Risk Factor For Myocardial Infarction Research Articles

Lifestyle and metabolic risk factors in patients with early-onset myocardial infarction: a case-control study.

Family history is a known risk factor for early-onset myocardial infarction (EOMI). However, the role of modifiable lifestyle and metabolic factors in EOMI risk is unclear and may differ from that of older adults. This case-control study included myocardial infarction (MI) patients aged ≤45 years from the Bremen ST-elevation MI Registry and matched controls randomly selected from the general population (German National Cohort) at the same geographical region. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the individual and combined associations of lifestyle and metabolic factors with EOMI risk, overall and according to family history for premature MI. A total of 522 cases and 1191 controls were included. Hypertension, current smoking, elevated waist-to-hip ratio, and diabetes mellitus were strongly associated with the occurrence of EOMI. By contrast, higher frequency of alcohol consumption was associated with decreased EOMI risk. In a combined analysis of the risk factors hypertension, current smoking, body mass index ≥25.0 kg/sqm, and diabetes mellitus, participants having one (OR = 5.4, 95%CI = 2.9-10.1) and two or more risk factors (OR = 42.3, 95%CI = 22.3-80.4) had substantially higher odds of EOMI compared to those with none of these risk factors, regardless of their family history. This study demonstrates a strong association of smoking and metabolic risk factors with the occurrence of EOMI. The data suggest that the risk of EOMI goes beyond family history and underlines the importance of primary prevention efforts to reduce smoking and metabolic syndrome in young persons.

A System-Wide Investigation and Stratification of the Hemostatic Proteome in Premature Myocardial Infarction.

IntroductionAdvancing understanding of key factors that determine the magnitude of the hemostatic response may facilitate the identification of individuals at risk of generating an occlusive thrombus as a result of an atherothrombotic event such as an acute Myocardial Infarction (MI). While fibrinogen levels are a recognized risk factor for MI, the association of thrombotic risk with other coagulation proteins is inconsistent. This is likely due to the complex balance of pro- and anticoagulant factors in any individual.MethodsWe compared measured levels of pro- and anticoagulant proteins in plasma from 162 patients who suffered an MI at an early age (MI <50 y) and 186 age- and gender-matched healthy controls with no history of CAD. We then used the measurements from these individuals as inputs for an established mathematical model to investigate how small variations in hemostatic factors affect the overall amplitude of the hemostatic response and to identify differential key drivers of the hemostatic response in male and female patients and controls.ResultsPlasma from the MI patients contained significantly higher levels of Tissue Factor (P = 0.007), the components of the tenase (FIX and FVIII; P < 0.0001 for both) and the prothrombinase complexes (FX; P = 0.003), and lower levels of Tissue Factor Pathway Inhibitor (TFPI; P = 0.033) than controls. The mathematical model, which generates time-dependent predictions describing the depletion, activation, and interaction of the main procoagulant factors and inhibitors, identified different patterns of hemostatic response between MI patients and controls, and additionally, between males and females. Whereas, in males, TF, FVIII, FIX, and the inhibitor TFPI contribute to the differences seen between case and controls, and in females, FII, FVIII, and FIX had the greatest influence on the generation of thrombin. We additionally show that further donor stratification may be possible according to the predicted donor response to anticoagulant therapy.ConclusionsWe suggest that modeling could be of value in enhancing our prediction of risk of premature MI, recurrent risk, and therapeutic efficacy.

Comparative Outcome of Obesity in Ischemic Heart Disease a Clinical Study

Objective: The purpose of this study is to determine the comparative outcome of obesity in ischemic heart disease. Duration of Study: July, 2021 to Dec, 2021 Place and Duration: CCU department D.G. Khan Medical College and Teaching Hospital Dera Ghazi Khan Methods: This research included 180 participants of both sexes. Patients were between the ages of 22 and 80 years old, according to the study. As part of their informed written permission, researchers collected demographic information such as age, sex and BMI. Patients were divided in two groups, group I had 90 obese patients and group II had non obese 90 patients. Follow up among patients were taken in duration of 12 months. Both groups' outcomes were evaluated and compared in terms of increase in risk factor of IHD, myocardial infarction and mortality because of these factors. SPSS 22.0 was used to analyze complete data. Results: There were 55 (61.1%) males and 35 (38.9%) females in group I and in group II 46 (51.1%) males and 44 (48.9%) females in group II. The mean age of the patients in group I was 41.4±11.62 years and had mean BMI 32.14±21.86 kg/m2 while in group II mean age was 38.41±12.42 years with mean BMI 25.2±11.34 kg/m2. 40 (44.4%) patients in group I and 45 (50%) patients in group II was educated. In group I 25 (27.8%) patients were smokers, 19 (21.1%) patients had DM and in group II 27 (30%) were smokers and 5 (5.6%) cases had DM. We found increase in Ischemic heart disease in 65 (72.2%) cases of group I and in group II IHD was found in 11 (12.2%) cases. Frequency of Myocardial Infarction was also higher in obese patients than non-obese cases. Systolic and diastolic blood pressure was also higher in obese patients. HDL was lower in obese patients while cholesterol, LDL, triglycerides and CRP was found higher in obese patients. Mortality in obese patients with IHD was 12 (13.3%) but no any mortality found in non-obese cases. Conclusion: In this study we found that obesity and increase in weight is a significant risk factor for ischemic heart disease and myocardial infarction and because of these diseases patients had poor outcomes with increase in rate of deaths. Keywords: MI, IHD, Mortality, Obese, Smoking

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Relation between Acetyl-CoA Carboxylase with some Biochemical Variables in Iraqi Men with Acute Myocardial Infarction and Diabetes

Background: Acute myocardial infarction (AMI) is a widespread cause of death in numerous parts of the world. Many factors raise the risk of myocardial infarction (MI). One of the most of it is atherosclerosis, caused by many factors such as Hyperlipidemia. Acetyl-CoA carboxylase (ACC) is the key regulatory enzyme in fatty acid synthesis. The disorder of lipid metabolism is one of the characteristics of diabetes, which is considered a risk factor for MI. Therefore, the activity ACC was estimated in patients with AMI and Diabetes. Method: The study included estimation of ACC activity and correlated with other biochemical variables such as Troponin T(cTnT), C-reactive protein (CRP), glucose‚ lipid profile, electrolytes [Sodium (Na⁺), Potassium(K⁺), Chloride (Cl⁻)]‚ urea and creatinine (Crea.), and evaluation of body mass index (BMI) effect in serum of 60 patients with AMI and diabetes compared with 30 serum from apparently healthy individuals as a control group, both groups are of males with an average age (25–60 years). Results and Conclusions: Results showed a significant increase in levels of ACC, cTnT, CRP, Glucose, and Lipid profile except for high-density lipoprotein – cholesterol (HDL-C) and urea, while a significant decrease with Na⁺and K⁺ also a non-significant variation was observed with Cl⁻ and creatinine in AMI and diabetes patients compared to control group.

Potential Therapeutic Effect of All-Trans Retinoic Acid on Atherosclerosis.

Atherosclerosis is a major risk factor for myocardial infarction and ischemic stroke, which are the leading cause of death worldwide. All-trans retinoic acid (ATRA) is a natural derivative of essential vitamin A. Numerous studies have shown that ATRA plays an important role in cell proliferation, cell apoptosis, cell differentiation, and embryonic development. All-trans retinoic acid (ATRA) is a ligand of retinoic acid receptors that regulates various biological processes by activating retinoic acid signals. In this paper, the metabolic processes of ATRA were reviewed, with emphasis on the effects of ATRA on inflammatory cells involved in the process of atherosclerosis.

Raised Glycated Hemoglobin (HbA1c) Level as a Risk Factor for Myocardial Infarction in Diabetic Patients: A Hospital-Based, Cross-Sectional Study in Peshawar

BackgroundDiabetes is a rapidly rising chronic illness in developing countries. The main objective of this research is to compare the frequency of myocardial infarction (MI) in controlled and uncontrolled diabetics in Pakistan, especially in the underprivileged district of Peshawar, and to determine raised blood glucose as a risk factor for MI.MethodologyThis cross-sectional study involving 237 diabetic patients aged 30-80 years was conducted in three major tertiary care hospitals in Peshawar, Pakistan. The inclusion criteria were diabetic patients with glycated hemoglobin (HbA1C) levels of less than 7% considered to be “controlled diabetics” and above 7% considered to be “uncontrolled diabetics.” Data were collected using structured questionnaires, past medical records, and patient history and were analyzed using SPSS software (IBM Corp., Armonk, NY, USA). The study was concluded in March 2022.ResultsThe highest number of MIs occurred in diabetics with HbA1c levels of 8-9% (47.9% of all MIs). There was a significant association between increasing HbA1c levels and the incidence of MI (p = 0.002). The adjusted prevalence odds ratio for MI in uncontrolled diabetics was 6.105 (95% confidence interval = 2.42-15.43), that is, six times increased incidence of MI in patients with HbA1c of more than 7%. Furthermore, with a 1% increase in HbA1c, there was a 10% increase in the proportion of MIs.ConclusionsFrom this study, it is clear that HbA1c levels of 8-9% were most significantly associated with the risk of MI in uncontrolled diabetics, and with rising levels of HbA1c, the risk of MI increased significantly. Thus, this study highlights the importance of HbA1c control in diabetic patients to prevent a heart attack.

1139-P: The Association between Age of Onset of Type 2 Diabetes and the Long-Term Risk for Major Diabetes-Related Complications

We evaluated the association between age of onset of type 2 diabetes and the risk for major diabetes complications. We included 1.1 million people with type 2 diabetes from the Australian diabetes registry, followed from 2010-2019. We evaluated the incidence of hospitalization for, or death from, myocardial infarction (MI) , stroke, and heart failure (HF) , and hospitalization for lower extremity amputation (LEA) ; the incidence of end-stage kidney disease (ESKD; including kidney replacement therapy or death from ESKD) ; and all-cause mortality (ACM) . Poisson regression was used to model rates by age of diabetes onset, current age, and diabetes duration. During 6.9 million person-years of follow-up, 72338, 46533, 101023, 20024, 13331, and 203542 MI, stroke, HF, LEA, ESKD, and ACM events occurred, respectively. The risk for all outcomes increased exponentially with diabetes duration (Figure) . The effects of age and duration differed for each: age was the stronger risk factor for MI, stroke, HF, and ACM, while duration was the predominant determinant of ESKD and LEA risk. At a given age, a 10-year younger age of onset was associated with a 1.1-1.5-fold increased risk of stroke and ACM, a 1.5-2-fold increased risk of MI and HF, and a 2-4-fold increased risk of LEA and ESKD. Thus, the increase in prevalence of young-onset type 2 diabetes may shift the burden of diabetes complications in coming decades. Disclosure J.I.Morton: None. P.Lazzarini: None. K.Polkinghorne: None. D.J.Magliano: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, AstraZeneca, Eli Lilly and Company, Pfizer Inc., Roche Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi. Funding JIM is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. PAL is supported by a National Health and Medical Research Council Early Career Fellowship. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. This work is partially supported by the Victorian Government’s Operational Infrastructure Support Program.

The Dash Diet Pattern and Blood Pressure Changes in US Veterans With Type 2 Diabetes – a Post-hoc Analysis of the Blueberry Consumption and Type 2 Diabetes Study

ObjectivesThe goals of nutrition therapy for adults with type 2 diabetes include promoting healthful eating patterns and supporting improvements in cardiometabolic risk factors. Hypertension, which is a risk factor for stroke, myocardial infarction and heart failure, is common in persons with diabetes. There is limited data on the relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and blood pressure in US veterans with type 2 diabetes. The primary objective of the study is to determine the effect of the DASH diet pattern on blood pressure in US veterans. MethodsA secondary analysis from the Blueberry Consumption and Type 2 Diabetes study (NCT02972996, clinicaltrials.gov) was conducted in fifty-two men (mean ± SD baseline characteristics: 67 ± 6 years; weight, 102 ± 14 kg; body mass index, 34 ± 4 kg/m2; systolic blood pressure, 129 ± 17 mmHg; diastolic blood pressure, 76 ± 8 mmHg; hemoglobin A1c, 7.3 ± 0.8%) with type 2 diabetes. DASH diet patterns for six nutrients (protein, total fat, calcium, potassium, sodium and fiber) were collected by three-day food records. DASH diet scores were created by summing the scores for the six nutrients. Baseline blood pressure was collected according to standard protocol and used for the analysis. Multiple linear regression was used to determine the association between the DASH diet score and blood pressure. ResultsIn multiple linear regression analysis, adjusted for age, body mass index and comorbid conditions, a higher DASH score was associated with a decrease in systolic blood pressure (β = –5.96; P = 0.026) but not diastolic blood pressure (β = –1.65; P = 0.169). For every one unit increase in the DASH score, the estimated mean systolic blood pressure decreased by approximately 6.0 mmHg. ConclusionsThese findings suggest that adherence to the DASH diet pattern is associated with a decrease in systolic blood pressure in men who are US veterans with type 2 diabetes. The results should be verified by randomized clinical trials evaluating the effects of the DASH diet on blood pressure in adults with type 2 diabetes. Funding SourcesThe U.S. Highbush Blueberry Council; the study is the result of work supported with resources and the use of facilities at the Stratton VA Medical Center, Albany, NY, USA.

A NOVEL VASOACTIVE PENTAPEPTIDE “PG1’’ FROM BUFFALO ICE-CREAM PROTECTS FROM ANGIOTENSIN-EVOKED HIGH BLOOD PRESSURE

Objective: Arterial hypertension is the most important risk factor for cardiovascular diseases, myocardial infarction, heart failure, renal failure and peripheral vascular disease. In the last decade, milk-derived bioactive peptides have attracted attention for their beneficial cardiovascular properties. Identify new vasoactive natural peptides able to fight arterial hypertension that can be used as a preventive strategy. Design and method: Here we combined in-vitro chemical assay such as LC-MS / MS analysis of buffalo ice cream, ex-vivo vascular studies evaluating endothelial and smooth muscle responses using pressure myograph, and translational assay testing in-vivo the vascular actions of PG1 administration in murine models. Results: We demonstrate that a novel buffalo ice-cream-derived pentapeptide “QKEPM’’, namely PG1, is a stable peptide that can be obtained at higher concentration after gastro-intestinal digestions (GID) of buffalo ice-cream (BIC). It owns potent vascular effect in counteract the effects of angiotensin II-evoked vasoconstriction and high blood pressure levels. Its effects are mediated by the inhibitory effect on AT1 receptor leading to a downregulation of p-ERK½ / Rac1-GTP and consequent reduction of oxidative stress. Conclusions: These results strongly candidate PG1, as a novel bioactive peptide for the prevention and management of hypertension, thus expanding the armamentarium of preventive strategies aimed at reducing the incidence and progression of hypertension and its related cardiovascular complicications.

Latent class cluster analysis of knowledge on acute myocardial infarction in community residents: a cross-sectional study in Tianjin, China

ObjectivePublic knowledge of early onset symptoms and risk factors (RF) of acute myocardial infarction (AMI) is very important for prevention, recurrence and guide medical seeking behaviours. This study aimed to...

Cross Sectional Comparative Relationship of Obesity with Ischemic Heart Disease and its impacts. A Clinical Study

Study task: This study was conducted in different CCU Departments of Baluchistan from February 2022 to June 2022 for providing health awareness to the people about obesity and its effects in cardiovascular complications. Aims and Objectives: The main purpose of this study was to find out the biological effects of obesity in cardiovascular complications in both male and female individuals. Data Collection: Total 164 individuals of age in between 40- 65 were selected for this study and divided them into two different groups. In group- A, 80 individuals were non- obese of BMI 15-25 while in Group-B, 84 individuals with BMI 30-35 were so obese as compared with individuals of group-A. A medical history Performa was used to collect history of each individual. Biochemical and Physiological analysis: BMI, systolic and diastolic blood pressure, cholesterol, triglycerides, low density lipoprotein (LDL), high density lipoprotein (HDL). Ischemic heart disease and myocardial infarction were studied in connection to the obesity rate and trends of individuals. BMI calculated by dividing weight in Kg by height in m2. Automatic Digital Blood Pressure Monitor was used for measurement of systolic and diastolic blood pressure. Lipid profile was performed with the help of kits on spectrophotometer. Bio-statistical analysis: Collected raw data were presented with the application of SPSS variant 20. All findings were represented in regression of each biomarker in the form of mean standard deviation and significant changes such as (P&lt;0.05). Results: Current study stated that an increase in ischemic heart disease in 60 (73.1%) cases of group I, and in 11 (12.2%) instances of group II. Myocardial infarction rates were also higher in obese patient substantially outperformed non-obese instances with a p value. &lt;0.05. Additionally, obese individuals' systolic and diastolic blood pressure levels were greater. While cholesterol, LDL, triglycerides were shown to be greater in obese people, HDL was found to be lower in these patients. Conclusion: It was concluded that obesity and weight gain are important risk factors for myocardial infarction and ischemic heart disease, which lead to poor outcomes for patients and an increase in the death rate. Keywords: Cholesterol, Triglycerides, Ischemic heart disease, systolic and diastolic blood pressure

Association between psoriasis and short-term outcomes of acute myocardial infarction: A matched-pair cohort study using a nationwide inpatient database in Japan

BackgroundPsoriasis is a known risk factor for acute myocardial infarction (AMI). However, the associations between psoriasis and short-term outcomes of AMI remain controversial.ObjectiveTo compare the short-term outcomes of AMI patients with and without psoriasis accounting for patient background characteristics and site-specific effects.MethodsWe identified patients with AMI between July 2010 and March 2020, using a Japanese national inpatient database. We matched patients with and without psoriasis to generate a 1:10 matched-pair cohort matched for sex, hospital, and fiscal year at admission. Multivariable regression analyses with adjustment for background characteristics including age and Killip class at admission were conducted to compare short-term outcomes of AMI.ResultsIn this study of AMI patients with psoriasis (n = 455) and without psoriasis (n = 438,534), 30-day in-hospital mortality was 5.6%. Patients with psoriasis had higher proportions of comorbidities than patients without psoriasis. Multivariable regression analyses in the matched-pair cohort revealed that psoriasis was significantly associated with decreased 30-day in-hospital mortality (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.08-0.85).LimitationsRetrospective study design without data on psoriasis severity.ConclusionThe matched-pair cohort analyses with adjustment for patient background characteristics and site-specific effects revealed decreased in-hospital mortality in AMI patients with psoriasis.

Incidence of myocardial infarction in people with diabetes compared to those without diabetes: a systematic review protocol

BackgroundDiabetes mellitus is an established risk factor for acute myocardial infarction (AMI). Incidence of AMI in people with diabetes remains significantly higher than in those without diabetes. However, published data are conflicting, and previous reviews in this field have some limitations regarding the definitions of AMI and source population (general population or people with diabetes as a population at risk) and concerning the statistical presentation of results.AimsTo analyse the incidence of AMI in people with diabetes compared to those without diabetes and to investigate time trends.MethodsWe will perform a systematic literature search in MEDLINE, Embase and LILACS designed by an experienced information scientist. Two review authors will independently screen the abstracts and full texts of all references on the basis of inclusion criteria regarding types of study, types of population and the main outcome. Data extraction and assessment of risk of bias will be undertaken by two review authors working independently. We will assess incidence rate or cumulative incidence and relative risk of AMI comparing populations with and without diabetes.DiscussionThis review will summarise the available data concerning the incidence of AMI in people with and without diabetes and will thus contribute to the assessment and interpretation of the wide variations of incidence, relative risks and time trends of AMI in these populations.Systematic review registrationPROSPERO CRD42020145562

Periodontitis and Other Risk Factors Related to Myocardial Infarction and Its Follow-Up.

The main issue in the prevention of myocardial infarction (MI) is to reduce risk factors. Periodontal disease is related to cardiovascular disease and both share risk factors. The purpose of this study is to investigate whether periodontitis can be considered a risk factor for MI and common risk factors in a case–control study and in a prospective follow-up study in patients with MI. The test group (MIG) was made up of 144 males who had MI in the previous 48 h. The control group (CG) was composed of 138 males without MI. Both groups were subdivided according to the presence or absence of stage III and IV of periodontitis. General data; Mediterranean diet and physical activity screening; periodontal data; and biochemical, microbiological and cardiological parameters were recorded. ANOVA, Mann–Whitney U and Kruskal–Wallis statistical tests and binary logistic regression analysis were applied. No differences in anthropometric variables were observed between the four groups. The average weekly exercise hours have a higher value in CG without periodontitis. The number of leukocytes was higher in MIG, the number of monocytes was higher in CG and the number of teeth was lower in MIG with periodontitis. Adherence to the Mediterranean diet was higher in CG. Porphyromonas gingivalis and Tannerella forsythia were higher in CG with periodontitis and in MIG with and without periodontitis. At follow-up, the left ventricular ejection fraction (LVEF) data were better in the non-periodontitis group: 15 patients had Mayor Cardiovascular Adverse Events (MACE), 13 of them had periodontitis and 2 did not show periodontitis. Periodontitis, exercise, diet and smoking are risk factors related to MI. MACE presented in the ‘MI follow-up’ shows periodontitis, weight, exercise hours and dyslipidemia as risk factors. LVEF follow-up values are preserved in patients without periodontitis. Our data suggest that periodontitis can be considered a risk factor for MI and MACE in the studied population.

Exploring the Causal Roles of Circulating Remnant Lipid Profile on Cardiovascular and Cerebrovascular Diseases: Mendelian Randomization Study.

BackgroundCausal evidence of circulating lipids especially the remnant cholesterol with cardiovascular and cerebrovascular disease (CVD) is lacking. This research aimed to explore the causal roles of extensive lipid traits especially the remnant lipids in CVD.MethodsTwo-sample Mendelian randomization (TSMR) analysis was performed based on large-scale meta-analysis datasets in European ancestry. The causal effect of 15 circulating lipid profiles including 6 conventional lipids and 9 remnant lipids on coronary heart disease (CHD) and ischemic stroke (IS), as well as the subtypes, was assessed.ResultsApolipoprotein B (Apo B), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were still important risk factors for CHD and myocardial infarction (MI) but not for IS. Apo B is the strongest which increased the CHD and MI risk by 44% and 41%, respectively. The odds ratios (ORs) of total TG on CHD and MI were 1.25 (95% confidence interval [CI], 1.13–1.38) and 1.24 (95% CI, 1.11–1.38), respectively. A one standard deviation difference increased TG in medium very-low-density lipoproteins (M.VLDL.TG), TG in small VLDL (S.VLDL.TG), TG in very small VLDL (XS.VLDL.TG), TG in intermediate-density lipoproteins (IDL.TG), TG in very large HDL (XL.HDL.TG), and TG in small HDL (S.HDL.TG) particles also robustly increased the risk of CHD and MI by 9–28% and 9–27%, respectively. TG in very/extremely large VLDL (XXL.VLDL.TG and XL.VLDL.TG) were insignificant or even negatively associated with CHD (in multivariable TSMR), and negatively associated with IS as well.ConclusionThe remnant lipids presented heterogeneity and two-sided effects for the risk of CHD and IS that may partially rely on the particle size. The findings suggested that the remnant lipids were required to be intervened according to specific components. This research confirms the importance of remnant lipids and provides causal evidence for potential targets for intervention.

Acute coronary syndromes in young patients and thrombophilia : the experience of our hospital

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of young patients presenting with acute coronary syndromes is increasing. Among them, there is a large number of patients without major cardiovascular risk factors raising concerns about the cause of the acute coronary syndrome. It is known that thrombophilia is an independent risk factor for myocardial infarction. Purpose To evaluate the frequency of thrombophilia in young patients presenting with acute coronary syndrome. Methods We performed genetic testing for the most frequent gene mutations responsible for thrombophilia (factor V Leiden, PAI I 4G/5G, prothrombin G20210A, MTHFR C677T, MTHFR A1257C, MTHFR A1298C) in all patients presenting with acute coronary syndrome that were aged &amp;lt;40 (men) or &amp;lt;45 (women), for a period of 10 years. Results We recorded 127 patients , 114 (89.76%) male and 13 (10.23%) female. Their mean age was 36±1.7years.Regarding the conventional cardiovascular risk factors, 67/127(52.75%) were smokers, diabetes mellitus was present in 26/127(20.47%), arterial hypertension in 12/127(15.24%), positive family history in 92/127(72.44%) and dyslipidemia in 79/127(62.2%).The genetic testing was positive for thrombophilia in 109/127 (85.82%). 25/109 (22.93%) were factor V Leiden homozygotes, 11/109 (10.09%) factor V Leiden heterozygotes, 17/109(15.59%), PAI I 4G/5G homozygotes, 8/109 (7.33%) PAI I 4G/5G heterozygotes, 36/109 (39.24%) G20210A homozygotes and 12/109 (13.08%) G20210A heterozygotes. Conclusion Thrombophilia seems to be present in the majority of young patients presenting with acute coronary syndrome and should not be overlooked. More studies are needed t identify whether the presence of thrombophilia affects the prognosis of these patients as well as whether is necessary a different approach in their treatment and management.

Is there a Role of Anti‐platelet Aggregation Agents in the Management of Primary Hypertension: An In‐Vivo Study

INTRODUCTIONHypertension is a leading identifiable and reversible risk factor for myocardial infarction, heart failure, atrial fibrillation, aortic dissection, peripheral arterial disease, stroke, kidney failure, etc with thrombus being the culprit lesion. South Asian ethnicity predisposes to higher mortality and morbidity from cardiovascular disease than other ethnic groups and is estimated to cause 7.5 million deaths, which accounts for 57 million disability‐adjusted life years (DALYs).Hypertension causes changes in platelets (shape, size, expression of P‐selectin, and sensitivity to catecholamines,) However, the data on platelet aggregation is sparse, inconclusive, and has shown contradictory results in Asian Indians. Therefore, this study is designed to study the platelet aggregation in Indian hypertensives and to investigate if platelet aggregation is determined by the level of blood pressure.MATERIALS AND METHODSThe study was conducted at the tertiary health center in 50 primary hypertensives &amp; compared with age &amp; sex‐matched healthy controls. After ethics approval from IRB, an informed and written consent was taken. All subjects completed a physical and cardiovascular system examination. Blood pressure recordings were done as per JNC‐VIII Guidelines and were further divided into sub‐groups as per the JNC‐VIII classification. Platelet rich plasma was used to estimate aggregation using a Chronolog aggregometer based on the principle of light transmission. ADP (5 µM) &amp; Epinephrine (2µM) were added to PRP to induce platelet aggregation. The normal value of platelet aggregation was compared between study subjects and controls using Independent t test and Mann‐Whitney Test.RESULTSAfter comparing platelet aggregation to ADP and epinephrine in primary hypertensives and healthy controls, 28 cases had stage I and 22 had stage II hypertension. The mean platelet aggregation to ADP in normotensives and primary hypertensives was 31.32±6.64 and 73±10.07, respectively (p value&lt;0.0001). Similarly, the mean platelet aggregation to Epinephrine in normotensives and primary hypertensives was 24.82±5.51and 50.94±12.19, respectively (p value&lt;0.0001). (Fig 1) Furthermore, platelet aggregability was found to be significantly increased in primary hypertensives as compared to controls. Moreover, it was further raised in stage II hypertensives in comparison to stage I hypertensives.(Fig 2)CONCLUSIONSThis study is the largest prospective study conducted on plasma from hypertensives and implicates platelet aggregation as a the causative factor leading to cerebrovascular accidents, ischemic heart diseases in primary hypertensives. Hence, any anti‐hypertensive drug which confers additional anti‐platelet aggregation properties may benefit in the management of hypertension especially in the Indian population. However, further larger studies are recommended to verify the same.

Outcomes of simultaneous carotid endarterectomy and coronary artery bypass grafting: A single centre experience.

Stroke following a coronary artery bypass surgery is a well-known complication often predisposed by carotid artery disease. Perioperative risk of stroke after on-pump cardiac surgery can overall affect 2% of patients. Patients with 80-99% unilateral carotid artery stenosis carry a 4% risk of stroke. Significant carotid artery stenosis is present in 3-10% of patients who are candidates for coronary artery bypass grafting (CABG). Those patients might be considered for either simultaneous or staged carotid endarterectomy and CABG to reduce the risk of stroke and death. The purpose of this study was to evaluate preoperative and intraoperative risk factors for myocardial infarction (MI), stroke and death and assess complications occurring during the early postoperative period after simultaneous CABG/CAE procedure. A single centre retrospective analysis of 134 patients from 2015 to 2019 who underwent simultaneous CABG/CEA was performed. At the same period, a total of 2827 CABG were performed, of which 4.7% were simultaneous interventions. We excluded staged CEA/CABG procedures, off-pump CABG and urgent CABG patients. All patients included in the study met the criteria for elective CABG for triple-vessel or left main trunk symptomatic coronary artery disease (CAD) with asymptomatic >70% carotid stenosis or symptomatic ipsilateral >50% carotid stenosis regardless of the degree of contralateral carotid artery stenosis. Patient demographics, comorbidities and operative details were reviewed. The primary endpoint was to assess the intraoperative and 30-day risk of stroke and death after simultaneous CEA/CABG procedure. Simultaneous CEA/CABG is effective procedure that can be performed in high-risk symptomatic patients with acceptable results. Predictors of postoperative stroke were smoking (P = 0.011), history of MI (P = 0.046), history of CABG (P = 0.013), and history of stroke/TIA (P = 0.005). Significant risk factors for adverse major postoperative complications after simultaneous CEA/CABG procedure were cardiac arrhythmia (AF or AFL) (P = 0.045), previous MI (P < 0.001), and smoking (P = 0.001). Synchronous CEA/CABG procedure can be performed with acceptable results in patients having a high risk of stroke, septuagenarians and older.

Mortality in patients with myocardial infarction and potential risk factors: A five-year data analysis.

Coronary artery disease (CAD) is among the most common causes of death in almost all countries across the world. Awareness of risk factors for the management and prevention of the disease can reduce complications and mortality rates. This study was conducted with the aim to investigate the mortality and potential risk factors of myocardial infarction (MI) as well as their relationships in patients who were admitted to one university hospital in the North of Iran from 2014 to 2018. This study had retrospective descriptive design. Using a checklist, all necessary information was extracted from 5-year medical records data of MI patients in the university hospital from 2014 to 2018 (n = 564). The data analysis was performed in SPSS software using descriptive statistics and two binary logistic regression analyses. The results showed that the mean age of the patients was 62.78 ± 13.38 years, and most of them were men (66.3%). The patients' mortality was 18.6% in a 5-year analysis. However, the number of mortalities was higher in the women (P = 0.001). Descriptive analysis showed that the most common risk factors of the disease in both genders were hypertension (46.6%), diabetes mellitus (DM) (38.5%), hyperlipidemia (24.1%), smoking (20%), and family history of CVDs (18.8%), respectively. However, the results of the adjusted regression model showed that the odds ratio (OR) of the patients' mortality increased in diabetic MI patients (OR: 2.33; 95%CI: 1.42-3.81; P = 0.001), but this ratio decreased in MI patients with a history of hyperlipidemia (OR: 0.23; 95%CI: 0.11-0.44; P ˂ 0.001). Based on the results, individual- and population-based prevention strategies by focusing on hypertension and diabetes are recommended in our health programs. Surprisingly, the mortality rate of MI patients was lower among those with a history of hyperlipidemia. There are different hypotheses for the cause of this. Therefore, laboratory studies with animal models and prospective cohorts are suggested for future studies.