vascular diseases.

Smoking and diabetes mellitus (DM) have been identified as two major cardiovascular risk factors for many years. In the field of cardiovascular diseases, considering sex differences, or gender differences, or both has become an essential element in moving toward equitable and quality healthcare. We reviewed the impact of sex or gender on the link between smoking and DM. The risk of type 2 DM (T2DM) due to smoking has been established in both sexes at the same level. As is the case in the general population, the prevalence of smoking in those with DM is higher in men than in women, although the decrease in smoking observed in recent years is more pronounced in men than in women. Regarding chronic DM complications, smoking is an independent risk factor for all-cause mortality, as well as macrovascular and microvascular complications, in both sexes. Nevertheless, in T2DM, the burden of smoking appears to be greater in women than in men for coronary heart disease morbidity, women having a 50% higher risk of fatal coronary event. Women are more dependent to nicotine, cumulate psychosocial barriers to quitting smoking, and are more likely to gain weight, which might make it more difficult for them to quit smoking. Smoking cessation advice and treatments should take into account gender differences to improve the success and long-term maintenance of abstinence in people with and without DM. This might include interventions that address emotions and stress in women or designed to reach specific populations of men.

Dukungan Keluarga Pada Pasien Penyakit Jantung Koroner (PJK) dalam Pemanfaatan Informasi dan Pelayanan Kesehatan

The morbidity and mortality rate of Coronary Heart Disease (CHD) in Indonesia is increasing every year. The results of the 2019 Basic Health Research showed that 1.5% or 15 out of 1000 Indonesians suffer from CHD. The lack of health literacy of CHD patients and their families related to symptoms, risks, lifestyle, and treatment of CHD will further worsen the patient's condition. The purpose of this study was to analyze family support in coronary heart disease (CHD) patients in the use of information and health services. Using qualitative research methods with a phenomenological approach, data collection techniques through indepth interviews, observations and documentation. There were 8 research informants consisting of one doctor as a key informant, 2 supporting informants and 5 ordinary informants with criteria for a patient's condition that was stable, communicative and willing to be an informant. The results showed that the ability of patients to receive and manage information called health literacy in CHD patients and their families is still low because they lack the ability to receive and manage information from doctors and lack of independent information search efforts. The conclusion of this study is that access to information, receipt and management of information are very important to improve health literacy of CHD and their families.

Urgent Notification Of High Temperature Induced Mortality of Patients with Diabetes and Hypertension in Hodeidah Governorate ،Yemen

Dear Editor: Many researches and studies have shown a relationship between high and cold air temperature and an increase in mortality, especially for patients with cardiovascular disease.[5,6] Recently, associations between ambient temperature and morbidity have also been reported,[7,8] even though these associations have not always been similar in magnitude to mortality,[8] and null findings have also been reported.[9] Also, while the association between temperature and cardiovascular mortality has been reported to be U- shaped in many studies,[10] the association with cardiovascular hospitalization was reported to be linear in the US [7]. Increased blood pressure (BP) is a risk factor for cardiovascular mortality [14,15] and for coronary heart disease and stroke morbidity [16,17]. Therefore changes in BP might also play a part in the development of cardiovascular events that are associated with changes in temperature. The mechanisms behind temperature-related cardiovascular mortality and morbidity are not fully established. As elevated BP is a known risk factor for cardiovascular disease and stroke events, BP can also be part of the mechanism leading to temperature-related deaths. Epidemiological studies have shown that cardiovascular diseases rank first among the causes of death in China and have become a major disease within the Chinese population [18]. The effects of type 1 and type 2 diabetes on the body's physiological response to thermal stress is a relatively new topic in research. Diabetes tends to place individuals at greater risk for heat- related illness during heat waves and physical activity due to an impaired capacity to dissipate heat. Specifically, individuals with diabetes have been reported to have lower skin blood flow and sweating responses during heat exposure and this can have important consequences on cardiovascular regulation and glycemic control. Those who are particularly vulnerable include individuals with poor glycemic control and who are affected by diabetes-related complications [19]. As a result of the war and the siege on Yemen, the deterioration of living and health conditions, the interruption of electricity, the suspension of salaries for six years, and the arrival of about 80% of the population of Al-Hodeidah Governorate to a level below the poverty line. We have monitored as a result of the high temperature, which reached 48 degrees Celsius in the city of Hodeidah, 28 deaths of people with diabetes and arterial hypertension were monitored for the period from 5-6-2022 to 25-6-2022. This catastrophe occurred due to the government power outage as a result of the war and the siege on Yemen and the inability of people to buy expensive commercial electricity. This is considered a humanitarian disaster that requires a serious stand by the government, international organizations and the international community to save Hodeidah residents from extreme heat and poverty by providing electricity and humanitarian aid to contribute to improving the health and living situation in the governorate and supporting hospitals with fuel by the World Health Organization.

Exploring mechanisms of blood pressure regulation in response to device-guided and non-device-guided slow breathing: A mini review.

Hypertension is a widespread disease that, if persistent, increases the risks of coronary heart disease mortality and morbidity. Slow breathing is a recommended blood pressure-lowering strategy though the mechanisms mediating its effects are unknown. This review aims to evaluate autonomic and vascular function as potential mediators driving BP adaptive responses with slow breathing. We searched EBSCO host, Web of Science, Cochrane Central Register of Controlled Trials, and PubMed using key words for optimized search results. Nineteen studies were included in this review (11 device-guided; 8 non-device-guided breathing). Though some studies showed increased vagally mediated components of heart rate variability during slow breathing, results from acute and long-term studies were incongruent. Increases in baroreflex sensitivity (BRS) following a single device-guided slow breathing bout were noted in normotensive and hypertensive adults. Long-term (4weeks to 3months) effects of slow breathing on BRS were absent. Device-guided breathing resulted in immediate reductions in muscle sympathetic nerve activity (MSNA) in normo- and hyper-tensive adults though results from long-term studies yielded inconsistent findings. Non-device-guided slow breathing posed acute and chronic effects on vascular function with reductions in arterial stiffness in adults with type I diabetes and increases in microvascular endothelial function in adults with irritable bowel syndrome. Non-device guided breathing also reduced pro-inflammatory cytokines in healthy and hypertensive adults in acute and chronic studies. No adverse effects or non-adherence to treatment were noted in these trials. Device-guided slow breathing is a feasible and effective modality in improving BRS, HRV, and arterial stiffness though its long-term effects are obscure. Though less evidence exists supporting the efficacy of non-device-guided slow breathing, acute and chronic studies demonstrate improvements in vascular function and inflammatory cytokines. More studies are needed to further explore the long-term effects of slow breathing in general and non-device-guided breathing in particular.

Effectiveness and safety of Tiaogan formula in the treatment of coronary heart disease: A protocol for systematic review and meta-analysis

The morbidity and mortality of coronary heart disease (CHD) has remained high, which greatly increases people's economic burden. Several studies have showed that Tiaogan formula (TGF), as a kind of Chinese herbal medicine, was of benefit to relieving angina pectoris symptoms and improving the quality of life for CHD patients. However, the intensity of evidence has been poor, limiting the further clinical application of TGF to CHD. This systematic review and meta-analysis will assess the effectiveness and safety of studies of TGF in CHD patients. A systematic search for literature up to December 2022 will be conducted in following public electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database Database, and Wanfang Database. Inclusion criteria are randomized controlled trials of Tiaogan formula in the treatment of coronary heart disease. The primary outcome measures will be mortality, acute cardiovascular events, total efficacy rate, and improvement of angina symptoms. The secondary outcome measures will be electrocardiogram, levels of blood lipid, and adverse events. RevMan 5.4 software Cochrane Collaboration (London, United Kingdom) will be applied for data synthesis, sensitivity analysis, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. This study will provide a systematic review of Tiaogan formula in the treatment of CHD. This study will provide a high-quality synthesis of the effects and safety of Tiaogan formula in the treatment of CHD patients.

Theory-based nursing interventions in adults with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis aimed to synthesize the outcomes of theory-based nursing interventions for coronary heart disease management. Web of Science, Scopus, Science Direct, and PubMed databases were electronically searched from January 2013 to August 2021. The Preferred Reporting Item for Systematic Reviews and Meta-analyses statement guidelines was followed for this meta-analysis. Randomized controlled trials on patients with coronary heart disease, using a theory-based nursing intervention were eligible. Methodological quality was examined by two authors using the Modified Jadad Scale. Based on the heterogeneity test, the results were analyzed using a pool of data with 95% confidence intervals, p-values, and fixed or random-effect models (PROSPERO registration number X). A total of 1030 studies were initially retrieved, and 8 randomized controlled trials were eventually included in the meta-analysis after screening. The big majority (81.3%) of participants were males, and the mean age was 54.8 (SD=8.7) years. This meta-analysis found theory-based nursing interventions had no significant effect on blood lipid profile, blood pressure, and healthy lifestyle. However, these interventions significantly reduced fasting blood glucose, and body mass index and improved the physical and psychological domains of quality of life. The evidence from this meta-analysis reveals that theory-based nursing interventions have a positive effect on fasting blood glucose, body mass index, and quality of life. However, their effects on blood lipid profile, blood pressure, and a healthy lifestyle are inconclusive. The results of this metanalysis are largely based on a few trials and were limited in terms of the number of outcomes. Conducting well-designed randomized controlled trials with adequate power is needed to make a firm conclusion on the influence of theory-based nursing interventions on patient outcomes in the CHD population. Considering the high mortality and morbidity of coronary heart disease, nurses may play a significant role in coronary heart disease management by providing interventions that are based on a certain theoretical framework. This meta-analysis provides insights into the implementation of theory-based nursing interventions in heart attack survivors or those newly diagnosed with coronary heart disease led by nurses and lasting longer than 6 months in coronary heart disease. In addition, future studies should consider enhancing the content of training programs for a healthy lifestyle within the theory-based nursing interventions and compare the effects of these interventions on acute and chronic coronary syndromes.

Risk factor recording and management in coronary heart disease patients from 32 countries: SURF CHD II

Abstract Introduction Patients with coronary heart disease (CHD) are at high cardiovascular risk, and controlling risk factors in this population is especially important to prevent CHD morbidity and mortality. SURF CHD (Survey of Risk factors in Coronary Heart Disease) II is a clinical audit on secondary prevention of CHD. The goals are to simplify and assess the recording and management of cardiovascular risk factors in patients with CHD. Methods SURF CHD II consists in a brief online survey conducted during routine outpatient visits in patients with a previous acute coronary syndrome (ACS), stable angina, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Information is collected electronically on demographics, risk factor history (smoking history, physical activity), risk factor measurements (blood pressure, BMI, waist circumference), laboratory values and medication. Risk factor targets were defined as follows: no prior smoking or having stopped smoking, practice of at least 30 minutes of moderate physical activity 3–5 times per week, BMI &amp;lt;25 kg/m2, waist circumference &amp;lt;94 cm in men and &amp;lt;80 cm in women, blood pressure of &amp;lt;140/90 mmHg (&amp;lt;140/85 mmHg in diabetics), LDL &amp;lt;70 mg/dL, HDL &amp;gt;40 mg/dL in men and &amp;gt;45 mg/dl in women, triglycerides &amp;lt;150 mg/dL, and HbA1c &amp;lt;7% in diabetic participants. Results 12884 patients from 32 countries participated in SURF CHD in 5 regions: 10195 in Europe, 2048 in South-East Asia (SEA), 415 in the Americas, 210 in North Africa-Eastern Mediterranean (NAEM), and 13 in Western Pacific. All centres participating were located in urban areas and 81.6% were public Women represented 24.6% of the participants, mean age 64.1 years (sd 11.2 years). 57.7% of the patients had a previous PCI, 50% ACS, 29.5% stable angina and 16.1% CAGB. The percentage of risk factor recording and target attainment by region is presented in Table 1. Risk factor recording ranged from 26.8% (waist circumference) to 94.3% for blood pressure. Target attainment varied from 25.8% with a BMI &amp;lt;25 kg/m2, to 76.3% of participants that had never smoked or had stopped smoking. The South East Asian region presented the highest percentages of risk factor target attainment for smoking, physical activity, BMI, waist circumference and LDL. 92.% of participants used antiplatelet medication, 100% antihypertensive medication and 89.4% lipid-lowering medications. Conclusion Risk factor recording was reasonable, but poor for some risk factors such as waist circumference and Hba1c. In line with earlier clinical audits, there is still substantial room for improvement in risk factor control in this high cardiovascular risk population. There were regional variations, with the highest level of attainment for most risk factors targets in South East Asia. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): SURF II is conducted within the framework of the ESC Prevention of CVD Programme, led by the European Association of Preventive Cardiology (EAPC).

Effects of sleep deprivation on coronary heart disease.

The presence of artificial light enables humans to be active 24 h a day. Many people across the globe live in a social culture that encourages staying up late to meet the demands of various activities, such as work and school. Sleep deprivation (SD) is a severe health problem in modern society. Meanwhile, as with cardiometabolic disease, there was an obvious tendency that coronary heart disease (CHD) to become a global epidemic chronic disease. Specifically, SD can significantly increase the morbidity and mortality of CHD. However, the underlying mechanisms responsible for the effects of SD on CHD are multilayered and complex. Inflammatory response, lipid metabolism, oxidative stress, and endothelial function all contribute to cardiovascular lesions. In this review, the effects of SD on CHD development are summarized, and SD-related pathogenesis of coronary artery lesions is discussed. In general, early assessment of SD played a vital role in preventing the harmful consequences of CHD.

Regulating mitochondrial homeostasis and inhibiting inflammatory responses through Celastrol.

BackgroundThe high morbidity and mortality rate of coronary heart disease poses a serious threat to human health. Atherosclerosis, a chronic inflammation of the blood vessel wall, is a significant pathological process leading to coronary heart disease. Macrophage inflammation plays a crucial role in the occurrence and development of atherosclerosis.MethodsMacrophage inflammation model was constructed by lipopolysaccharide (LPS), and macrophages were treated with Celastrol at different concentrations (0, 0.1, 1, 10, 100 ng/mL) and different time points (0, 1, 3, 6, 12 h). Real-time quantitative PCR (qPCR) and Western Blot were used to detect the expression of Nur77 mRNA and protein. Macrophages were then pretreated with 100 nmol/L tripterine for 40min and co-cultured with 100 ng/mL LPS. The expression levels of inflammatory factors and chemokines, phosphorylation of phospho-dynamin-related protein 1 (p-Drp1) at Ser637 and expression of mitochondrial fusion protein mitochondrial fusion protein mitofusin-2 (Mfn2) were detected by qPCR, Western blot and ELISA, respectively. The changes of mitochondrial membrane potential were detected by JC-1 probe.Results100 nmol/L Celastrol can significantly inhibit LPS-induced inflammatory responses and down-regulate the expression levels of cytokines such as inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX2), tumor necrosis factor-α (TNF-α), chemokines (CCL-2, and CXCL-10), as well as chemokines. And Celastrol could regulate mitochondrial fission and fusion by promoting the phosphorylation of the Drp1 at the Ser637 site, thereby inhibiting mitochondrial fission. At the same time, by up-regulating the level of the Mfn2, Celastrol also promoted mitochondrial fusion. In addition, we found that the nuclear factor-k-gene binding (NF-κB), extracellular signal-regulated kinase 1/2 (ERK1/2), and p38 signaling pathways aided the drug’s anti-inflammatory effects. We also explored the relationship between Celastrol and the nuclear receptor Nur77 and found that it could up-regulate the expression of Nur77.ConclusionsOur study found that Celastrol could reduce inflammation by regulating Drp1 dependent mitochondrial fission and fusion, as well as the ERK1/2, p38, NF-κB signaling pathways. This finding provides a strong direction for the development of new anti-inflammatory drugs for atherosclerosis.

Hyperlipidemia management in diabetes: First line or supportive therapy?

Background & Aims: Coronary heart disease (CHD) is the most important cause of morbidity and mortality in type 2 diabetes. Current therapeutic approach has changed from glucocentric to vasculoprotective. This brief review highlights importance of management of hyperlipidemia (raised LDL cholesterol and triglycerides) on CHD outcomes in diabetes.Methods: Literature seach was done till March 2022 (Pubmed, Google scholar) using following search words; lipids, cholesterol, statins, triglycerides, fibrates, omega-3 polyunsaturated fatty (Omega-3 PUFAs) acids, LDL, diabetes, coronary heart disease.Results: Meta-analyses of randomized controlled trials have reported that LDL cholesterol lowering using moderate to high intensity statins significantly reduces adverse CHD outcomes in diabetes. Evidence of triglyceride reduction using fenofibrate or omega-3 PUFAs is not very robust although a trial of a purified omega-3 PUFAs has shown significant benefit.Conclusion: Lipid lowering with statins along with comprehensive lifestyle changes in addition to glucose control is recommended as first-line therapy to reduce CHD mortality and morbidity in diabetes.

Effectiveness of education using ha-man module on self-efficacy of adults in preventing coronary heart disease

Every year, there is a significant increase in deaths caused by coronary heart disease (CHD). Many programs have been implemented to reduce the morbidity and mortality of CHD. Early detection and control of CHD risk factors is a challenge in educating adults about lifestyle changes. Also, it is recognized that self-efficacy is a vital factor in initiating and maintaining healthy behaviors. Health education is given as an effort to increase self-efficacy, but educational media that are innovative in promoting CHD health are limited. This study aimed to determine differences in the self-efficacy of adults in preventing coronary heart disease before and after given health education. This was a quasi-experimental study with a pretest-posttest control group design. The sample were 60 respondents which were grouped into 30 respondents in the intervention group and control group through purposive sampling. The HA-Man education intervention was given 3 times for a-week, self-efficacy was evaluated through a structured questionnaire interview. The results showed that there were differences in self-efficacy before and after intervention in the intervention group (p &lt;0.05). This research is expected to provide information in the development of educational media in increasing awareness and self-efficacy of people who are at risk of CHD

Prospective increases in depression symptoms and markers of inflammation increase coronary heart disease risk - The Whitehall II cohort study

ObjectiveStress, inflammation, and depression are associated to coronary heart disease (CHD). However, how these constructs collectively contribute to CHD incidence is not well understood. For the first time, this study explored the concurrent relationship between workplace stress, depression symptomology and levels of low-grade inflammation with future CHD incidence. MethodsData from the 5-year intervals at phase 5, 7, and 9 of the Whitehall II study (N = 8348, Mage = 56) provided measures of workplace stress, depression symptomology, inflammation (interleukin-6, C-reactive protein, fibrinogen), and CHD incidence. The proposed stress-inflammation-depression-CHD pathway was assessed with a longitudinal design incorporating a structural equation model (SEM) that measured if changes in stress, depression, and inflammation between phase 5 to phase 7 predicted first-time CHD events between phases 7 and 9. ResultsThe SEM empirically supported this proposed pathway and demonstrated excellent model fit, χ (72) = 3582.959, p < .001, CFI = 0.896, RMSEA = 0.076 (CI90 = 0.074, 0.079), while depression symptoms mediated the association between workplace stress and CHD incidence, B = 0.003 (CI90 = 0.001, 0.004). Further, survival analysis indicated that individuals with higher mean scores (across phases) of depression symptoms or fibrinogen levels were more likely to experience a first time CHD event. ConclusionsIncreases in depression symptoms and fibrinogen levels may be good indicators of future CHD morbidity among older employees. Future research is encouraged to monitor negative affective states and the potential use of biobehavioural options to reduce depression and inflammation that may mitigate CHD risk.

Epidemiology of Acute Coronary Syndrome in Azadi Teaching Hospital in Kirkuk Governorate

Background: Coronary heart disease (CHD), the principal manifestation of cardiovascular diseases, is the leading cause of morbidity and mortality worldwide. The World Health Organization (WHO) predicts that by 2020, CHD will become the world‘s most important cause of death, disability and premature death. The major factors are an elevated cholesterol level, hypertension, smoking, genetic factors, a sedentary lifestyle, obesity, and diabetes; and the risk increase with age. Adequate control and well awareness of cardiovascular disease risk factors and health habits are important for preventing CHD. Objective: 1- To make a change of morbidity of CHD by education. 2- To evaluate the health-related quality of life in development of ACS. Patients and Methods: A hospital based case-control study was conducted in the Coronary Care Unit (CCU), which is located in Kirkuk (Azadi Teaching Hospital); from March 2017 to September 2017. The study included 180 cases of coronary heart disease and 180 age and sex matched controls. All the participants were interviewed with special questionnaire form. In addition, the weight and height were measured and the fasting lipid profile was sent to the laboratory of same hospital for all participants. Statistical Package for Social Science (SPSS) version 20.0 was used for data analysis. Results: The males accounts two third of cases, 112(62.2%) in comparison to females 68(37.8 %); 63(35 %) of the cases were in the age group (70-79) years. About (54.7%) of all participants were unemployed, (68.3%) had low education and (38.3%) with low income. The study showed a statistical significant association between the following risk factors and educational level: hypertension, diabetes, dyslipidemia, economic level, occupation, and alcohol consumption. Conclusion: Overall there is a significant relation between educational level and risk of developing CHD. The prevalence of CHD was more common in age group (≥ 60) years and the males were more likely to be affected; hypertension is the most prevalent risk and then diabetes mellitus, occupation respectively.

Coronary Artery Disease Awareness: Levels of Socioeconomic Status and Dietary Restriction

Introduction: India has undergone a remarkable demographic transition over the period time. Socioeconomic status indicators including education, income, and occupation are associated with coronary heart disease risk factors, morbidity, and mortality.&#x0D; Objective: To assess the socioeconomic status and diet restriction in patients with coronary artery diseases.&#x0D; Methods: The present study was a type of observational study conducted on total 200 subjects in Dhiraj Hospital, Sumandeep Vidyapeeth from August-2019 to July-2020 after ethical approval. Out of which 100 were coronary artery diseases and 100 were healthy controls. Patients with other than coronary artery diseases were excluded from the study, data were collected with the help of a pre-val­idated questionnaire and analyzed by SPSS-16 software.&#x0D; Results: Eighty-nine subjects with coronary artery diseases and seventy-five healthy controls were physically inactive. Eighty-five subjects with coronary artery diseases do not have any diet restriction, however, fifty-nine subjects had exposure to only primary education.&#x0D; Conclusion: Majority of the subjects were from a rural area, there were high illiteracy levels so there was low awareness. Patients could come to know the importance of physical activities and how to maintain a normal weight by following a dietary regimen to minimize the risks of disease.

Abstract 012: Association Between Premature Menopause And Lifetime Risk Of Coronary Heart Disease: Lifetime Risk Pooling Project

Introduction: Menopause before the age of 40 years is recognized as a risk enhancer for coronary heart disease (CHD) by the 2019 AHA/ACC Primary Prevention guidelines. Race-specific prevalence of premature menopause and its association with lifetime risk of CHD morbidity and mortality have not been well described in Black and White women, and could inform risk stratification and intensity of prevention efforts. Hypothesis: We hypothesized that Black and White women who experience premature menopause (&lt;40 years) will have similarly elevated lifetime burden of CHD compared with women of the same race who do not have premature menopause. Methods: We pooled individual-level data from Black and White postmenopausal women aged 55-69 years from 6 US population-based cohorts. We included women without CHD at baseline and excluded women who reported surgical menopause. We defined premature menopause as age &lt;40 years. We performed (1) modified Kaplan Meier analysis and (2) competing Cox models to estimate joint cumulative risk for CHD or non-cardiovascular death adjusted for age, smoking, education, obesity, hypertension, and diabetes. Results: Of the 3522 Black women and 6514 White women, mean ages were 61.2 ± 4.3 and 60.0 ± 4.4 years, respectively. Premature menopause (&lt;40 years) occurred more commonly in Black (15.5%) compared with White (4.8%) women. Lifetime risk of CHD was higher in Black and White women with premature menopause ( Figure ). Hazard ratios adjusted for risk factors and accounting for competing risk of death were higher in Black (1.41 [1.04, 1.90]) and White (1.39 [1.03, 1.87]) women with premature menopause compared those Black and White women without premature menopause, respectively. Conclusions: Black women are three times more likely to experience premature natural menopause (&lt;40 years) than White women. Premature menopause is independently associated with 40% higher risk of CHD in both Black and White women and should be assessed as a risk-enhancing feature in clinical prevention decisions.