Background: C-reactive protein (CRP) and glycohemoglobin (HbA1c) are established risk factors for the development of cardiovascular disease. We investigated the joint effects of these parameters on the severity of coronary artery disease (CAD) in patients with ischemic heart disease.Methods: This cross sectional study was performed on 668 patients of ischemic heart disease. CRP value were divided into normal (<6 mg/L), borderline (6-10 mg/L) and high (>10 mg/L) and HbA1c was divided <6.5% and ≥ 6.5%. After performing Coronary angiography the extent of disease was divided into insignificant CAD of (<50% stenosis), significant CAD considered as >50% stenosis and single vessel, double vessel, triple vessel CAD and normal coronaries.Results: Most (65.0%) of the patients belonged to age 41-60 years. The mean age was found 51.4±10.7 years. Majority (82.3%) of patients were male. Among risk factors, highest (40.0%) patients had hypertension followed by 209 (31.3%) diabetes mellitus and 204 (30.5%) smoker. The relationship of CRP with the whole spectrum of ischemic heart disease was found statistically significant (p<0.05). The relationship of HbA1c and CRP were significantly associated with the severity of coronary artery disease. At HbA1c e”6.5 percent, severe CAD (double vessel and triple vessel) were found higher in high CRP than normal and borderline CRP group.Conclusion: Inflammation, presented by CRP, and hyperglycemia, presented by HbA1c, jointly contributes to the cardiovascular risk of patients. Patients with high CRP and elevated HbA1c are associated with severe coronary artery diseases.Cardiovasc. j. 2018; 11(1): 53-58
Background: Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Recent data suggest that beta-blockers are beneficial in patients with CHF. Among β-blocker class of drugs, bisoprolol is a highly selective β1-adrenergic receptor blocker whereas Carvedilol is non-selective. Many large-scale trials have confirmed that both these β-blockers are superior to placebo and other β-blockers. This study was designed to compare the effects of carvedilol and bisoprolol in patients with chronic HF in a single center.Methods: It was a quasi experimental study. A total of 288 cases of heart failure were selected by purposive sampling, from January 2017 to June 2017. Each patient was allocated into either of the two groups, and was continued receiving treatment with either bisoprolol (Group-I) or carvedilol (Group-II). Each patient was evaluated clinically and echocardiographically at the beginning of treatment (baseline) and at the end of 3rd month. Echocardiography was performed to find out change in left ventricular systolic function.Result: After 3 months of treatment, ejection fraction was found higher in the bisoprolol group (42.6 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 8.4% in bisoprolol group and 4.1% in carvedilol group. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (3.2±0.1 in group I versus 2.3±0.5 in group II; P<0.05) occurred after 3 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (10.1±3.2 versus 6.1±6.4; P=0.101) and left ventricular diastolic diameter (1.7±0.8 versus 1.3±0.8; P=0.081) between groups. Three months after treatment, heart rate was reduced in the bisoprolol group from 87.7±9 to 74.5±8.1 and carvedilol group from 88.8±9.1 to 80.1±8.7. Differences in heart rate responses between 2 groups were not statistically significant (P=0.113). Assessment of blood pressure three months later of treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both group but difference between two groups were statistically non significant (p>0.05).Conclusion: In this study, bisoprolol was superior to carvedilol in increasing left-ventricular ejection fraction, improving left ventricular end systolic volume and left ventricular end systolic diameter but no significant difference was observed in LV end diastolic volume, LV end diastolic diameter, heart rate and blood pressure.University Heart Journal Vol. 14, No. 1, Jan 2018; 3-8
Background: Recent evidence suggests that inflammatory markers and poor glycemic control are significantly associated with the development of cardiovascular complications. The purpose of this study was to determine the association between inflammatory marker (CRP) and glycemic status (HbA1c) in ischemic heart disease patients. Method: This cross sectional study was performed on 668 patients of ischemic heart disease in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, who underwent Coronary angiogram from January 2017 to December 2017. CRP value were divided into normal (<6 mg/L), borderline (6-10 mg/L) and high (>10 mg/L) and HbA1c was divided <6.5% and ≥6.5%. After performed Coronary angiography the extent of disease was divided into insignificant CAD of (<50% stenosis), significant CAD considered as >50% stenosis and single vessel, double vessel, triple vessel CAD and normal coronaries. The relationship between CRP with HbA1c was analyzed by Chi square test. ANOVA test was used to analyze the continuous variables, shown with mean and standard deviation. Pearson’s correlation coefficient was used to test the relationship between CRP and HbA1c in CAD patients. p value <0.05 was considered as statistically significant. Result: Most (65.0%) of the patients belonged to age 41-60 years. The mean age was found 51.4±10.7 years. Majority (82.3%) of patients were male. Among risk factors, highest (40.0%) patients had hypertension followed by 209 (31.3%) diabetes mellitus and 204 (30.5%) smoker. Positive correlation was found (r=0.220, p= 0.001) between HbA1c with CRP in CAD patients. High CRP was found 138(38.4%) in <6.5% HbA1c and 187(60.5%) in ≥6.5 percent HbA1c. The difference was statistically significant (p<0.05). Multi variable logistic regression was found high HbA1c, high CRP and diabetes mellitus were statistically significant (p<0.05) in severe CAD (Double and triple vessel) patient. Conclusion: Positive correlation was found between serum levels of CRP and HbA1c in CAD patients. Thus, aiming at good glycemic control and estimation of serum CRP levels will possibly be of help in planning early intervention, thereby preventing further complications which in turn may help preserve cardiac functions in ischemic heart disease patients. Bangladesh Heart Journal 2018; 33(2) : 100-105
Background: Coronary heart disease (CHD) is the leading cause of death worldwide, with acute myocardial infarction (AMI) being the most severe manifestation. Recent evidence suggests that vitamin D deficiency (moderate/severe) is an important risk factor for coronary artery disease. Objectives: Considering paucity of the literature focusing young MI, the study was planned to assess the relation of different grades of low serum vitamin D with AMI in young patients admitted in a tertiary care hospital. Methods: This Hospital based case-control study was conducted in the department of cardiology in Dhaka Medical College Hospital (DMCH) over 1-year period. Patients with acute MI in young age (≤40 years) admitted in the CCU of DMCH were approached for inclusion in the study. Total 120 subjects (60 cases and 60 controls) were studied. Patients with acute MI were considered as cases and similar number of age and sex matched apparently healthy individual were included as controls. All study population were subjected to relevant investigations and detailed history along with socio-demographic data were collected. Serum vitamin D levels were categorized as severe vitamin D deficiency as a level <10ng/ml, moderate vitamin D deficiency at a level 10-20 ng/ml, vitamin D insufficiency as 21-29 ng/ml and a level of ≥30ng/ml was considered as normal. Serum 25(OH) vitamin D assay was performed for cases and controls using chemiluminescence immunoassay. Vitamin D status (normal/insufficiency vs moderate/severe deficiency) was studied among cases and controls. All necessary information were recorded in a pretested case record form. Statistical analyses were done by SPSS 22. Results: Mean age of cases and controls were 35.31±4.84 and 33.83±5.11 years respectively. Vitamin D deficiency (moderate/severe) was present in 86.7% cases and 46.7% controls and the difference was statistically significant (P<0.001). Among 60 cases of acute MI, 83% patients had acute ST segment elevated myocardial infarction and 17% patients had acute non-ST segment elevated myocardial infarction. Vitamin D deficient (moderate/severe) subjects were more likely to develop AMI than subjects who had normal/insufficient vitamin D levels in blood (OR 7.42, 95%CI 3.18-18.28, P<0.001). And among all the usual coronary risk factors, vitamin D deficiency (moderate/ severe), Hypertension, Family history of premature CAD and smoking were significantly associated with increased incidence of acute MI (STEMI and NSTEMI) (P value<0.05 in all cases). Conclusion: Vitamin D deficiency (moderate/severe) is associated with increased incidence of acute MI in young age (≤40 years). Bangladesh Heart Journal 2019; 34(2) : 80-85
Background: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification. Objectives: To assess whether inclusion of admission blood glucose in a model with GRACE risk score improves risk stratification of ACS patients admitted in a tertiary hospital of Bangladesh. Methods: This cross sectional comparative study was carried out in the department of cardiology, Dhaka Medical College Hospital (DMCH), Dhaka between May 2016 to April 2017. Data were collected from ACS patients admitted at CCU, DMCH who fulfilled inclusion and exclusion criteria. GRACE score was calculated for each patient. The predictive value of death by GRACE score was compared with the predictive value of combined GRACE score + admission blood sugar. Comparison between these results in two groups were done by unpaired t-test, analysis was conducted SPSS-22.0 for windows software. The significance of the results was determined in 95.0% confidence interval and a value of p <0.05 was considered to be statistically significant. Results: A total of 249 cases of ACS patients were selected. Most of the patients belonged to 5th and 6th decades 25.3% vs 37.3% and the mean age was 55.7±11.7 years. Most of the patients were male. High GRACE risk score (≥155) and elevated admission blood sugar (≥11) was found significantly higher in-hospital death whereas only high GRACE risk score (≥155) and normal admission blood sugar (<11) was found non significant regarding in-hospital death. Test of validity showed sensitivity of GRACE risk score regarding in-hospital death was 85.29%, specificity 57.7%, accuracy 61.4%, positive and negative predictive values were 24.2% and 96.1% respectively. The sensitivity of GRACE risk score + admission blood sugar regarding in-hospital death was 85.29%, specificity 62.33%, accuracy 65.46%, positive and negative predictive values were 26.36% and 96.4% respectively. Receiver-operator characteristic (ROC) were constructed using GRACE score and GRACE score + admission blood sugar of the patients with in-hospital death, which showed the sensitivity and specificity of GRACE score for predicting in-hospital death were found to be 79.4% and 58.1%, respectively. Whereas after adding admission blood sugar value to GRACE score both the sensitivity and specificity increased to 82.4% and 58.6% respectively in this new model. Logistic regression analysis of in-hospital mortality with independent risk factors showed GRACE score (≥155) + admission blood sugar (≥11.0 mmol/l) was more significantly associated with in-hospital mortality (P =0.001, OR = 6.675, 95% CI 2.366-13.610). Conclusion: In patients with the whole spectrum of acute coronary syndrome admission blood glucose can add prognostic information to the established risk factors with the GRACE risk score. Bangladesh Heart Journal 2018; 33(2) : 94-99
Background: Obesity is now becoming a global epidemic. It is most of the times associated with hypertension, diabetes mellitus (DM), metabolic syndrome and dyslipidemia which are known risk factors for coronary artery disease (CAD). Coronary arteriosclerosis comprises a series of inflammatory responses at cellular and molecular level, whose reactions are stronger in obese patients. The objective of this study was to observe the association of obesity and raised inflammatory markers with CAD. Method: This cross-sectional study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, Bangladesh, involving 668 patients of ischemic heart disease who underwent coronary angiography (CAG) from January 2017 to December 2017. Obesity was defined as body-mass index (BMI) ≥30.0 kg/m2. C-reactive protein (CRP) was measured as the inflammatory marker, and was considered as high if >10 mg/L. CAD was classified on the basis of CAG findings: insignificant if stenosis is <50% and significant if stenosis is ≥50%; and single-vessel, double-vessel, triple-vessel disease and normal coronaries according to number of vessels involved. Chi square test was used to analyze the categorical variables, and Pearson’s correlation coefficient was used to test the relationship between CRP and BMI in CAD patients. p values of <0.05 were considered as statistically significant. Results: Demographic characteristics like age, sex and educational status did not differ significantly between obese and non-obese patients. Risk factors for CAD were similar between obese and non-obese, as well as, between high-CRP (>10 mg/L) and non-high CRP (≤10 mg/L) groups, however, DM, hypertension and dyslipidaemia were significantly more common in obese and high-CRP groups than in non-obese and non-high CRP groups. Raised CRP was significantly more common in obese than in non-obese patients (56.9% vs. 47.9%, p=0.04). Significant positive correlation was found between CRP and BMI (r=0.228; p=0.001). Triple-vessel CAD was found significantly more commonly in obese group than in non-obese group (29.3% vs 24.4%, p=0.04), whereas normal coronaries were more common in nonobese than in obese counterpart. Obesity, high CRP (>10 mg/L), DM, and high HbA1c (≥6.5%) were found significant predictors of severe CAD (p <0.5) in multivariate logistic regression analysis. Conclusion: Obesity is associated with raised inflammatory marker in patients with CAD, and a significant positive association exists between obesity and inflammation and CAD. Future studies are needed to explore the impact of type of obesity and inflammation on CAD. Bangladesh Heart Journal 2021; 36(1): 9-16
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