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
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