Past History Of Myocardial Infarction Research Articles

Lung cancer surgery in patients aged 80years or older: an analysis of risk factors, morbidity, and mortality.

As the population ages, the age of patients undergoing thoracic surgery increases, and elderly patients often have more comorbidities than younger patients. This retrospective study observed preoperative comorbidities, surgical procedures and postoperative morbidity and mortality after lung cancer surgery in patients 80 years of age or older. The medical records of lung cancer patients 80 years of age or older who underwent surgery from January 2003 to December 2012 were reviewed. There were 49 patients (27 males, 22 females), with a median age of 83 years. Thirty patients underwent major pulmonary resection and 18 patients underwent limited pulmonary resection. The median Charlson comorbidity index was 3. Although approximately two-thirds of the patients (20 patients; 40.8%) experienced some kind of postoperative morbidity, more than 80% of the complications were grade 1 or 2 according to the Clavien-Dindo classification. Cerebrovascular disease and chronic obstructive pulmonary disease were significantly associated with moderate-to-severe complications. Postoperative death was observed in two cases (4.1%). In addition, an increased American Society of Anesthesiologists classification score and past history of myocardial infarction, congestive heart failure and/or diabetes mellitus with end-organ damage were significantly associated with mortality. The overall survival rate was 79.6% at 3 years and 53.1% at 5 years. Thoracic surgery shows acceptable morbidity and mortality in patients 80 years of age or older. Patients 80 years of age or older should be offered the best treatments, including surgery, with careful patient evaluation and selection.

Are There Gender Differences in Coronary Artery Disease? The Malaysian National Cardiovascular Disease Database – Percutaneous Coronary Intervention (NCVD-PCI) Registry

ObjectivesTo assess whether gender differences exist in the clinical presentation, angiographic severity, management and outcomes in patients with coronary artery disease (CAD).MethodsThe study comprised of 1,961 women and 8,593 men who underwent percutaneous coronary intervention (PCI) and were included in the Malaysian NCVD-PCI Registry from 2007–2009. Significant stenosis was defined as ≥70% stenosis in at least one of the epicardial vessels.ResultsWomen were significantly older and had significantly higher rates of diabetes mellitus, hypertension, chronic renal failure, new onset angina and prior history of heart failure whereas smokers and past history of myocardial infarction were higher in men. In the ST-elevation myocardial infarction (STEMI) cohort, more women were in Killip class III-IV, had longer door-to-balloon time (169.5 min. vs 127.3 min, p<0.052) and significantly longer transfer time (300.4 min vs 166.3 min, p<0.039). Overall, women had significantly more left main stem (LMS) disease (1.3% vs 0.6%, p<0.003) and smaller diameter vessels (<3.0 mm: 45.5% vs 34.8%, p<0.001). In-hospital mortality rates for all PCI, STEMI, Non-STEMI (NSTEMI) and unstable angina for women and men were 1.99% vs 0.98%, Odds ratio (OR): 2.06 (95% confidence interval (CI): 1.40 to 3.01), 6.19% vs 2.88%, OR: 2.23 (95% CI: 1.31 to 3.79), 2.90% vs 0.79%, OR: 3.75 (95% CI: 1.58 to 8.90) and 1.79% vs 0.29%, OR: 6.18 (95% CI: 0.56 to 68.83), respectively. Six-month adjusted OR for mortality for all PCI, STEMI and NSTEMI in women were 2.18 (95% CI: 0.97 to 4.90), 2.68 (95% CI: 0.37 to 19.61) and 2.66 (95% CI: 0.73 to 9.69), respectively.ConclusionsWomen who underwent PCI were older with more co-morbidities. In-hospital and six-month mortality for all PCI, STEMI and NSTEMI were higher due largely to significantly more LMS disease, smaller diameter vessels, longer door-to-balloon and transfer time in women.

Glutathione S-transferase M1 and T1 genotypes and myocardial infarction

Myocardial infarction (MI), which is the most important manifestation of coronary artery disease, is the leading cause of morbidity and mortality in the world. Glutathione S transferases (GSTs) are enzymes responsible for the metabolism of numerous xenobiotics and are known to be polymorphic in humans. We investigated the association between the GSTM1 and GSTT1 gene polymorphisms and MI. The study consists of 296 healthy controls and 324 consecutive patients who had undergone coronary angiography for suspicion of coronary artery disease and with a past history of myocardial infarction. DNA was extracted from whole blood of patient and control. GSTM1 and GSTT1 gene polymorphisms were examined using multiplex PCR. We found that the null GSTM1 was associated with protective effect on MI, although this increase was not significant for GSTM1 (p < 0.054). However, GSTT1 genotype was associated with an increase in the risk of developing MI. In addition to after adjusting other all coronary risk factors, the interactive effect of GSTT1 null genotype remained statistically significant (p < 0.001) for MI disease but GSTM1 null genotype was not statistically significant. Patients, who smoke having the null genotypes of GSTM1, were at a higher risk for developing MI (p < 0.001, OR = 0.41, 95 % CI = 0.240-0.207). There was an effect of interaction of GSTM1 null genotype and smoking on MI development between patient and control groups (p < 0.001). Our results showed that individuals with the null genotypes for GSTM1 had protective effect, while GSTT1 was at a higher risk for MI disease. In addition, there was additional effects of smoking when smoking and non-smoking groups were compared.

Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria

IntroductionAppropriateness of referrals for myocardial perfusion imaging (MPI) in developing countries has not been extensively studied. Our study was conducted to describe the ordering practices of physicians and appropriateness of MPI referrals in Iran. MethodWe prospectively applied 2005 and 2009 versions of the Appropriateness Use Criteria published by the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) to 291 consecutive patients (age 55.3 ± 10.3 years) who underwent SPECT-MPI. For this purpose, we convened a panel, consisting of two academic cardiologists, one academic clinician in internal medicine, and one academic clinician in nuclear medicine. The panelists were invited for a face-to-face meeting to judge appropriateness of SPECT-MPI and independently assign a specific indication (scenario), whenever possible, for each case in accordance with ACCF/ASNC appropriateness scenarios. ResultsBased on the 2005 ACCF/ASNC criteria, SPECT-MPI studies were judged appropriate for 211 (72.5%), uncertain for 36 (12.4%), inappropriate for 32 (11.0%), and unclassifiable for 12 (4.1%) referrals. The same figures based on the 2009 version were 219 (75.3%), 15 (5.2%), 49 (16.8%), and 8 (2.7%) patients, respectively. Overall agreement between the 2005 and 2009 versions was good (κ 0.63). Lack of chest pain and age below 60 years were significant indicators increasing the likelihood of inappropriate referrals by 2.9-3.4 fold. Absence of diabetes mellitus and hypertension, a normal lipid profile, lack of a past history of myocardial infarction or cardiovascular interventions (CABGs or PCI), as well as lack of application and exercise ECG stress test as the gate keeper (keeping abnormal ETT or inability of the patient to perform exercise as the appropriate indication for SPECT-MPI referral) were significant indicators, decreasing the odds of appropriate referrals. Generally a higher percentage of referrals with inappropriate indications had normal MPI. ConclusionOur study provides an evidence for the fact that SPECT-MPI ordering practices in our developing community largely parallel the ACCF/ASNC recommendations. The implementation of appropriateness criteria is feasible in clinical settings and might provide an alternative to utilization management.

APOE and FABP2 Polymorphisms and History of Myocardial Infarction, Stroke, Diabetes, and Gallbladder Disease

Dysfunctional lipid metabolism plays a central role in pathogenesis of major chronic diseases, and genetic factors are important determinants of individual lipid profiles. We analyzed the associations of two well-established functional polymorphisms (FABP2 A54T and APOE isoforms) with past and family histories of 1492 population samples. FABP2-T54 allele was associated with an increased risk of past history of myocardial infarction (odds ratio (OR) = 1.51). Likewise, the subjects with APOE4, compared with E2 and E3, had a significantly increased risk of past history myocardial infarction (OR = 1.89). The OR associated with APOE4 was specifically increased in women for past history of myocardial infarction but decreased for gallstone disease. Interactions between gender and APOE isoforms were also significant or marginally significant for these two conditions. FABP2-T54 allele may be a potential genetic marker for myocardial infarction, and APOE4 may exert sex-dependent effects on myocardial infarction and gallbladder disease.

"Blues" ain′t good for the heart

Byline: Krishnamachari. Srinivasan Research in recent decades suggests that depression and coronary heart disease (CHD) have a bidirectional relationship. Depression, independent of other risk factors in an otherwise healthy person, doubles the risk of developing CHD. [sup][1] Depression is seen in about 20% of the patients hospitalized with acute coronary syndromes either at admission or in the immediate period following recovery from CHD. [sup][2] Depression in Patients with Coronary Heart Disease Cross-sectional studies have reported that between 19 and 66% of the patients with myocardial infarction (MI) have depressive and anxiety symptoms, [sup][3],[4] and a significant proportion of these patients (17-44%) are diagnosed with major depression. [sup][5],[6],[7] In addition, major depression is also common following coronary bypass surgery [sup][8] and in patients with unstable angina. [sup][9] Thus, these studies suggest that the prevalence rate of depression among patients with CHD is far greater than the 12-month prevalence rate of 6.6% reported in the community. [sup][10] Impact of Depression on Pre-Existing Coronary Heart Disease Over the last two decades, evidence has accumulated for the adverse impact of depression in patients with CHD. In one of the earliest studies in this area, Frasure Smith et al. [sup][11] in their study of depression and coronary heart disease in 222 patients post MI, those diagnosed with major depression on a modified version of the Diagnostic Interview Schedule had an adjusted hazard ratio of 3.44 (95% CI 2.25-4.63) for mortality over 6 months of follow-up compared with the controls. This was approximately equivalent to the risk engendered by clinical factors such as diminished left ventricular function and past history of MI. In a subsequent study, the same group of investigators followed-up this cohort over 18 months. [sup][12] Although baseline depression still predicted mortality at 18 months, its impact mainly occurred in the first 6 months. Similar findings of high mortality in subjects with unstable angina and comorbid depression have been reported. [sup][9] In addition, depression also has a negative impact on survival rates following coronary artery bypass graft (CABG). Two studies reported that the presence of depression at baseline prior to CABG was an independent predictor of cardiovascular mortality post-CABG. [sup][13],[14] There is also a dose-response relationship between depression and death due to adverse cardiac events, [sup][15] with increased baseline depression scores being associated with a higher risk of cardiac mortality. [sup][16] Depression and the Risk of Development of Coronary Heart Disease Several prospective studies have reported depression as a risk factor for the development of CHD, and this risk is independent of other cardiovascular risk factors. In a large prospective community-based study, patients with a history of dysphoria or depression had 4.5-times relative risk (RR) of having an acute MI compared with non-depressed subjects independent of other cardiovascular risk factors. [sup][17] It was also noted in this study that the risk of developing CHD was linked to the severity of depression, with an RR of 4.5 for developing CHD in subjects with major depression as opposed to 2.1 for subjects with dysphoria. A metaanalysis of studies in this area reported an RR of 1.64 for the development of CHD in subjects with depression. [sup][1] Pathophysiological Link between Depression and Coronary Heart Disease Depression and lifestyle behavior There exist several possible mechanisms that underlie the relationship between depression and CHD. Depression is associated with unhealthy lifestyle; depressed patients have a sedentary lifestyle, more likely to smoke and consume alcohol and are overweight/obese. [sup][18],[19],[20] Depression is also associated with non-compliance to medical treatment. …

035 Percutaneous coronary intervention in the elderly: changes in case-mix and peri-procedural outcomes in 40 933 patients treated between 1998 and 2008

<h3>Introduction</h3> The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularisation in the elderly. This study examines whether case-mix and peri-procedural outcome are different in the elderly (≥75 years), and explores the impact of increasing age on PCI case-mix and outcomes over time. <h3>Methods</h3> The Scottish Coronary Revascularisation Register was used to undertake a retrospective cohort study on all 40 933 patients undergoing non-emergency PCI in Scotland between April 1998 and March 2008 inclusive. The Register collects comprehensive, prospective information on all patients undergoing PCI in Scotland, including demographic characteristics, postcode of residence, cardiac disease severity, co-morbidity, procedure details, past medical and surgical history, and in-hospital complications. Datalinkage with the Scottish Morbidity Record 01 and the Registrar General for Scotland provided follow up data. <h3>Results</h3> There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 111 (2.5%) in 1998 to 848 (11.1%) in 2008. Compared with younger patients, the elderly were more likely to have multi-vessel disease, multiple comorbidity and a past history of myocardial infarction or coronary artery bypass grafting (χ² tests, all p&lt;0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% vs 2.8%, χ test p&lt;0.001). Over the 10-year-period, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (χ test for trend, p&lt;0.001). In spite of this, the risk of adverse outcomes did not change significantly over time in the elderly, and fell overall. <h3>Conclusions</h3> Our findings suggest that the increasing age and comorbidity of patients undergoing PCI have been offset by technological and therapeutic improvements in negating the adverse impact of age on peri-procedural adverse events.

Chapter 4: Chemotherapy and radiotherapy

Chapter 4: Chemotherapy and radiotherapy

Fourteen Year Follow-Up After Direct Percutaneous Intervention (DPCI) with Remote Surgical Backup for Anterior ST Elevation Myocardial Infarction (STEMI)

Background: We performed DPCI for acute STEMI between June 1995 and August 1998 with back-up from a cardiac surgery centre 362 km away. DPCI procedures were provided from 8am to 8pm. Methods: In this analysis, we compared patients who were enrolled in the Post Myocardial Infarction Study and who were treated for first anterior STEMI by DPCI (n= 46) or thrombolysis (TS, n= 108). Patients were excluded from this analysis if they presented in cardiogenic shock, had a past history of myocardial infarction, or received rescue PCI. Results:Medianagewas61yrs (48–68, 25–75thcentile) in theDPCI groupand63 yrs (53–70) in theTSgroup (p= 0.13) and 89% and 75% were men (p= 0.05). Two patients were transferred electively to the surgical centre for observation after PCI but neither received cardiac surgery. Cumulative mortality is presented in the Kaplan–Meier figure below, 19

Prevalence of calcified carotid artery on panoramic radiographs in postmenopausal women.

Background and aims This study was designed to evaluate the prevalence of calcified carotid artery in 50 year-old and older postmenopausal dental outpatients for early diagnosis of individuals at risk of stroke. Materials and methods This is a descriptive study of 200 panoramic radiographs. These radiographs included post-menopausal women referring to the Department of Oral Medicine at Shahid Beheshti Faculty of Dentistry during 2006-2007. The x-ray machine, developer and film type were the same for all the radiographs. Statistical analysis included chi-square test and Fisher’s exact test. Results We found 22 calcified carotid arteries. The left and right carotid arteries were involved in 7 and 9 cases, respec-tively. In 6 cases both carotid arteries were calcified. Four individuals had no vascular risk factor excluding age and others had at least one risk factor. We found significant statistical correlation between hypertension, past history of myocardial infarction, and hypercholesterolemia with calcified carotid artery on panoramic radiographs. Conclusion Under the limitations of the present study, prevalence of calcified carotid arteries is 11.0 % in 50 year-old and older postmenopausal dental outpatients.

Management of diabetes in cardiovascular patients

Type 2 diabetes mellitus (T2DM) is a common disease affecting ∼3–5% of people living in the western world. Cardiovascular disease (CVD) (coronary heart disease (CHD), stroke and peripheral vascular disease)...

Non-Compliance Is the Predominant Cause of Aspirin Resistance.

Classifying patients as resistant to aspirin is an arbitrary designation with up to 60% of patients reported to be aspirin resistant. Our previous publication showed that 16 or 9% of 192 patients with a history of M.I. could be labeled as aspirin resistant and that all of these patients were aspirin resistant because of non-compliance. This report compares the relative frequency of aspirin resistance between known compliant and non-compliance subjects to demonstrate that non-compliance is the predominant cause of aspirin resistance. Platelet prostaglandin agonist (PPA) stimulated light aggregometry was used to measure amount of aspirin induced platelet inhibition and arachidonic acid (AA) stimulated platelet aggregation to classify platelets as either aspirin inhibited or not. After not taking aspirin for 7 days blood for aggregation studies was drawn, off aspirin time point, which was followed by observed ingestion of 365mg of aspirin. Two hours after observed aspirin ingestion aggregation studies were repeated, on aspirin time point. The difference in the slopes of the PPA light aggregation curves on and off aspirin was defined as the net aspirin response. After supposedly refraining from aspirin for 7 days, 45 subjects were judged non-compliant with the protocol and removed from the study. Of the remaining 185 subjects 39 were normals and 146 had a past history of myocardial infarction (MI). There was no difference in net aspirin response between normal and MI subjects. The net aspirin response in known compliant patients was statistically normally distributed. Only 4% of complaint subjects (2 normals and 5 MI) had a net aspirin response of less than one standard deviation which would qualify as a conservative designation of aspirin resistance. Of the 230 enrolled subjects 16 were noncompliant with their daily prescribed aspirin, 45 were non-compliant with the protocol not to take aspirin for 7 days and one patient had NANSAID interference with aspirin's effect. In total a maximum of 30% of the 230 patients could be classified as aspirin resistant and or non-compliant with 9% aspirin resistant because of non-compliance 18% non-compliant with the protocol and only 3% because of a decreased net aspirin response in known compliant patients. We conclude that:1.the predominant cause of aspirin resistance is noncompliance;2.net aspirin response in compliant patients is normally distributed;3.in compliant patients no difference in net aspirin response is observed between normals and MI patients; and4.PPA stimulated light aggregometry measured off aspirin and 2 hours after observed aspirin ingestion is a useful technique for measuring net aspirin response.

Diabetes mellitus as a prothrombotic condition

Diabetes mellitus (DM) is characterized by fasting hyperglycaemia and a high risk of atherothrombotic disorders affecting the coronary, cerebral and peripheral arterial trees. The risk of myocardial infarction (MI) is 3-5 fold higher in Type 2 DM and a DM subject with no history of MI has the same risk as a non-DM subject with a past history of MI. In total around 70% of deaths are vascular with poorer outcomes to both acute events and cardiological interventions. It was proposed that clustering of vascular risk factors (hyperinsulinaemia, dysglycaemia, dyslipidaemia and hypertension) around insulin resistance (IR) accounted for the increase in risk with Type 2 DM. The importance of this became apparent with the recognition that risk clustering occurs in normoglycaemic and impaired glucose tolerance (IGT) subjects with IR, in total around 25% of the population in addition to long-standing Type 1 subjects with renal disease. Evidence indicates that thrombotic risk clustering also occurs in association with IR, suppression of fibrinolysis due to elevated concentrations of the fibrinolytic inhibitor, plasminogen activator inhibitor-1 (PAI-1) is invariable with IR and there is evidence that this is regulated by the effects of triglyceride on the PAI-1 gene promoter. Other studies indicated that prothrombotic risk (coagulation factors VII, XII and fibrinogen) also associates with the IR syndrome. The development of endothelial cell dysfunction with suppression of nitric oxide and prostacyclin synthesis, combined with platelet resistance to the anti-aggregatory effects of these hormones leads to loss of control over platelet activation. In addition, hyperglycaemia and glycation have marked effects on fibrin structure function, generating a clot which has a denser structure, resistant to fibrinolysis. The combination of increased circulating coagulation zymogens, inhibition of fibrinolysis, changes in fibrin structure/function and alterations in platelet reactivity creates a thrombotic risk clustering which underpins the development of cardiovascular disease.

Postresuscitation myocardial dysfunction: correlated factors and prognostic implications

To evaluate the clinical factors correlated with postresuscitation myocardial dysfunction and the prognostic implication such dysfunction may have. Prospective observational study in a university medical center 58 adult patients successfully resuscitated from nontraumatic out-of-hospital cardiac arrest over 2 years. Echocardiographic evaluation of the left ventricular systolic and diastolic functions was performed 6 h postresuscitation and was analyzed in correlation to the clinical features and resuscitation factors. Univariate analysis revealed left ventricular ejection fraction (LVEF) to be significantly lower in patients with hypertension, past history of myocardial infarction, resuscitation duration longer than 20 min, defibrillation, and use of more than 5 mg epinephrine. Isovolumic relaxation time (IVRT) was significantly longer in patients with noncardiac cause and initial rhythm of nonventricular fibrillation/tachycardia. Multiple regression analysis showed epinephrine dose and past history of myocardial infarction to be independent factors for LVEF, while the cause of cardiac arrest was independently associated with IVRT. For prognosis, 27 patients survived to hospital discharge. Both LVEF under 40% and IVRT 100 ms or longer were associated with poor survival outcomes. In Cox regression analysis IVRT 100 ms or longer served as an independent factor predicting poor survival prognosis. Postresuscitation left ventricular dysfunction is correlated with a number of clinical factors, among which past history of myocardial infarction, epinephrine dose, and the cause of cardiac arrest play independent roles. Meanwhile, IVRT 100 ms or longer 6 h postresuscitation predicts poor survival outcomes and serves as a marker of poor prognosis.

Hospital-acquired oral myiasis due to Boettcherisca septentrionalis (Diptera: Sarcophagidae) in Shimane Prefecture, Japan

A 74-year-old woman, who has been suffering from type II diabetes with insulin therapy, was found infested with around 5mm-long maggots in her oral cavity in a general hospital in Shimane Prefecture, Japan. The maggots were identified as Boettcherisca septentrionalis Rohdendorf, 1937 from their morphological characteristics of the emerged adult fly. This is the first myiasis case caused by B. septentrionalis. She also had a past history of myocardial infarction and cerebral infarction. She underwent left femoral amputation due to left femoral artery embolism. The present case revealed that the patient had many predisposing factors for acquiring myiasis.

Pseudo-aneurisma femoral micótico após onze anos de cateterismo

The authors report the unusual case of a 52-year-old mountain climber that presented with pain and swelling in his right thigh which revealed to be a ruptured mycotic pseudoaneurysm with no history of recent trauma or other apparent cause. The patient reported a past history of myocardial infarction 11 years before, with the performing of two femoral catheterisms for coronary angiography. He denied any episode of fever or diagnosis of bacteraemia at that time or later, nor any other complaint during these 11 years. The rarity of the case, the appearance of this extremely late complication together with the patient's kind of sportive activity prompted us to publish the case.

Prehospital 80-LAD mapping: Does it add significantly to the diagnosis of acute coronary syndromes?

Early detection of acute myocardial infarction (MI) is vital in the management of acute coronary syndromes (ACS). Hence we compared the diagnostic capability of the standard 12-lead electrocardiogram (ECG) with the 80-lead ECG body surface map (BSM) prehospital. Methods: Consecutive patients (n = 294) presenting prehospital with ischemic type chest pain were included. All had an ECG and BSM pretreatment and a baseline and 12-hour cardiac troponin-T or I (cTnT or cTnI). Acute MI was defined as cTnT > 0.09 or cTnI > 0.1 ng/mL. Acute MI on the BSM was defined as ST elevation measured at the J-point, ≥1mm inferior/right ventricular/high right anterior/lateral regions, ≥2 mm anterior region, ≥0.5 mm posterior region. Results: Acute MI occurred in 182/294 (62%) based on cTnT or I. ST elevation on the standard ECG predicted acute MI in 103 (sensitivity 57%, specificity 94%; c-statistic 0.73). The optimal model for the standard ECG included ST elevation, summed ST depression and past history of MI (c-statistic 0.82; Chi-square (Wald) 120.7, 3df). The BSM predicted acute MI in 146 (sensitivity 80%, specificity 92%; c-statistic 0.86). The optimal model for the BSM included BSM criteria for acute MI and past history of MI (c-statistic 0.91; Chi-square (Wald) 180.3, 2df). Conclusion: The 80-lead BSM is superior to the standard 12-lead ECG in predicting acute MI prehospital.

Glutathione S-transferase gene polymorphism as a susceptibility factor in smoking-related coronary artery disease.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world, and cigarette smoking is a major contributing factor to the disease. Glutathione S-transferase (GST) enzyme is implicated in the detoxification of carcinogens present in tobacco smoke and consequent polymorphisms in this gene may confer susceptibility to cardiovascular disease if DNA damage is important in CAD. Therefore, we examined this question in a case-control study of subjects having coronary atheroma by angiography and with a past history of myocardial infarction (MI). The study population consists of 247 healthy controls and 148 consecutive patients who had undergone coronary angiography for suspicion of coronary artery disease. DNA was extracted from whole blood, and the GSTM1 and GSTT1 polymorphisms were determined using a real-time polymerase chain reaction (PCR). We found that the null GSTM1 and GSTT1 genotypes were associated with an increase in the risk of developing coronary heart disease (OR = 1.14; 95% CI: 0.71 - 1.82; OR = 1.38; 95% CI: 0.82 - 2.32), respectively, but this increase was not significant. Patients who smoke having the null genotypes of GSTM1 (OR: 1.63 (1.10 - 2.63)) and GSTT1 (2.66 (1.50 - 4.72)) and both (3.20 (1.37 - 7.45)) were at a higher risk for developing coronary heart disease. In conclusion, the finding of a significant association between GSTM1 and T1 with smoking status may influence cardiovascular disease via DNA damage.

Plasma Homocysteine Levels in Indian Patients with Essential Hypertension and Their Siblings

Background. An association between plasma homocysteine and essential hypertension and their non-hypertensive siblings is controversial. Methods and Results. Plasma homocysteine levels were measured in subjects with essential hypertension (n = 50), their normotensive siblings (n = 50) and normotensive controls (n = 50). All the subjects were non-diabetic, had no past history of myocardial infarction, stroke or peripheral vascular disease and had normal renal functions. The mean homocysteine values were 18.96 ± 8.08 µmol/L in patients, 14.84 ± 5.55 µmol/L in siblings and 10.50 ± 4.92 µmol/L in controls. Plasma homocysteine level were found to be significantly higher in patients with hypertension (p < 0.0001) and their normotensive siblings (p<0.0001) when compared to controls. Also patients with hypertension had their higher plasma homocysteine levels compared to their siblings (p<0.0036). Conclusion. Plasma homocysteine levels are significantly elevated in Indian patients with essential hypertension and their normotensive siblings. Thus, plasma homocysteine may serve as a marker for the development of essential hypertension.

Stroke in Hospitalized Patients: Are There Special Risk Factors?

Background and Purpose: The occurrence of stroke in patients hospitalized for various illnesses remains a particular challenge for neurologists. Determining the potential causes for these particular cerebrovascular events may help to define the population at risk and to take measures in order to prevent stroke during hospitalization. The aim of our study was to evaluate the potential risk factors associated with stroke, which occurred in patients hospitalized for other illnesses. Methods: This retrospective case-control study based on data of patients who underwent an ischemic stroke while being hospitalized not because of stroke and a control group of patients admitted during the same period who were matched for age and sex to the study patients. Common vascular risk factors, e.g. fever, leukocytosis, blood pressure, hemoglobin, cardiac arrhythmia and dehydration, were compared between the study and control groups. Results: Of 2,247 consecutive patients with ischemic stroke, the stroke had occurred during hospitalization not related to any surgical procedure in 80 (3.5%). Six parameters were found as being significant independent risk factors for in-hospital stroke: fever and leukocytosis during hospitalization, elevated diastolic and unstable blood pressure, dehydration and past history of myocardial infarction. Conclusion: Careful monitoring of temperature, blood count, blood pressure, and clinical and laboratory signs of dehydration is needed to prevent in-hospital stroke.