Predictor Of Myocardial Infarction Research Articles

Soluble urokinase plasminogen activator receptor (suPAR) is a novel, independent predictive marker of myocardial infarction in HIV-1-infected patients: a nested case-control study.

ObjectivesPatients infected with HIV are at increased risk of myocardial infarction (MI). Increased plasma levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) have been associated with increased risk of cardiovascular diseases (CVD), including MI in the general population. We tested suPAR as a predictive biomarker of MI in HIV‐1‐infected individuals.MethodssuPAR levels were investigated in a nested case‐control study of 55 HIV‐1‐infected cases with verified first‐time MI and 182 HIV‐1‐infected controls with no known CVD. Controls were matched for age, gender, duration of antiretroviral therapy (ART), smoking and no known CVD. suPAR was measured in the four plasma samples available for each patient at different time‐points; 1, Before initiation of ART; 2, 3 months after initiation of ART; 3, 1 year before the case's MI; and 4, The last sample available before the case's MI.ResultsIn unadjusted conditional regression analysis, higher levels of suPAR were associated with a significant increase in risk of MI at all time‐points. Patients in the third and fourth suPAR quartiles had a three‐ to 10‐fold higher risk of MI compared to patients in the lowest suPAR quartile at all time‐points. suPAR remained a strong significant predictor of MI, when adjusting for HIV‐1 RNA, total cholesterol, triglycerides and high‐density lipoprotein.ConclusionElevated suPAR levels were associated with increased risk of MI in HIV‐infected patients, suggesting that suPAR could be a useful biomarker for prediction of first‐time MI in this patient group, even years before the event.

Fructosamine is a risk factor for myocardial infarction and all-cause mortality – Longitudinal experience from the AMORIS cohort

Background and aimsGlycation is linked to microvascular complications of diabetes and also to macrovascular events. Fructosamine is a biomarker of glycation but its associations to macrovascular complications are not well documented. The aim of this study was to evaluate fructosamine as a predictor of myocardial infarction and all-cause mortality in a large population based cohort. Methods and resultsInformation on glucose and fructosamine was obtained from subjects of the AMORIS cohort (n = 338,443) followed for 19 years on average. Incident cases of myocardial infarction and death from any cause were identified from national patient and cause of death register respectively. The incidence of myocardial infarction (n = 21,526 cases) and all-cause mortality (n = 73,458 deaths) increased at a fructosamine of 2.30 mmol/L or above. For myocardial infarction, the sex-age- fasting- and entry period adjusted hazard ratio in subjects above 2.70 mmol/L vs. reference range subjects was 2.88 (95% CI: 2.70–3.07). The corresponding hazard ratio for all-cause mortality was 2.31 (95% CI: 2.21–2.41). These associations remained basically unchanged after adjustment for total cholesterol, triglycerides, albumin, social class, smoking and hypertension. When additional adjustment for glucose was performed the associations were attenuated but remained. In a sub cohort with simultaneous measurements of fructosamine, HbA1c and fasting glucose respectively similar associations were observed (n = 9746). ConclusionThere is a strong association between fructosamine and myocardial infarction and death from any cause when major cardiovascular risk factors are accounted for. In addition, this association could only partly be explained by glucose levels.

Epidemiology and Management Cost of Myocardial Infarction in North Punjab, Pakistan.

Background:Coronary heart disease (CHD) is an important cause of morbidity and mortality in Pakistan. The temporal trends in the risk factors for myocardial infarction (MI) and the impact of socioeconomic status on these risk factors remain ambiguous.Objectives:The objectives of the present analysis were to investigate the potential association between various risk factors and MI in North Punjab, Pakistan, and to assess the status of the control of the risk factors associated with MI in this population.Patients and Methods:The present study included 515 patients admitted to the coronary care units or equivalent cardiology wards of the participating hospitals between 2011 and 2012 in North Punjab, Pakistan. The analysis was focused on identifying the socioeconomic status, lifestyle, family history of MI, and risk factors (i.e. hypertension, diabetes, smoking, and hyperlipidemia). A structured questionnaire was designed to collect data. The lipid profile was recorded from the investigation chart of every patient. For statistical analysis, the Kruskal Wallis, Mann-Whitney U, Wilcoxon, and chi-square tests were used.Results:MI was common in the males at the age of 41 - 60 years as compared to the females (P = 0.015). Patients with a positive parental history of CHD experienced MI at a younger age (P = 0.0001) at a body mass index (BMI) ≤ 25 kg/m2. Sedentary lifestyle (70%) and smoking (60%) had a male predominance. Hypertension accounted for nearly 37%, hyperlipidemia 26%, and diabetes 19.4% of the rural and urban subjects (P < 0.01). High-density lipoprotein cholesterol decreased (up to 34 mg/dl), while low-density lipoprotein cholesterol and hypertension increased with age. The mean monthly cost of medicines and physicians’ fees per patient was 2381.132 Pakistani Rupees (24.24 USD).Conclusions:Higher BMI, positive family history, smoking, hypertension, hyperlipidemia, and diabetes were the strong predictors of MI in North Punjab, Pakistan. Preventive efforts are needed to start early in life and continue throughout the life course.

Incidence of Myocardial Infarction and Vascular Death in Elderly Patients With Atrial Fibrillation Taking Anticoagulants: Relation to Atherosclerotic Risk Factors

Recent findings suggest that patients with atrial fibrillation (AF), in addition being at thromboembolic risk, are at risk of myocardial infarction (MI). Our aim was to investigate predictors of MI and cardiovascular death in a cohort of patients with AF who were taking anticoagulants. We prospectively followed up 1,019 patients with AF for a median of 33.7 months (3,223 person-years). All patients were treated with oral vitamin K antagonists. Primary outcome was a composite end point of cardiovascular events (CVEs) including fatal/nonfatal MI, cardiac revascularization, and cardiovascular death. The mean age of the patients was 73.2 years, and 43.8% were women. At follow-up, 111 CVEs (3.43%/y) had occurred: 47 fatal-nonfatal MI/revascularization and 64 cardiovascular deaths. In addition, 31 stroke/transient ischemic attacks (0.96%/y) were recorded. Patients experiencing CVEs were older (P < .001) and had a higher prevalence of metabolic syndrome (MetS) (P = .005), heart failure (P = .001), and prior cardiac (P < .001) and cerebrovascular events (P < .001). On a Cox proportional hazard analysis, age (hazard ratio [HR], 1.083; 95% CI, 1.053-1.113; P < .001), smoking (HR, 2.158; 95% CI, 1.193-3.901; P = .011), history of cerebrovascular (HR, 1.704; 95% CI, 1.119-2.597; P = .013) and cardiac (HR, 1.658; 95% CI, 1.105-2.489; P = .015) events, MetS (HR, 1.663; 95% CI, 1.107-2.499; P = .014), heart failure (HR, 1.584; 95% CI, 1.021-2.456; P = .040), and male sex (HR, 1.499; 95% CI, 1.010-2.223; P = .044) predicted CVEs. Patients with AF still experience a high rate of CVEs despite receiving anticoagulant treatment. MetS is a common clinical feature in patients with AF, which increases the risk of CVEs. A holistic approach is needed to reduce the cardiovascular risk in patients with AF. ClinicalTrials.gov; No.: NCT01882114; URL: www.clinicaltrials.gov.

PP.30.16

Objective: The relationship between blood pressure (BP) and cardiovascular disease (CVD) has been extensively documented. However the benefit of anti-hypertensive drugs is less pronounced for coronary prevention than for stroke prevention. Because coronary and cerebral circulation obey different regulatory mechanisms we questioned the role of BP level per se (estimated by mean BP (MBP)) and aortic stiffness (estimated by aortic atherosclerosis and pulse pressre (PP)) on 2 different outcomes: acute myocardial infarction (MI) and acute stroke. The analysis was also repeated for 2 more liberal outcomes: coronary heart disease and cerebrovascular disease. Design and method: 1031 subjects referred in the seventies for hypertension work-up were included and outcomes assessed 30 years later. A 3-grade aortic atherosclerotic score was built on the aortography, initially performed to seek for renal artery stenosis. Results: At baseline, mean age was 44 years with two third of men; MBP and PP were 136 ± 22 and 77 ± 23 mmHg, respectively. MBP, PP, and aortic atherosclerotic score were all significantly associated with MI and stroke in univariate analysis (p < 0.001 for all). In multivariate analysis taking into account the major risk factors (see Table on the following page), PP and atherosclerotic score, but MBP appeared as significant predictors of MI. On the contrary, only MBP appeared as a significant predictor of stroke. Similar results were obtained for coronary heart disease and cerebrovascular disease.Conclusions: These results highlight that MI is primitively a vascular problem tightly related to aortic stiffness; this may explain why strategy only aimed at lowering BP do not confer a complete reversion of the risk (i.e. a residual risk remains despite treatment). Some new strategy aimed at aortic destiffnening could be more efficient on this outcome. On the contrary, stroke is a “pure BP disease”. No destiffening is needed provided that BP is lowered.

Abstract W P157: Frequency of Occurrence and Predictors of Myocardial Infarction after Incident Ischemic Stroke: A Population-Based Study

Background: Coronary artery disease (CAD) is a significant cause of morbidity and mortality in ischemic stroke (IS) patients. IS and CAD often coexist and share common risk factors. Absolute risk and predictors of myocardial infarction (MI) in IS and by IS etiology subtype is not well known. We determined the risk of MI and its predictors in patients with incident IS in a population based cohort. Methods: Using the Rochester Epidemiology Project (REP) medical records linkage system we identified all residents with incident IS in a 5-year period between January 1, 1990, and December 31, 1994. Comprehensive medical records were reviewed and variables of interest were retrieved and analyzed. Univariate Cox proportional hazard regression models were constructed to assess hazard ratios and 95% CI for predictors of MI occurrence after IS. Results: We identified 490 persons with IS, mean age at IS was 76.6 (SD 12.9) years, mean follow up to death or final follow-up was 6.5 (SD 6.3, range 0.0-23.8) years. There were 126 recurrent strokes and 93 MIs during followup. The 1-year actuarial risk of MI was 3.6% (95% CI, 2.2% - 5.9%), and 5-year actuarial risk of MI was 11.4% (95% CI, 8.4% - 15.3%). Univariate predictors of MI included (HR; 95% CI): age (1.02;1.0-1.04), pre-IS history of MI (1.37;1.13-1.65), CHF (1.85;1.06-3.23), CABG (2.11;1.19-3.75), left ventricular dyskinesia (2.14;1.32-3.4), peripheral vascular disease (1.32;1.18-1.49), diabetes mellitus (1.54;1.21-1.96), elevated creatinine (1.93;1.44-2.59), LDL level (1.01;1.00-1.01). Conclusion: MI is common after first IS. Several factors predicted an increased risk of MI after stroke, and should be taken into account in determining CAD screening strategies at the time of IS. Recurrent stroke was more common than MI during long-term followup.

Symptoms of depression and anxiety before and after myocardial infarction: The HUNT 2 and HUNT 3 study

The long-term effect of having a myocardial infarction (MI) and to what extent post-MI anxiety and depression can be attributed to pre-MI anxiety and depression are not known. Anxiety as an independent risk factor for the onset of MI is not clear and studies treating anxiety and depression as continuous variables are lacking. Baseline data in this prospective study were obtained from the Health Study of Nord-Trøndelag County (HUNT 2). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS) at HUNT 2. Age, gender, waist circumference, hypertension, total cholesterol, diabetes, and years of daily smoking were included as control variables. In the sample of 28,859 participants, 770 MI were reported in the follow-up study 5–8 years later (HUNT 3). The level of depressive symptoms at HUNT 2 was a significant and independent predictor of MI at HUNT 3, while symptoms of anxiety were not. Level of anxiety and depression at HUNT 3 was best predicted by baseline anxiety and depression. Having an MI had only a marginal effect on the levels of anxiety and depressive symptoms at HUNT 3. In the MI group, time since MI was not a significant predictor of anxiety and depression.

Abstract 11866: Left Ventricular Diastolic Function Assessed by Echocardiography and Tissue Doppler Imaging is a Strong Predictor of Cardiovascular Events in Patients With Diabetes Mellitus Type 2

Aims: The aim of the study was to evaluate the independent role of left ventricular systolic function in terms of global longitudinal strain, and diastolic function expressed as the ratio between early diastolic transmitral flow- and mitral annular motion velocities (E/é) in predicting cardiovascular events in patients with diabetes mellitus type 2. Methods: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, carotid intima media thickness, carotid-femoral pulse wave velocity, pulse pressure measurement (pp) and glycosylated hemoglobin (HbA1c) were analysed. Results: Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 ± 17 months. Univariate Cox regression analysis showed that E/é was a strong predictor of cardiovascular events (HR 1.12; 95 % CI 1.06 to 1.18, p &lt; 0.001) and in a multivariate analysis E/é was prospectively associated with cardiovascular events independent of age, sex, global longitudinal strain, pulse wave velocity, carotid intima media thickness, pp and HbA1c. The addition of HbA1c and pp to E/é increased the predictive value of the model significantly, [(E/é vs. E/é + HbA1c vs. E/é + HbA1c + pp) χ 2 = 18.1 vs. χ 2 = 23.0 vs. χ 2 =30.0, p = 0.030 vs. p = 0.007], but global longitudinal strain did not. An elevated E/é ratio, defined as &gt; 15, was also predictive of major cardiovascular events in a Kaplan-Meyer analysis. The cumulative probability of the development of an event during the follow-up period for patients with an E/é ratio &gt; 15 was 8.6 % compared with 2.6 % for patients E/é ratio ≤ 15, p = 0.021. Conclusion: Left ventricular diastolic dysfunction expressed as E/é is a strong predictor of myocardial infarction and stroke in middle-aged patients with diabetes mellitus, superior to global longitudinal strain, arterial stiffness and carotid intima media thickness.

Prediction of myocardial infarction in patients with transient ischaemic attack.

Determinants of risk of myocardial infarction (MI) after transient ischaemic attack (TIA) are not well defined. The aim of our study was to determine the risk and risk factors for MI after TIA. We prospectively recruited patients within 24 h of transient ischaemic cerebrovascular events between October 2006 and January 2013. A total of 628 TIA patients were followed for six months or more. MI and stroke recurrence (SR) were recorded. The duration and typology of clinical symptoms, vascular risk factors and aetiological work-ups were prospectively recorded and established prognostic scores (ABCD2, ABCD2I, ABCD3I, Essen Stroke Risk Score, California Risk Score and Stroke Prognosis Instrument) were calculated. Twenty-eight (4.5%) MI and 68 (11.0%) recurrent strokes occurred during a median follow-up period of 31.2 months (16.1-44.9). In Cox proportional hazards multivariate analyses, we identify previous coronary heart disease (CHD) (hazard ratio [HR] 5.65, 95% confidence interval [CI] 2.45-13.04, P < 0.001) and sex male (HR 2.72, 95% CI 1.02-7.30, P = 0.046) as independent predictors of MI. Discrimination for the prognostic scores only ranged from 0.60 to 0.71. The incidence of MI did not vary among the different aetiological subtypes. Positive diffusion weighted imaging (DWI) (7.5% vs 2.5%, P = 0.007), and ECG abnormalities (Q wave or ST-T wave changes) (13.6% vs 3.6%, P = 0.001) were associated to MI. According to our results, discrimination was poor for all previous risk prediction models evaluated. Variables such as previous CHD, male sex, DWI and ECG abnormalities should be considered in new prediction models.

Are myocardial infarction and venous thromboembolism associated? Population-based case–control and cohort studies

IntroductionBecause the association of myocardial infarction (MI) and venous thromboembolism (VTE) is uncertain, we tested MI as a VTE risk factor and VTE as a predictor of MI. Materials and MethodsUsing Rochester Epidemiology Project resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE over the 13-year period, 1988–2000 (n=1311), one to two resident controls per VTE case (n=1511), and all residents with incident MI over the 31-year period, 1979–2010. For VTE cases and controls, we reviewed their complete medical records in the community for VTE and MI risk factors. Using conditional logistic regression we tested MI as a potential VTE risk factor, both unadjusted and after adjusting for VTE risk factors. We also followed VTE cases and controls without prior MI forward in time for incident MI through 12/31/2010, and using Cox proportional hazards modeling, tested VTE as a predictor of MI, both unadjusted and after adjusting for MI risk factors. ResultsThe number (%) of MI prior to VTE among cases and controls were 75 (5.7) and 51 (3.4), respectively, and the number (%) of MI after VTE among cases and controls were 58 (4.4) and 77 (5.1), respectively. In univariate analyses, MI was significantly associated with VTE but not after adjusting for VTE risk factors. In both univariate and multivariate analyses, VTE (overall or idiopathic) was not a predictor of MI. ConclusionsMI is not an independent risk factor for VTE, and VTE is not a predictor of MI.

Prognostic Indicators for Recurrent Thrombotic Events in HIV-infected Patients with Acute Coronary Syndromes: Use of Registry Data From 12 sites in Europe, South Africa and the United States

AimsLimited data are available on prognostic indicators for HIV patients presenting with ACS. Methods and resultsData on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm3 were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24months (10–41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm3 was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016]). ConclusionsHIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm3, suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.

Abstract P014: Clinically Significant Novel Biomarkers for Prediction of First-ever Myocardial Infarction-The Tromsø Study

Background: Identification of individuals with high risk for first-ever myocardial infarction (MI) can be improved. The objectives of the study ere to survey multiple protein biomarkers for association with the 5-year risk of incident MI and identify a clinically significant risk model that adds information to current common risk models. Methods: We employed an immunoassay platform that utilizes a sensitive, sample efficient molecular counting technology to measure 51 proteins in samples from the fourth survey (1994) in the Tromsø Study, a longitudinal study of men and women in Tromsø, Norway. A nested case control design was used with 182 first-ever MI cases (60 females/122 males) and 467 controls (277 females/190 males). Results: Of the proteins measured, 21 were predictors of MI before and after adjustment for traditional risk factors either in men, women or both. In stepwise multivariable analysis with these biomarkers and traditional risk factors, kallikrein; OR 0.58 (95% CI 0.47 - 0.71), matrix metalloproteinase 8; OR 1.41 (1.13 - 1.75), the interaction term CCL5/RANTES*women; OR 0.57 (0.44 - 0.74), the interaction term apolipoprotein B/apolipoprotein A1 ratio*men; OR 1.53 (1.27 - 1.84) and lipoprotein a; OR 1.33 (1.10 - 1.61) added significantly to the model with a net reclassification improvement of 0.10 (p=0.01), while the ROC area increased from 0.77 to 0.83, p&lt;0.001. Conclusion: Novel protein biomarker models improve identification of MI risk above and beyond traditional risk factors with more than 10% better allocation to either high or low risk group than traditional risk factors alone.

Smoking is a more dangerous risk factor than metabolic syndrome in Egyptian patients with acute myocardial infarction

The effect of metabolic syndrome (MS) and other risk factors of myocardial infarction (MI) are not consistent in all studies. Aim: To assess the incidence of each risk factor in our community as a predictor of acute myocardial infarction. Methods: Fifty patients (Pts) admitted to the main university hospital with acute myocardial Infarction were studied. All risk factors were recorded as well as echocardiographic measurements. Metabolic syndrome components were defined as detailed in the ATP III report: (1) waist circumference >102 cm in men and > 88 cm in women, (2) fasting triglycerides ⩾ 150 mg/dl, (3) HDL cholesterol <40 mg/dl in men and < 50 mg/dl in women, (4) blood pressure ⩾ 130/85 mmHg, and (5) fasting – glucose ⩾ 110 mg/dl. Participants with at least three of these components were determined to have the MS. MS was present in 27 pts (54%). The incidence of different risk factors in the 50 pts: Family history of any point as before age 60 as coronary disease, sudden death, diabetes, Ht was present in 36 pts (72%), smoking (current or stopped less than 6 months 38 pts (76%)). Comparison of those with MS vs. those without: Male to female ratio: Not significant (NS), Diabetes present/absent: 21/6 vs. 9/14, p = 0.005; HT : 18/9 vs. 6/17, p = 0.004; Smoking 18/9 vs. 20/3, p = 0.09; family history of any major risk factor including sudden death or premature coronary disease: 21/6 vs. 16/7, p = NS; BMI > 30 : 14/13 vs. 5/18, p = 0.02; waist > 102, 88 in m and f respectively: 18/9 vs. 7/14, p = 0.01. Comparison with Egyptian prevalence: data in our study vs. prevalence in Egypt above age 15 yr respectively: Diabetes: 30 (60%) vs. 10%, p = 0.000; HT 24 (48%) vs. 26%, p = 0.007; smoking 76% vs. 40 in males, p = 0.000; Ms 27 (54%) vs. 24%, p = 0.0003. Smoking was the highest risk factor among pts with acute MI (76%0 followed by positive family history (72%) then diabetes (60%), metabolic s. (54%), HT (48%). We highlight the danger of smoking beside other factors as predictors of MI in Egyptian population.

Intraoperative very late stent thrombosis in patient undergoing arthroscopic shoulder surgery.

Intraoperative very late stent thrombosis in patient undergoing arthroscopic shoulder surgery.

The Unholy Alliance between Obesity, Type-2 Diabetes, the Sympathetic Nervous System, and Hypertension in Young/Middle-Aged Subjects

There is an obesity/type-2 diabetes (DM2)/hypertension epidemic in developed countries around the world. The purpose of this review is to examine the interrelationships between obesity, DM2 and hypertension in young/middleaged subjects, highlighting the importance of raised sympathetic nerve activity and treatment implications. Central obesity is associated with insulin-resistance, and high plasma insulin and leptin levels. Insulin and leptin act upon the mid-brain, resulting in increased sympathetic nerve activity and blood pressure. Chronically raised sympathetic nerve activity, independent of blood pressure, is a powerful predictor of myocardial infarction in the middle-aged. Weight-loss, via life-style change or bariatric surgery, results in blood pressure reduction. Anti-hypertensive agents that increase sympathetic nerve activity, e.g. diuretics, dihydropyridine calcium antagonists, and angiotensin receptor blockers (ARBs), do not reduce (and may increase) the risk of myocardial infarction in younger/middleaged subjects with hypertension and DM2. Beta-1 blockade, which is effective in regressing and stabilising coronary atheromataous plaque, is preferable to ACE-inhibition, and is the first-line treatment of choice.

Serum Lipoprotein(A) Concentration is a Better Predictor of Myocardial Infarction than Traditional Lipid Profile and Lipid Ratios

Background- Lipoprotein(a) is a variant form of Low Density Lipoprotein (LDL) which comprises of an LDL like particle in which apo B-100 is firmly linked to apo-a glycoprotein. A large number of genetic and epidemiologic studies have identified Lipoprotein(a) as a risk factor for atherosclerotic diseases such as coronary heart disease and stroke. Based on our knowledge, this is the first study comparing Lipoprotein(a) with lipid profile and lipid ratios in Nepal. Aim &amp; Objective- To compare the serum Lipoprotein(a) and Lipid panel concentrations in myocardial infarction patients and normal healthy control subjects. Materials &amp; Methods- Study was carried out in 45 myocardial infarction patients as cases and 45 healthy subjects as controls. Lipoprotein(a) and Lipid profile tests were measured in serum using HumaStar 600 fully automated analyzer, Human, Germany.Results- Mean serum Lipoprotein(a) concentration in myocardial infarction group was significantly higher as compared to healthy controls. Lipid panel assays were not statistically significant among the groups.Conclusion- Our study revealed that myocardial infarction patients have elevated levels of serum Lipoprotein(a) as compared to healthy subjects. High concentration of serum Lipoprotein(a) is strongly associated with the risk of coronary heart disease.DOI: http://dx.doi.org/10.3126/ijasbt.v1i3.8583 Int J Appl Sci Biotechnol, Vol. 1(3) 2013 : 106-109

Risk Factors, Incidence, and Effect of Cardiac Failure and Myocardial Infarction in Aneurysmal Subarachnoid Hemorrhage Patients

Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown. To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications. We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications. Among 53713 cases of aSAH, there were 3609 (6.72%) and 151 (0.28%) incidences of cardiac failure (CF) and myocardial infarction (MI), respectively. The overall in-hospital mortality rate was 24.8%, whereas the mortality rate for patients with CF was 34.4% and the mortality rate for patients with MI was 29.8%. Patients who experienced CF were significantly more likely than other patients to die in the hospital (odds ratio: 1.6, 95% confidence interval: 1.47-1.68; P < .001). The difference in mortality rates between MI patients and other patients, however, was not statistically significant. The generalized estimating equation model identified 7 factors that were predictive of CF: age, sex, race, primary payer, diabetes, smoker, and cardiac disease. For MI, the model identified age, race, and primary payer as significant predictors of MI. Our results suggest that an important association exists between cardiac complications and mortality/morbidity in aSAH patients. aSAH patients with CF appear to have a higher mortality rate, longer hospital length of stay, and higher hospitalization costs compared with those without CF.

English

BACKGROUND : Dermatoglyphics is the scientific study of epidermal ridges and their configurations on the palmar region of hand and fingers and plantar region of foot and toes. The myocardial infarction is almost always caused by coronary artery disease. Against the genetic background of dermatoglyphic patterns and coronary artery disease, the study was undertaken to determine the correlation between them. AIMS To do a comparative study of the dermatoglyphics (finger tip pattern) in patients with myocardial infarction and control group and to assess the usefulness of finger tip pattern in serving as a predictor for myocardial infarction. SETTING AND DESIGN: The study was done in 200 persons of age between 40 to 75 years . Out of them,100 were confirmed cases of CAD and 100 were normal healthy controls. METHODS AND MATERIAL: The finger and palmar prints of both hands were taken on white paper by Ink method and kores duplicating ink was used for taking the prints . STATISTICAL ANALYSIS USED: In statistical analysis SPSS software was used and Z test was used. The p value less than .001 and .05 was considered statistically significant. RESULTS AND CONCLUSIONS: It was found that the total number of whorls are significantly higher in patients with myocardial infarction and total number of loops are significantly lower in patients with CAD. Such difference was significant only in right thumb, left thumb, right ring finger and left little finger. Similarly, loops were significantly less in right thumb, right index finger, right and left little finger. With regard to high incidence of MI, it can be concluded that the knowledge of dermatoglyphics in patients with MI can be utilized to find out genetic correlation. The existence of such relation might be important in the screening program for prevention of MI.

CPAP effect on recurrent episodes in patients with sleep apnea and myocardial infarction

Obstructive sleep apnea (OSA) is linked to increased cardiovascular risk, but the association between OSA and myocardial infarction (MI) remains controversial. Our objectives were to compare the frequency of OSA in patients with acute MI and in a population-based sample of control subjects, and to evaluate the impact of CPAP on recurrent MI and coronary revascularization. Case-control study with a 6-year follow-up of the case cohort. 192 acute MI patients and 96 matched control subjects without coronary artery disease (CAD) (ratio 2:1). After overnight polysomnography, CPAP was recommended if apnea-hypopnea index (AHI) ≥ 5, and a mean daily use >3.5h/day was considered necessary to maintain the treatment. Lipids, fasting glucose, blood pressure, spirometry, comorbidity and current treatment were also registered. End-points were recurrent MI or need of revascularization. OSA was an independent predictor of MI, with odds ratio 4.9 (95% confidence interval [CI] 2.9-8.3, p=0.017). 63 MI patients without OSA, 52 untreated patients with OSA and 71 OSA patients treated with CPAP were included in the follow-up study. After adjustment for confounding factors, treated OSA patients had a lower risk of recurrent MI (adjusted hazard ratio 0.16 [95%CI 0.03-0.76, p=0.021]) and revascularization (adjusted hazard ratio 0.15 [95%CI 0.03-0.79, p=0.025]) than untreated OSA patients, and similar to non-OSA patients. Mild-severe OSA is an independent risk factor for MI. Risk of recurrent MI and revascularization was lower in OSA patients who tolerated CPAP.

Influence of Peripheral Artery Disease and Statin Therapy on Apolipoprotein Profiles

Apolipoprotein B is a stronger predictor of myocardial infarction than LDL cholesterol, and it is inversely related to physical activity and modifiable with exercise training. As such, apolipoprotein measures may be of particular relevance for subjects with PAD and claudication. We compared plasma apolipoprotein profiles in 29 subjects with peripheral artery disease (PAD) and intermittent claudication and in 39 control subjects. Furthermore, we compared the plasma apolipoprotein profiles of subjects with PAD either treated (n = 17) or untreated (n = 12) with statin medications. For the apolipoprotein subparticle analyses, subjects with PAD had higher age-adjusted Lp-B:C (P < 0.05) and lower values of Lp-A-I:A-II (P < 0.05) than controls. The PAD group taking statins had lower age-adjusted values for apoB (P < 0.05), Lp-A-II:B:C:D:E (P < 0.05), Lp-B:E + Lp-B:C:E (P < 0.05), Lp-B:C (P < 0.05), and Lp-A-I (P < 0.05) than the untreated PAD group. Subjects with PAD have impaired apolipoprotein profiles than controls, characterized by Lp-B:C and Lp-A-I:A-II. Furthermore, subjects with PAD on statin medications have a more favorable risk profile, particularly noted in multiple apolipoprotein subparticles. The efficacy of statin therapy to improve cardiovascular risk appears more evident in the apolipoprotein sub-particle profile than in the more traditional lipid profile of subjects with PAD and claudication. This trial is registered with ClinicalTrials.gov NCT00618670.