Background
Coronary artery disease (CAD) is a universal public health challenge, more prominently so in the low- and middle-income countries. In this study, we aimed to determine prevalence and trends of CAD risk factors in patients with documented CAD and to determine their effects on the age of CAD diagnosis.
Materials and methods
We conducted a registry-based, serial cross-sectional study using the coronary angiography data bank of the Tehran Heart Center. Adult patients who had obstructive (> 50% stenosis) CAD were included in the study. The prevalence and 11-year trends of conventional CAD risk factors were analyzed by sex and age, and their adjusted effects on the age of CAD diagnosis were calculated.
Results
From January 2005 to December 2015, data for 90,094 patients were included in this analysis. A total of 61,684 (68.5%) were men and 28,410 (31.5%) were women. Men were younger at diagnosis than women, with a mean age of 60.1 in men and 63.2 in women (p < 0.001), and had fewer risk factors at the time of diagnosis. Mean age at diagnosis had an overall increasing trend during the study period. Increasing trend was seen in body-mass index, hypertension prevalence, diabetes mellitus. All lipid profile components (total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol) decreased over time. Of particular interest, opium consumption was associated with 2.2 year earlier age of CAD diagnosis.
Conclusion
The major results of this study (lower age of CAD diagnosis in men, lower age of diagnosis associated with most risk factors, and lower prevalence of serum lipids over time) were expected. A prominent finding of this study is confirming opium use was associated with a much younger age of CAD onset, even after adjusting for all other risk factors. In addition to recommendations for control of the traditional risk factors, spreading information about the potential adverse effect of opium use, which has only recently been associated with higher risk of CAD, may be necessary.
Background Primary percutaneous coronary intervention (PPCI) as the treatment of choice for ST-segment elevation myocardial infarction (STEMI) should be rapidly performed. It is necessary to use preventive strategies during the coronavirus disease 2019 (COVID-19) outbreak, which is an ongoing global concern. However, critical times in STEMI management may be influenced by the implementation of infection control protocols. aims We aimed to investigate the impact of our dedicated COVID-19 PPCI protocol on time components related to STEMI care and catheterization laboratory personnel safety. A subendpoint analysis to compare patient outcomes at a median time of 70 days during the pandemic with those of patients treated in the preceding year was another objective of our study. methods Patients with STEMI who underwent PPCI were included in this study. Chest computed tomography (CT) and real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) tests were performed in patients suspected of having COVID-19. A total of 178 patients admitted between February 29 and April 30, 2020 were compared with 146 patients admitted between March 1 and April 30, 2019. results Severe acute respiratory syndrome coronavirus 2 infection was confirmed by rRT-PCR in 7 cases. In 6 out of 7 patients, CT was indicative of COVID-19. There were no differences between the study groups regarding critical time intervals for reperfusion in STEMI. The 70-day mortality rate before and during the pandemic was 2.73% and 4.49%, respectively (P = 0.4). conclusions The implementation of the dedicated COVID-19 PPCI protocol in patients with STEMI allowed us to achieve similar target times for reperfusion, short-term clinical outcomes, and staff safety as in the prepandemic era.
Background
Serial chest computed tomography (CT) scans are used to detect coronavirus disease 2019 (COVID-19) pneumonia and monitor the disease course. This study investigates relationship between total severity score by first chest CT and the outcome of coronavirus COVID-19 patients with coronary artery disease (CAD).
Results
A total of 48 patients with a history of CAD (mean age=60.83±3.06 years, 75% male) with positive real-time reverse transcription-polymerase chain reaction for COVID-19 were included. Outcome was defined as acute respiratory distress syndrome or death. The unadjusted and adjusted effects of the CT score on the outcome were reported through odds ratio (OR) with 95% confidence interval (CI). Outcome occurred in 17 (35.5%) patients (8 deaths). The CT score was directly and significantly correlated with the outcome in the univariate analysis (OR 1.38, 95% CI 1.12–1.70; P=0.003) and remained significant after adjustment for diabetes, hypertension, body mass index, and serum level of highly sensitive C-reactive protein (OR 1.51, 95% CI 1.11–2.05; P=0.009). Outcome rate was 24.1% in patients with a CT score <2.5, whereas it was 8.3% in patients with a CT score>2.5.
Conclusions
The first chest CT score could be a robust predictor of adverse events in confirmed COVID-19 patients with coronary artery disease.
Background This study was to develop, implement, and evaluate the impact of lifestyle education package in order to control metabolic syndrome components.Methods Totally, 72 women and men aged 18-68 years with MetS from two health centers enrolled through randomized sampling to either intervention group who take usual care plus a 3-month lifestyle modification intervention or control group. Anthropometric indices, blood pressure, lipid profiles, and fasting blood glucose were assessed at baseline and after 3month.Results Lifestyle modification program was associated with modest weight loss (2 ± 0.4 kg, P<0.001), a significant reduction in waist circumference (2.3 ± 0.9 cm, P <0.001) and hip circumference (1 ± 0.3cm, P <0.001), and a significant reduction in diastolic blood pressure (5.3 ± 1.4 mm Hg, P<0.001) compared with baseline values in the intervention group. Also, 33.8% of the changes in metabolic syndrome components were attributable to educational intervention (P<0.001, F= 5.27).Conclusions Lifestyle educational package had a significant effect on waist, hip circumference, and diastolic blood pressure at a 3-month. It is suggested that long-term educational interventions should perform to control other MetS components such as blood sugar and systolic blood pressure.Retrospectively registered: This study was retrospectively registered in the Iranian website (www.irct.ir) for registration of clinical trials (IRCT20200212046470N1), on 2020-02-23.
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