Objective: Diabetes mellitus, a common metabolic disorder, is often associated with severe coronary artery disease. In this study, we compared the angiographic severity of coronary artery disease in diabetic patients compared with that of non diabetic patients.Methods: This observational study comprised of 102 subjects who had coronary artery disease on coronary angiography in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. The patients were divided into two groups: one group with 24 (23.5%) diabetic patients and another group with 78 (76.5%) non diabetic patients. Demographic, clinical, laboratory and angiographic data were analyzed and compared between two groups.Results: Mean age±SD of the study subjects was 52.8±9.5 years and 94 (92%) of them were male. Diabetic patients were older (mean age±SD; 57.6±9.5 versus 51.3±9.9 years; p 004), and had higher frequency of hypertension (75% versus 50%, p 0.036), chronic stable angina (71% versus 41%, p 0.018), and lower frequency of smoking (42% versus 67%, p 0.034) and acute coronary syndrome (29% versus 59%; p 0.018) in comparison to non diabetic patients. Left main stem disease (21% versus 5%, p 0.031) and three-vessel disease (50% versus 31%, p 0.094) were more prevalent in diabetic patients. Severe coronary artery stenosis was significantly more present in diabetics than non diabetics (Gensini score, 50.9±29.9 versus 32.6±21.9, p 0.001).Conclusion: Diabetic patients are more likely to have severe and extensive coronary artery disease. Left main stem and triple vessel disease are more commonly seen in diabetic patients compared to non diabetic patients.University Heart Journal Vol. 10, No. 1, January 2014; 13-17

Objective: To determine and compare the incidence of in-hospital and 30-day hemorrhagic complication and major adverse cardiac events (MACEs) as evidence of safety and efficacy using three different anti- thrombotic strategies using Bivalirudin, Heparin plus Eptifibatide (GPI: GP IIb/IIIa inhibitor), and Unfractionated Heparin (UFH) monotherapy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a tertiary care cardiac hospital. Background: UFH or Heparin plus Eptifibatide or Bivalirudin is the most commonly used antithrombotic regimen to improve peri and post-PCI clinical outcomes in a patient undergoing PCI for ACS. Among them, the most effective and optimal antithrombotic regimen for preventing ischemic complications while limiting bleeding risk in ACS patients undergoing PCI is still far from being clear. Methods: 324 ACS patients ( age >18 years and ≤75 years) who underwent PCI from May 2018 to May 2019 at UCC, BSMMU, Dhaka were consecutively enrolled in the study and were divided into three groups according to antithrombotic. The choice of Anti-thrombotic strategy was at the discretion of the operator(s) and the patient’s affordability. Group-A: 107 patients received Bivalirudin as intravenous (I/V) bolus of 0.75 mg/ kg, followed by an infusion of 1.75 mg/kg/hr up to 4 hours. Group-B: 111 patients received UFH as an I/ V bolus of 70-100 U/kg (targeted ACT: 250-300 s). Group-C: 106 patients were administered UFH plus Eptifibatide as per the standard hospital guidelines. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors ( Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complication and MACEs [death, MI, stroke, stent thrombosis and target-vessel revascularization (TVR)] Results: In-hospital outcome: Patients treated with Bivalirudin as compared with UFH had a significantly lower incidence of QMI lesions (0% vs.6%; p=0.038) and major bleeding (0% vs. 7%; p=0.021). The bleeding rate was also significantly lower in Bivalirudin arm as compared with Heparin plus GPI arm (0% vs. 6%; p=0.038). However, the incidence of cardiac death, stent thrombosis, TVR were no differences among the three groups. 30-day outcome: There was only one NQMI in the bivalirudin group as opposed to 8% in the heparin group (p=0.041). No other adverse effects were found significantly different among the study groups. Conclusion: In this perspective, observational study of ACS patients undergoing PCI in a single-center showed that Bivalirudin monotherapy is safer than other contemporary antithrombotic strategies. In terms of efficacy, Bivalirudin is non inferior to Heparin plus Eptifibatde but superior to UFH monotherapy. University Heart Journal Vol. 17, No. 2, Jul 2021; 91-98

The incidence rate and mortality of coronary artery disease is obviously higher in men than in women, which may be related to the influence of serum testosterone. This cross-sectional study was conducted at Department of Laboratory Medicine in collaboration with Department of Cardiology, BSMMU and National Institute of Cardiovascular Diseases (NICVD), Dhaka from March 2020 to February 2021 to investigate the association of serum testosterone with coronary artery disease in young adult males in Bangladesh. Total 110 subjects from inpatient Department of Cardiology were enrolled, 60 were CAD patients and 50 were Normal Coronaries according to coronary angiography report. In this study, 60 patients with coronary artery disease were compared with 50 normal coronary subjects. Mean age in CAD group and normal coronaries was 37.72±2.73 and 37.48±2.54 years respectively. Hypertension, diabetes mellitus and dyslipidemia were significantly higher in CAD group. Total testosterone levels of CAD were significantly lower than those of normal coronaries (2.11±0.81ng/ml vs 2.94±0.78ng/ml). Among 60 CAD patients, 10 patients had single vessel disease, 17 patients had double vessel disease and 33 patients had triple vessel disease. There was significant association between the level of total testosterone and the number of affected vessels within CAD group (p=0.1). This study also showed that total testosterone level was negatively correlated with Gensini score. Serum total testosterone was significantly lower in patients with CAD compared to normal coronaries. Patients with lower total testosterone levels had higher Gensini score. Low level of total testosterone may be related to the develop- ment of coronary artery disease. BSMMU J 2021; 14(3): 67-73

According to the Islamic Hijri calendar, Ramadan is the holiest month and Muslims fast during this month 6 . It lasts between 29 to 30 days. Believers are commanded to abstain from food, drink and conjugal relationships from sunrise to sunset as a sign of restraint and introspection. It is believed that Ramadan fasing improves health status. During the Ramadan fast, Muslims eat two meals a day, one before dawn and the other shortly after sunset. In addition, there is a tendency to consume foods that are rich in carbohydrate and lipids, particularly those containing mono-and polyunsaturated fatty acids 7,8 . This change in the meal schedule accompanied by changes in sleeping habits and physical activities bring a change in lifestyle with reduced duration of sleep at night, less daily physical activities along with decrease in smoking frequency and less psychological stress 7,9,10,11 .Many physiological and psychological changes take place during Ramadan, most probably due ABSTRACTThe study was conducted to evaluate the effects of fasting for a period of one month during Ramadan on the lipid profile of Bangladeshi female volunteers who fasted during the Arabic month of Ramadan, when there occurs a change, both in the pattern and timing of dietary intake. Findings of the study showed that Ramadan fast significantly reduced serum Total cholesterol (TC) (p=0.030) and Low density lipoprotein (LDL-C) (p=0.011). A statistically nonsignificant elevation of triglyceride (TG)) was observed (p=0.598). High density lipoprotein cholesterol (HDL-C) also found to be raised significantly at the end of fasting (p = 0.037). Findings of the study revealed that fasting during the month of Ramadan changes lipid profile pattern in an aniatherogenic direction and may be beneficial to health.

Risk of coronary heart disease and other forms of atherosclerotic vascular diseases, rises with plasma cholesterol concentration and in particular with the rise of ratio of total cholesterol to high density lipoprotein (HDL-C) cholesterol. A much weaker correlation also exists with plasma triglyceride concentration. Extensive large-scale randomized trials have shown that lowering total cholesterol and LDL-C concentrations reduces the risk of cardiovascular events including death, myocardial infarction and stroke and reduces the need for revascularisation.This cross-sectional analytical study was designed to observe association between lipid profile level with chronic ischaemic heart disease and the study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011. A total of 50 cases were selected purposively according to the selection criteria from the patients admitted in the Department of Cardiology, Dhaka Medical College Hospital with chronic ischaemic heart disease (IHD). Diagnosed IHD patients were taken as cases and 50 age- & sex- matched healthy subjects were taken as controls. Serum TC, TG, LDL-C & HDL-C were measured in all study subjects.The mean±SD of serum TC, TG, HDL-C and LDL-C concentration in cases were 314.54±73.72 mg/dl, 288.04±60.45 mg/dl, 36.02±4.12 mg/dl, and 178.62±22.7 mg/dl respectively and in controls were 174.64±18.97 mg/dl, 119.42±12.47 mg/dl, 43.04±2.58 mg/dl & 126.28±11.45 mg/dl respectively. Serum Total Cholesterol, TG & LDL-C were found to be significantly higher in cases than that of controls. Serum HDL-C was found to be significantly lower in cases than that of controls. The present study reveals that the patients with chronic ischemic heart disease is accociated with significantly higher levels of serum TC, TG and LDL-C whereas HDL-C was found to be lower in IHD patients. DOI: http://dx.doi.org/10.3329/bjmb.v7i1.18574 Bangladesh J Med Biochem 2014; 7(1): 14-16

Background: Acute Kidney Injury (AKI), a common complication of acute coronary syndromes (ACS), is associated with higher mortality and longer hospital stays. ACS patients with renal impairment during hospitalization are associated with adverse in-hospital outcomes in the form of heart failure, cardiogenic shock, arrhythmia, dialysis requirement and mortality. Objective: To compare the in-hospital adverse outcomesof patients with ACS with or without AKI. Materials and Methods: This prospective comparative study was conducted in the Department of Cardiology, BSMMU, Dhaka, during the period of August 2017 to July 2018. A total of 70 eligible patients were included in this study of which 35 patients were included in group A (ACS with AKI) and 35 patients were included in group B (ACS without AKI). AKI was diagnosed, on the basis of increased serum creatinine level 0.3mg/dL from baseline within 48 hours after hospitalization. They were subjected to electrocardiography, blood test for serum creatinine (on admission, 12 hours, 48 hours and at the time of discharge), lipid profile, 2-D echocardiography along with serum troponin, CK MB and electrolytes. Results: It was observed that mean age was 58.0±8.5 years in group A and 55.6±12.3 years in group B. Heart failure was more common in group A than in Group B (74.3% vs 34.2% p=0.001 respectively) and arrhythmia was more common in group A than in Group B (100% vs 74.2% respectively). 7(20%) patients of group A required dialysis. The mean duration of hospital stay was significantly higher in Group A than in the Group B (9.4±2.3 vs 7.2±0.6; p=0.001) days. Multiple logistic regression analysis revealed that heart failure, cardiogenic shock, duration of hospital stay were found to be the independently significant predictors of outcome of the patients with AKI with odds ratio being 5.53 (p=0.001), 4.353 (p=0.001) and 6.92 (p=0.001) Conclusion: This study shows that, heart failure, cardiogenic shock, arrhythmia, dialysis requirement, were more common in the patients with AKI (group A) than in the patients without AKI (group B). The duration of hospital stays were longer in patients with AKI (group A) than in the patients without AKI (group B). Therefore, an important research target is the identification of high-risk patients with ACS experiencing AKI, thereby appropriate medication and follow-up should be implemented. University Heart Journal Vol. 16, No. 1, Jan 2020; 3-10

This study was designed to compare the blood lipid profile and conventional cardiovascular risk factors in patients with acute coronary syndrome (ACS) and chronic stable angina (CSA). A total of 110 patients, 55 of which were of ACS and 55 with chronic stable angina (CSA) who underwent coronary angiography in the Department of Cardiology, BSMMU, Dhaka were enrolled for the study. Lipid profile and age, sex, diabetes mellitus, hypertension, hyperlipidemia, smoking habit, family history of premature coronary artery diseases (CAD) of the patients were recorded and compared. Mean±SD age of the studied patients was 52.2±10 years. Prevalence of diabetes mellitus (p<0.05) and hypertension (p <0.05) was significantly higher in patients with CSA than that with ACS. Frequency of hyperlipidemia, smoking habit and family history of CAD was similar between groups. Patients with CSA had significantly higher triple vessel diseases (TVD) (p < 0.001) and significantly lower high-density lipoprotein cholesterol (HDLc) (p < 0.05) compared to that of patients with ACS. ACS patients had significantly higher single vessel diseases (SVD) (p <0.001) compared to that of CSA but the distribution of low-density lipoprotein cholesterol (LDLc), total cholesterol and triglycerides were variable between groups. This study showed that CSA patients had substantially higher frequency of having some CVD risk factors with alteration in certain lipid profile parameters and higher number of triple vessels disease than patients with ACS. This might aid in selecting appropriate criteria for angiographic evaluation and better management of patients with coronary artery diseases. DOI: http://dx.doi.org/10.3329/bjmb.v7i2.22413 Bangladesh J Med Biochem 2014; 7(2): 52-56

Background: Coronary artery disease (CAD) is predicted to be the most common cause of death globally. Early detection of coronary artery disease and adequate management can reduce CAD related morbidity and mortality. Various non-invasive procedures have been developed to diagnose CAD. Stress echocardiography, myocardial perfusion (SPECT) and cardiac MRI are accepted as useful tools for evaluation of inducible myocardial ischaemia in intermediate risk group patient documented by pre test probability. Among them exercise echocardiography is a remarkable physiological, safe, feasible and cost effective. Objective: To see the role of exercise echocardiography to predict CAD. Materials and methods: This cross sectional study was conducted in University Cardiac Center (UCC), BSMMU. This study include the patients who are appointed for exercise tolerance test (ETT). Echocardiographic wall motion study was recorded at rest and after peak exercise and analyzed to diagnosis the regional wall motion abnormality. Specific CAD was confirmed by coronary angiogram. Results: A total of 40 patients were included in the study from the patients who are appointed for ETT. Patients diagnosed as CAD has the mean age of 50.6 ± 9.7 years and majority of the patients were male (72.5%). Sensitivity, specificity, positive predictive value and negative predictive value of exercise echocardiography were 85.5%, 76.9%, 88.5% and 71.4% respectively in predicting coronary artery disease by exercise echocardiography. The predominant risk factors was hypertension (40.0%) followed by diabetes mellitus, smoking, dyslipidaemia and family H/O CAD were significantly associated with the development of CAD in the study subjects. Conclusion: Treadmill exercise stress echocardiography demonstrates high significance for diagnosis of CAD. University Heart Journal Vol. 17, No. 2, Jul 2021; 114-117