Risk Factor For Ischemic Heart Disease Research Articles

Coexistence of Metabolic Dysfunction-Associated Fatty Liver Disease and Chronic Kidney Disease Is a More Potent Risk Factor for Ischemic Heart Disease.

Background Metabolic dysfunction-associated fatty liver disease (MAFLD), defined as fatty liver with overweight/obesity, type 2 diabetes, or metabolic abnormalities, is a newly proposed disease. However, it remains unclear whether the coexistence of MAFLD and chronic kidney disease (CKD) is a more potent risk factor for ischemic heart disease (IHD). Methods and Results We investigated the risk of the combination of MAFLD and CKD for development of IHD during a 10-year follow-up period in 28 990 Japanese subjects who received annual health examinations. After exclusion of subjects without data for abdominal ultrasonography or with the presence of IHD at baseline, a total of 14 141 subjects (men/women: 9195/4946; mean age, 48 years) were recruited. During the 10-year period (mean, 6.9 years), 479 subjects (men/women, 397/82) had new onset of IHD. Kaplan-Meier survival curves showed significant differences in rates of the cumulative incidence of IHD in subjects with and those without MAFLD (n=4581) and CKD (n=990; stages 1/2/3/4-5, 198/398/375/19). Multivariable Cox proportional hazard model analyses showed that coexistence of MAFLD and CKD, but not MAFLD or CKD alone, was an independent predictor for development of IHD after adjustment for age, sex, current smoking habit, family history of IHD, overweight/obesity, diabetes, hypertension, and dyslipidemia (hazard ratio, 1.51 [95% CI, 1.02-2.22]). The addition of the combination of MAFLD and CKD to traditional risk factors for IHD significantly improved the discriminatory capability. Conclusions The coexistence of MAFLD and CKD predicts new onset of IHD better than does MAFLD or CKD alone.

Occupational physical activity predicts baseline and 8-year progression of carotid atherosclerosis among women.

Recent reviews link higher levels of occupational physical activity (OPA) to cardiovascular disease (CVD). However, the evidence for women is inconsistent and studies of activity-limiting symptomatic CVD are prone to healthy worker survivor effect. To address these limitations, this study investigated OPA effects on asymptomatic carotid artery intima-media thickness (IMT) among women. Participants include 905 women from the population-based Kuopio Ischemic Heart Disease Risk Factor Study with baseline (1998-2001) data on self-reported OPA and sonographic measurement of IMT. Linear mixed models with adjustment for 15 potential confounders estimated and compared mean baseline IMT and 8-year IMT progression for five levels of self-reported OPA. Analyses stratified by cardiovascular health and retirement status were planned because strong interactions between preexisting CVD and OPA intensity have previously been reported. Light standing work, moderately heavy active work, and heavy or very heavy physical work were all consistently associated with greater baseline IMT and 8-year IMT progression than light sitting work. The greatest baseline IMT was observed for heavy or very heavy physical work (1.21 mm), and the greatest 8-year IMT progression for light standing work and moderately heavy active work (both 0.13 mm), 30% above sitting work (0.10 mm). Stratified analyses showed that these differences were driven by much stronger OPA effects among women with baseline carotid artery stenosis. Retired women experienced slower IMT progression than those working at baseline. Higher levels of OPA predict higher baseline IMT and 8-year IMT progression, especially among women with baseline stenosis.

The association between population drinking and ischemic heart disease mortality in educational groups.

A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.

Frailty alone and interactively with obesity predicts heart failure: Kuopio Ischaemic Heart Disease Risk Factor Study.

We aim to evaluate the association of frailty and high body mass index with risk of incident heart failure. From the Kuopio Ischaemic Heart Disease Risk Factor Study, 408 women and 369 men, aged 61-74years were included in this study. Frailty was ascertained with the presence of 3-5 and prefrailty 1-2 of the following criteria: weight loss (highest 20% over 7years), self-reported tiredness, weakness (measured by handgrip strength), slow walking speed (walking pace), and low physical activity (lowest 20%). At the baseline, participants were allocated to frail (n=36), prefrail (n=340), and robust (n=441). HF incidents were obtained by record linkages from the national hospitalization registry in Finland up to 31 December 2019. Multivariate Cox proportional hazards regression estimated the hazard ratio (HR) of incident events, adjusted for potential confounders. Two hundred one HF events were recorded (111 in women and 90 in men) during the 14.2years follow-up. After adjustment for the age and sex, the risk of HF events was higher among prefrail (HR 1.42, 95% CI 1.08 to 1.79, P=0.02) and frail (HR 3.39, 95% CI 1.89 to 4.79, P≤0.001) compared with the robust group. After adjusting for multiple confounders result remained significant for HF indecent in prefrail [1.46 (HR 1.46, 95% CI 1.09 to 1.95, P=0.01] and frail (HR 3.33, 95% CI 1.86 to 5.70, P≤0.001). In the sensitivity analysis, significant interaction between high BMI (≥25kg/m2 ) and frailty was observed (P for interaction=0.02). The association of frailty [multivariate-adjusted HR: 2.88 (1.56 to 5.33), P≤0.001)] and prefrailty [multivariate-adjusted HR: 1.40 (1.08 to 1.91), P=0.03)] with risk of HF indecent was more pronounced in those with high BMI. Frailty is highly common in older age, and our results indicated the high risk of HF incident in frail and prefrail groups. While frailty is clinically recognized by weight loss phenotype, our finding showed that frailly and high BMI can coexist and worsen the risk of HF incidence. Further research is warranted to substantiate these results in large studies and clinical settings.

The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002–2018: a nationwide population-based study

The burden of cardiovascular diseases (CVDs) is on the rise in China, yet a comprehensive and systematic understanding of the temporal trends and distribution of CVD burden attributable to dietary factors across the provinces remains elusive. This study endeavors to provide a comprehensive depiction of the burden of CVDs attributable to dietary risk factors across China's geographical regions from 2002 to2018. Data from the China National Nutrition Surveys, the China Chronic Disease and Risk Factor Surveillance, the Hypertension Survey, and the Chinese Centre for Disease Control and Prevention cause-of-death reporting system were used to estimate the intake of dietary factor, the number of deaths, and disability-adjusted life years (DALYs), mortality rate, for ischemic heart disease (IHD), ischemic stroke (IS), hemorrhage and other stroke (HOS) attributable to dietary factors at national and provincial levels in China from 2002 to 2018. Using a comparative risk assessment approach, we estimated the proportion of CVDs burden attributable to suboptimal intake of seven dietary factors, both individually and collectively, among Chinese citizens aged 20 years or older. The mean consumption of whole grains, soybeans, nuts, vegetables, fruits, red meat, and sugar-sweetened beverages (SSBs) exhibited an upward trend from 2002 to 2018. However, with the exception of red meat and SSBs, the average intake remained below the levels recommended levels outlined in the Chinese national dietary guidelines. Inadequate fruit, whole grain, and vegetables intake were the leading dietary risk factors for IHD, IS and HOS in China, while nuts, soybean and SSB were only associated with IHD mortality. From 2002 to 2018, the number of deaths and mortality rate for CVDs attributable to suboptimal diet among Chinese males were greater than that of females. With increasing age, the diet-related mortality rate for CVDs increased substantially. In 2018, the nationwide mortality rate attributable to diet was found to be 77.9 (95% UI, 77.5-78.1) per 100,000 population for IHD, 34.1 (95% UI, 33.8-34.2) for IS, and 32.8 (95% UI, 32.4-32.8) for HOS. Suboptimal diet was responsible for 16.0 million (95% UI, 13.8-18.4) DALYs and 1137.1 (95% UI, 980.4-1312.3) DALYs per 100,000 population for stroke, and 13.9 million (95% UI, 11.8-16.3) DALYs and 990.2 (95% UI, 841.2-1158.6) DALYs for IHD. Across the provinces of China, in 2018, the highest age-standardized mortality rates of all diet-related deaths were observed in Shandong (92.8 [95% UI, 89.9-93.3]) for IHD, Heilongjiang (38.1 [95% UI, 36.2-38.8]) for IS, and Tibet (68.3 [95% UI, 65.0-70.1]) for HOS. The highest diet related DALYs were observed in Henan (1.4 million [95% UI, 1.2-1.6] for IS, and 1.3 million [95% UI, 1.1-1.5] for IHD). This study provides a comprehensive picture of the geographic variation and temporal trends of the burden of CVDs attributable to dietary risk factors at the national and provincial levels from 2002 to 2018 in China, highlighting the need for geographically targeted intervention strategies to improve the quality of diet and reduce the diet-related burden of CVDs. National Key Research and Development Program of China (2018YFC1315303), National Natural Science Foundation of China (82103966).

What is the most appropriate follow-up time for detecting the epidemiological relationship between coronary artery disease and its main risk factors: novel findings from a 35-year follow-up study.

The aim was to investigate the most appropriate follow-up time to detect the associations of coronary artery disease (CAD) with its traditional risk factors in a long-term prospective cohort study. The Kuopio Ischaemic Heart Disease Risk Factors Study provided the study material of 1958 middle-aged men free from CAD at baseline and followed up for 35 years. We performed Cox models adjusted for age, family history, diabetes, obesity, hypercholesterolemia, hypertension, smoking, and physical activity, investigated covariate interactions, and tested Schoenfeld residuals to detect time-dependent covariates. Moreover, we applied a sliding window procedure with a subarray of 5 years to better differentiate between risk factors manifested within years and those manifested within decades. The investigated manifestations were CAD and fatal acute myocardial infarction (AMI). Seven hundred seventeen (36.6%) men had CAD, and 109 (5.6%) men died from AMI. After 10 years of follow-up, diabetes became the strongest predictor of CAD with a fully adjusted hazard ratio (HR) of 2.5-2.8. During the first 5 years, smoking was the strongest predictor (HR 3.0-3.8). When the follow-up time was 8-19 years, hypercholesterolemia predicted CAD with a HR of >2. The associations of CAD with age and diabetes depended on time. Age hypertension was the only statistically significant covariate interaction. The sliding window procedure highlighted the significance of diabetes over the first 20 years and hypertension after that. Regarding AMI, smoking was associated with the highest fully adjusted HR (2.9-10.1) during the first 13 years. The associations of extreme and low physical activity with AMI peaked when the follow-up time was 3-8 years. Diabetes showed its highest HR (2.7-3.7) when the follow-up time was 10-20 years. During the last 16 years, hypertension was the strongest predictor of AMI (HR 3.1-6.4). The most appropriate follow-up time for most CAD risk factors was 10-20 years. Concerning smoking and hypertension shorter and longer follow-up times could be considered, respectively, particularly when studying fatal AMI. In general, prospective cohort studies of CAD would provide more comprehensive results by reporting point estimates in relation to more than one timepoint and concerning sliding windows.

Evaluation of Iron Profiles and Coagulation Profiles in Ischemic Heart Diseases Patients in Elmer Nimr Hospital, Sudan

Back ground chemic heart disease (IHD) isa constellation of diseases that includes stableangina,unstableangina,myocardialinfarction,andsuddencardiacdeath.It belongs to the group of cardiovascular diseases and is the most common type among them. Iron is an essential trace element .it plays an important role in maintaining various cellular function and enzymatic reactions. On the other hand, excessive intake of iron is known to be a risk factor for the progression of atherosclerosis. Abnormal iron deposition in the heart causes hem chromatists and dilated cardiomyopathy, which leads to is chemic heart disease .Objectives :This study aims to investigate the role of serum iron ,serum ferritin ,total iron-binding capacity(TIBC), PT, and PTT in is chemic heart disease(IHD)and their relationship with other risk factors for IHD This is a prospective, case-control, cross-sectional analytical study conducted at Elmer Narmer University Hospital, Shendi City, to assess their on profile and coagulation profile of patients with is chemic heart disease. The study included (30) patients diagnosed with is chemic hear the diseases and the study group was compared with the mean of the control group (20). Serum iron ,ferritin ,and TIBC were estimated using a Spectro photo meter ,and PT and PTT were estimated using manual methods. Data were collected using a structured personal questionnaire and the program (SPSS) version(11.5)was used for data analysis

Ischemic Heart Disease and Vascular Risk Factors Are Associated With Accelerated Brain Aging

BackgroundIschemic heart disease (IHD) has been linked with poor brain outcomes. The brain magnetic resonance imaging–derived difference between predicted brain age and actual chronological age (brain-age delta in years, positive for accelerated brain aging) may serve as an effective means of communicating brain health to patients to promote healthier lifestyles. ObjectivesThe authors investigated the impact of prevalent IHD on brain aging, potential underlying mechanisms, and its relationship with dementia risk, vascular risk factors, cardiovascular structure, and function. MethodsBrain age was estimated in subjects with prevalent IHD (n = 1,341) using a Bayesian ridge regression model with 25 structural (volumetric) brain magnetic resonance imaging features and built using UK Biobank participants with no prevalent IHD (n = 35,237). ResultsPrevalent IHD was linked to significantly accelerated brain aging (P < 0.001) that was not fully mediated by microvascular injury. Brain aging (positive brain-age delta) was associated with increased risk of dementia (OR: 1.13 [95% CI: 1.04-1.22]; P = 0.002), vascular risk factors (such as diabetes), and high adiposity. In the absence of IHD, brain aging was also associated with cardiovascular structural and functional changes typically observed in aging hearts. However, such alterations were not linked with risk of dementia. ConclusionsPrevalent IHD and coexisting vascular risk factors are associated with accelerated brain aging and risk of dementia. Positive brain-age delta representing accelerated brain aging may serve as an effective communication tool to show the impact of modifiable risk factors and disease supporting preventative strategies.

Exploring Healthcare Seeking Behavior Among Patients with Ischemic Heart Disease and Stroke; A Cross-Sectional Study in a Tertiary Care Centre in South India

Background: Ischemic heart disease (IHD) and stroke represent the leading cause of mortality globally. Delays in seeking medical attention that result in diagnostic and treatment delays are significant roadblocks in achieving the best possible treatment outcomes for IHD and stroke. Aims and Objectives: This study aims to assess the pattern of healthcare seeking behavior among patients of IHD and stroke in a tertiary care hospital at Salem District in Tamil Nadu, South India. Materials and Methods: This cross-sectional study was conducted among 250 patients of IHD and stroke. A validated and structured questionnaire was used to collect information on socio-demographic details, knowledge, and health-care seeking behavior with regard to IHD and stroke based on the Health Belief Model. Results: The mean age of study participants was 60 years with a male preponderance (56%). About 75% of IHD patients and 61.9% of stroke patients had no formal education. The prevalence of hypertension (74%) was higher than diabetes mellitus (45.6%) among the study subjects. The seriousness of the initial symptoms of IHD and stroke was perceived only by 7.75% of IHD patients and 2.23% of stroke patients. Alarmingly, 39.66% of IHD patients and 61.2% of stroke patients were not aware of any risk factors for IHD and Stroke. Only 21.56% of IHD patients and 14.17% of stroke patients sought immediate medical assistance whereas the others ignored the symptoms or did not undergo treatment even after knowing the symptoms of the disease. Conclusion: This study depicted suboptimal healthcare seeking behavior and significant lack of knowledge about risk factors, initial symptoms, preventive measures, and reasons for pre hospital delay related to IHD and stroke. The study yields valuable references to incorporate the pattern of health-care seeking response of the community along with their sociocultural and economic factors in designing and implementation of any health program.

Platelet adhesion mediated by von Willebrand factor in patients with premature coronary artery disease

Aim To study platelet adhesion mediated by von Willebrand factor (VWF) in patients with premature ischemic heart disease (IHD).Material and methods This study enrolled 58 patients with stable IHD, including 45 men younger than 55 years with the first manifestation of IHD at the age of &lt;50 years and 13 women younger than 65 years with the first manifestation of IHD at the age of &lt;60 years. The control group consisted of 33 patients, 13 men younger than 55 years and 20 women younger than 65 years without IHD. Platelet adhesion to the collagen surface at the shear rate of 1300 s-1 was studied by evaluating the intensity of scattered laser light from the collagen-coated optical substrate in a flow chamber of a microfluidic device after 15-min circulation of whole blood in the chamber. Decreases in platelet adhesion after addition to the blood of monoclonal antibodies (mAb) to platelet receptors glycoproteins Ib (GPIb) to inhibit the receptor interaction with VWF were compared for patients of both groups.Results In patients with premature IHD, the decrease in platelet adhesion following the platelet GPIb receptor inhibition was significantly less than in patients of the control group (74.8 % (55.6; 82.7) vs. 28.9 % (-9.8; 50,5), p &lt;0.001). For the entire sample, the median decrease in platelet adhesion following the GPIb receptor inhibition was 62.8 % (52.2; 71.2). With an adjustment for traditional risk factors of IHD, a decrease in platelet adhesion of &gt;62.8% after blocking GPIb receptors increased the likelihood of premature IHD (OR=9.84, 95 % CI: 2.80-34.59; p &lt;0.001).Conclusion Blocking the interaction of GPIb receptors with VWF in patients with premature IHD and increased shear rate induced a greater decrease in platelet adhesion than in patients without this disease. This suggested that an excessive interaction of VWF with platelets might contribute to the pathogenesis of premature IHD.

The association between renal hyperfiltration and mortality is not mediated by diabetes mellitus

BackgroundRenal hyperfiltration (RHF), recently established as a risk factor for mortality, is linked to current and subsequent diabetes mellitus (DM). DM could be seen as a mediator in the pathway between RHF and mortality. However, the mediating role of DM in the relationship between RHF and mortality is unclear.Methods and resultsBased on a cohort of 2682 Finnish men from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) followed-up for 35 years, we evaluated the association between RHF and mortality, with DM as a mediator, following two methods: a classic mediation analysis approach, using Cox regression, and a counterfactual framework for mediation analysis, using g-computation, Cox regression, and logistic regression. RHF is associated with an increased risk of mortality. This association was not mediated by DM. Under a counterfactual framework and on a hazard ratio scale, RHF association with mortality had a total effect of 1.54 (95% confidence interval, 1.26–1.98) and a controlled direct effect of 1.66 (1.34–2.16).ConclusionAn association between RHF and mortality risk, independent of DM, was established. RHF should be considered, managed, and followed-up as a mortality-associated condition, regardless of the status of DM. We suggest clinicians to consider including RHF screening in routine clinical care, especially diabetic care.

Prospective relationship between occupational physical activity and risk of ischaemic heart disease: are men and women differently affected?

High occupational physical activity (OPA) seems to increase risk of cardiovascular diseases among men. However, findings are mixed, and it is not known if women are differently affected. Therefore, the aim of this study is to investigate the relationship between OPA and risk for ischaemic heart disease (IHD), and whether it differs across sex. This prospective cohort study was based on 1399 women and 1706 men, aged 30-61 years, participating in the Danish Monica 1 study in 1982-84, actively employed, without prior IHD and answering an OPA question. The information on incidence of IHD, before and during the 34-years follow-up, was retrieved by individual linkage to the Danish National Patient Registry. Cox proportional hazards models were used to investigate the association between OPA and IHD. Compared to women with sedentary work, women in all other OPA categories had lower hazard ratio (HR) for IHD. Among men, the risk of IHD was 22% higher among those with light OPA, and 42% and 46% higher among those with moderate OPA with some lifting or strenuous work with heavy lifting, respectively, compared to men with sedentary OPA. Compared to women with sedentary work, HR for IHD was higher among men in all OPA categories. There was statistically significant interaction between OPA and sex. Demanding or strenuous OPA seems to be a risk factor for IHD among men, whereas a higher level of OPA seems to protect women from IHD. This emphasizes the importance of taking sex differences into account in studies of health effects of OPA.

A 30-year trend of ischemic heart disease burden in a developing country; a systematic analysis of the global burden of disease study 2019 in Iran

BackgroundEvaluating the burden of ischemic heart disease (IHD) as the first cause of mortality worldwide is necessary to develop healthcare policies. This study aimed to report the national and subnational IHD burden and risk factors in Iran according to the Global Burden of Disease (GBD) study 2019. MethodsWe extracted, processed, and presented the results of the GBD 2019 study regarding incidence, prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and attributable burden to risk factors of IHD in Iran during 1990–2019. ResultsAge-standardized death and DALY rates decreased by 42.7% (95% uncertainty interval, 38.1–47.9) and 47.7% (43.6–52.9) during 1990–2019, slower since 2011 and reached 163.6 deaths (149.0–176.2), 2842.7 DALYs (2657.0–3103.1) per 100,000 persons in 2019. Meanwhile, with a lower reduction of 7.7% (6.0–9.5), the incidence rate reached 829.1 new cases (719.9–945.2) per 100,000 persons in 2019. High systolic blood pressure and elevated low-density lipoprotein cholesterol (LDL-C) contributed to the highest deaths, and DALYs age-standardized rates in 1990 and 2019. They followed by high fasting plasma glucose (FPG), and high body-mass index (BMI) with an upward trend of contribution from 1990 to 2019. A convergence pattern in the provincial death age-standardized rate was observed, with the lowest rate in Iran's capital city; 84.7 deaths per 100,000 (70.6–99.4) in 2019. ConclusionThe incidence rate reduced remarkably lower than the mortality rate, which necessitates promoting primary prevention strategies. Also, interventions should be adopted to control growing risk factors like high FPG, and high BMI.

Abstract 45: Life's Essential 8 and the Risk of Stroke in Finnish Men: The Kuopio Ischaemic Heart Disease Risk Factor Study

Background: Primordial prevention is an important way towards reducing risk of stroke with its associated health and economic burdens. So far, no study has shown how the recently updated American Heart Association’s cardiovascular health metrics, Life’s Essential 8 (LE8), relates to stroke events. Therefore, we sought to examine the association between LE8 and the risk of stroke among Finnish men. Methods: We employed the population-based Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) comprising men, aged 42 to 60 years, without pre-existing history of stroke at baseline. The LE8 was computed for 2614 men using AHA’s recently updated metrics. The LE8 includes four health behaviours (diet, physical activity, nicotine exposure, and sleep health) and four health factors (BMI, blood lipids, blood glucose and blood pressure). Each factor had points ranging from 0 to 100. Participants were classified into quartiles based on LE8 scores - Q1, ≤ 420; Q2, &gt;420 to 485; Q3, &gt;485 to 550; Q4, &gt;550. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LE8 scores for stroke event. Results: During a median follow-up of 26 years, 446 stroke events were recorded. The higher the LE8 scores, the more protection from future risk of stroke event. Thus, per quartile increase was associated with 26% lower risk of stroke (HR:0.74; 95%CI:0.68-0.82). Men within the 4 th quartile (Q4) of LE8 score had the highest protection (65%) from risk of stroke when compared with those within the 1 st quartile (Q1) (HR: 0.45; 95%CI:0.34-0.60). Conclusion: Life’s Essential 8 was strongly and inversely associated with the risk of stroke among middle-aged and ageing Finnish men. Measures that promote LE8 should be encouraged among the general population in Finland.

Multiplicative, additive, and interactive associations of 25-hydroxyvitamin D with lung and prostate cancer.

Results regarding the epidemiological association of vitamin D with lung (LCA) and prostate cancer (PCA) are controversial. This study tested whether serum 25-hydroxyvitamin D [25(OH)D] concentrations have interactive epidemiological associations with smoking, the number-one risk factor for LCA, and age, the number-one risk factor for PCA. Also, this study investigated whether the associations of 25(OH)D, smoking, age, alcohol consumption, body mass index, diet (the healthy Nordic diet score), and physical activity with incident LCA and PCA are multiplicative or additive. The study of association types makes it easier to select appropriate statistical methods. The Kuopio Ischaemic Heart Disease Risk Factor Study provided the data of 2578 men with 112 LCA and 300 PCA cases over 35 years by the end of 2019. Serum 25(OH)D did not associate with LCA and PCA or interact with smoking and age. The association of smoking with LCA was additive; 13 extra cases per 1000 men every 10 years. Age and alcohol consumption multiplicatively increased the hazard of LCA (hazard ratio, 95% confidence interval for age >50: 3.56, 1.82-6.17; drink per week: 1.01, 1.00-1.03), whereas adherence to healthy Nordic diet decreased it (per score point: 0.95, 0.89-1.00). The association of age >50 with PCA was additive; 2.5 extra cases per 1000 men every 10 years. To conclude, there was no epidemiological relationship of pre-diagnostic 25(OH)D concentrations with the incidence of LCA and PCA. The respective associations of smoking and age >50 with LCA and PCA were additive rather than multiplicative.

Investigating factors associated with the prevalence of IHD among uncontrolled diabetic patients

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Monash University Malaysia Background Ischaemic Heart Disease (IHD) is the leading cause of death in Malaysia (1), and there is an increasing trend in mortality due to IHD from 15.2% in 2019 to 17.2% in 2020 (2). IHD is one of the NCDs, estimated to have an RM100.79 billion burden of disease cost (health burden resulting from disability and loss of healthy life years), equivalent to 7% of GDP (3). Diabetes mellitus (DM) is known to be one of the risk factors for IHD. Purpose This study aimed to investigate the risk factors associated with the prevalence of IHD in uncontrolled diabetic patients. Besides, these characteristics were also compared among the duration of uncontrolled DM (&amp;lt;10 years vs. ≥10 years) Materials and Methods A single-center, cross-sectional study was conducted in a cardio referral center using Electronic Medical Record from 1 January 2020 to 31 December 2020. Adult patients aged ≥ 18 years old with uncontrolled type 2 diabetes mellitus (defined as HbA1c ≥7%) had their medical records examined for IHD upon first contact with the Diabetes Mellitus Therapy Adherence Clinic (DMTAC) pharmacist. Results A total of 495 participants with uncontrolled diabetes were included in the final analysis. The mean age and HbA1c in the overall cohort were 52.2 (10.9) years and 10.5%, respectively, with 59.4% (n=294) of them having &amp;lt;10 years of underlying diabetes. The majority were obese (64.8%) and had underlying hypertension (78.4%) and hyperlipidemia (78.4%). The prevalence of ischemic heart disease (IHD) among the overall cohort was 19.0% (n=94). Patients with longer underlying diabetes (≥10 years) were significantly older [mean age 56.8 (8.4) vs. 49.0 (11.4), p=&amp;lt;0.001], drinks alcohol [12.0% vs. 6.0%; p=0.022], had underlying hypertension [86.6 vs. 72.8; p=&amp;lt;0.001] and more comorbidities [mean 1.7 (0.55) vs. 1.5 (0.65); p=&amp;lt;0.001] compared to those with &amp;lt;10 years respectively. Independent predictors of IHD events were age 40-49 [OR 5.1 (95% CI 1.1-23.3); p=0.038], 50-59 [OR 5.36 (1.2-23.7); p=0.027] and ≥60 [OR 7.1 (1.6-32.3); p=0.011], alcohol use [OR 2.4 (1.1-5.1); p=0.023], ≥10 years of uncontrolled diabetes [OR 2.0 (1.2-3.3); P=0.007], and underlying hypertension [OR 2.6 (1.2-5.8); p=0.016]. Conclusion IHD has an indirect impact on social and economic development due to the high burden of the disease cost. In our study, older age, alcohol use, prolonged uncontrolled diabetes, and underlying hypertension seem to be associated with the prevalence of IHD complications. With the understanding of the recent outlook on diabetes, health education for the targeted population may negate this complication.

Assessing Community Awareness of Ischemic Heart Disease Risk Factors in Nangarhar: A Comprehensive Study

‌Background: Ischemic heart disease (IHD) is the impairment of the heart due to reduced blood flow to the heart. Usually, the reduced flow is the result of coronary artery disease, a condition in which the coronary artery is narrowed. The risk factors for IHD are classified into modifiable risk factors (age, sex, ethnicity, family history) and non-modifiable risk factors (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, poor diet, sedentary lifestyle). The study aimed to evaluate the awareness of adults about IHD-related risk factors and to recognize demographic variables correlated with this knowledge level. Materials and Methods: This descriptive cross-sectional study was conducted among a convenience sample of 114 adults taking part in a health awareness fair held in a shopping mall in Nangarhar, in January 2023. A modified version of the IHD Facts questionnaire was used to estimate awareness of IHD risk factors. The number of correct responses for each item, which ranged from 0 to 21, has been integrated up in order to calculate the score. A mean score of less than 70% indicated insufficient awareness. To determine correlated demographic variables and demonstrate the participants' knowledge level, descriptive and multivariate logistic regression analyses were carried out. Findings: The study had a response rate of 87.7%, with 114 subjects participating in total. Of the participants, 69 individuals (60.5%) showed a mean IHD awareness score that was insufficient. It was found that there was a significant correlation between body mass index (odds ratio = 0.739; p = 0.023), marital status (OR = 0.057; p = 0.036), and education level (OR = 9.243; p = 0.006) and awareness of IHD risk factors. Conclusion: The Nangarhar study population showed a low level of awareness regarding IHD risk factors. It appears that the participants' inability to engage in prevention is a result of their limited awareness. These results underline how important it is for Nangarhar to carry out educational initiatives to raise public awareness of IHD risk factors and prevention.

Prevalence of the Novel COVD-19 in Nangarhar Province Corona Center Hospital during June 2020 to August 2021

Background: In 2019, a novel coronavirus appeared, quickly circling the world from its Chinese source. The illness brought on by this virus is known as coronavirus disease 2019 (COVID-19), and the virus was given the designation SARS-CoV-2 by the Centers for Disease Control and Prevention. On March 11, 2020, the World Health Organization proclaimed COVID-19 to be a pandemic. During 2020, the virus spread to Afghanistan and infected thousands of individuals. This study's aim is to describe the incidence of COVID-19 in the Nangarhar Corona Center Hospital in Afghanistan between June 2020 and August 2021. Thus, quick administration of the necessary therapy can stop future complications. Additionally, the management of upcoming pandemic virus illnesses will benefit from this study's findings. Materials and Methods: A descriptive retrospective investigation using interview approach and an accidental sampling technique was used to collect data for this study from the inpatient medical records of patients who were identified as having SARS-CoV-2 infection following admission to the Corona Center Hospital in Nangarhar province, Afghanistan, between June 2020 and August 2021. Additionally, information on the laboratory tests was taken from the hospital file. In addition, 140 patients were questioned about their ischemic heart disease, diabetes, hypertension, and other COVID-19 risk factors. Additionally, 100 patients were given a questionnaire about the socioeconomic effects of COVID-19 on their daily lives and behavior. Findings: In this study, patients who met the inclusion criteria provided 11000 samples. 3380 female patients and 7620 male patients in all have been reported. There were 9267 negative cases and 1733 positive cases out of them. 1133 (10.1%) of the positive instances were found in male patients, whereas 600 (5.5%) were found in female patients. The 140 patients who were examined for COVID-19 risk factors identified four, including hypertension, diabetes, chronic liver disorders, and ischemic heart disease. Additionally, 75% of participants believed that COVID-19 would be controlled in Afghanistan, compared to 70% who believed that COVID-19 would be managed globally. Conclusion: The findings of this study indicated that the majority of COVID-19 patients were of productive age. Additionally, our study found that there was a negative overall influence of COVID-19 on Afghan population social life. Immediate action is required on the part of the general public in the shape of focused mass psychological support initiatives in order to improve the mental health of those impacted by the COVID-19 problems.

Epidemiological study in admitted patients with ischaemic heart disease at a Tertiary Care Hospital in North-Western India

Background/Aim: Ischaemic heart disease (IHD) is a major cause of morbidity and the leading cause of mortality in either men or women globally. IHD incidence is more common in the elderly and there are multiple well-known risk factors for IHD. This study aimed to evaluate the epidemiological trend of IHD in North-Western India. This study also evaluated the risk factors of IHD and associated comorbidities. Methods: A cross-sectional observational study for a period of 12 months was conducted in the Cardiology Department of the Tertiary Care Hospital, Jaipur, India. A total of 400 IHD patients were enrolled in this study. Statistical Package for Social Sciences (SPSS) version 20.0 software was used for statistical calculation. Results: The most common age group was 61-80 years (mean age was 57.8 ± 0.66) with men predominated (76.3 %). More patients (56 %) were from urban areas than rural areas (44 %). Among all the patients, 161 (40.3 %) patients were smokers and 42 (10.3 %) were alcoholics. Hypertension (34.8 %) followed by diabetes mellitus (17 %) and obesity (7.3 %) were found to be the predominant risk factors. Conclusion: IHD was more common in elderly patients and in men. Heavy alcohol consumption and smoking were potential risk factors for the development of IHD. Hypertension, diabetes mellitus and obesity also significantly contributed to occurrence of IHD. The burden of the IHD can be reduced by the limiting alcohol consumption, smoking cessation and adaptation of healthy lifestyle.

Assessment of right atrial function in inferior wall AMI

Background: Approximately 30–50% of patients with inferior infarction have some involvement of the right ventricle. The right ventricular (RV) infarction almost invariably develops in association with a large infarction of the adjacent septum and inferior 0 walls, but isolated infarction of the right ventricle is seen in just 3–5% of autopsy-proven cases of MI. This study is designed to assess the right atrial (RA) functions in inferior wall acute myocardial infarction (AMI) (IWMI) echocardiographically and to compare it with patients who do not have history of ischemic heart disease (IHD) but having risk factors for IHD. Aims and Objectives: The aims of this study were to study the patients presenting with Inferior wall MI IWMI for RA function. Materials and Methods: Patients admitted in the Cardiology ward of R G Kar Medical College and Hospital with IWMI from March 2020 to March 2022 were included in the study. Results: Average Measurement of RA volume index (RAVI) and RA Pressure (RAP) was highest among patients with IWMI+RV myocardial infarction (RVMI). Out of 100 IWMI patients, 33 had high RAVI and RAP and out of 100 non-IHD patients none had high RAVI. Conclusion: In our study, there was no statistically significant difference in average RAVI and RAP in patients presenting with IWMI and in patients with risk factors for myocardial infarction but without AMI. However, patients presented with IWMI+RVMI showed statistically significant increased RAVI and RAP as compared to inferior wall AMI only.