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These are the results of MeSh search for the terms “Pakistan” and “Coronary artery disaease” and “Coronary disease”. 1. J Pak Med Assoc. 2011 Apr;61(4):340-2. Coronary artery disease in patients undergoing valve replacement at a tertiary care cardiac centre. Shaikh AH, Hanif B, Hasan K, Adil A, Hashmani S, Raza M, Qazi HA, Mujtaba I. Tabba Heart Institute, Karachi. OBJECTIVE: To determine the prevalence of coronary artery disease in patients undergoing valve surgery at a tertiary care cardiac centre. METHODS: The medical records of 144 consecutive patients who underwent mitral, aortic or dual (mitral and aortic) valve replacement surgery at the Tabba Heart Institue between January 2006 to December 2008 were retrospectively reviewed. All patients underwent coronary angiogram. Significant coronary artery disease (CAD) is defined as coronary stenosis of > or = 50%. RESULTS: There were 74 (51.4%) males and 70 (48.6%) females in the study. The mean age was 51.64 +/- 11 years. Of all, 73 (50.7%) underwent mitral valve replacement, 47 (32.6%) had aortic and 24 (16.7%) had dual valve replacement. Out of 144 patients, 99 (68.8%) had < 50% coronary stenosis and remaining 45 (31.3%) had > or = 50% stenosis. In patients who had undergone mitral valve replacement (MVR), significant coronary disease was found in 32.9%, whereas in patients who had undergone aortic valve replacement (AVR) and dual valve replacement (DVR) the prevalence of coronary disease was 31.9% and 25% respectively.

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These are the results of MeSh search for the terms “Pakistan” and “Coronary artery disaease” and “Coronary disease”.

1. J Pak Med Assoc. 2011 Apr;61(4):340-2.

Coronary artery disease in patients undergoing valve replacement at a tertiarycare cardiac centre.

Shaikh AH, Hanif B, Hasan K, Adil A, Hashmani S, Raza M, Qazi HA, Mujtaba I.

Tabba Heart Institute, Karachi.

OBJECTIVE: To determine the prevalence of coronary artery disease in patientsundergoing valve surgery at a tertiary care cardiac centre.METHODS: The medical records of 144 consecutive patients who underwent mitral,aortic or dual (mitral and aortic) valve replacement surgery at the Tabba HeartInstitue between January 2006 to December 2008 were retrospectively reviewed. Allpatients underwent coronary angiogram. Significant coronary artery disease (CAD) is defined as coronary stenosis of > or = 50%.RESULTS: There were 74 (51.4%) males and 70 (48.6%) females in the study. Themean age was 51.64 +/- 11 years. Of all, 73 (50.7%) underwent mitral valvereplacement, 47 (32.6%) had aortic and 24 (16.7%) had dual valve replacement. Outof 144 patients, 99 (68.8%) had < 50% coronary stenosis and remaining 45 (31.3%) had > or = 50% stenosis. In patients who had undergone mitral valve replacement(MVR), significant coronary disease was found in 32.9%, whereas in patients whohad undergone aortic valve replacement (AVR) and dual valve replacement (DVR) theprevalence of coronary disease was 31.9% and 25% respectively.CONCLUSIONS: Our results suggest that the overall prevalence of coronary arterydisease in patients undergoing valve surgery in our population is comparable withprevalence reported in international data.

PMID: 21465968 [PubMed - indexed for MEDLINE]

2. J Pak Med Assoc. 2010 Jun;60(6):512-3.

Hypercholesterolaemia: an emerging dilemma.

Shaikh F, Zubair MM.

PMID: 20527662 [PubMed - indexed for MEDLINE]

3. Am J Prev Med. 2010 Apr;38(4):439-42.

Knowledge gaps and misconceptions about coronary heart disease among U.S. South

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Asians.

Kandula NR, Tirodkar MA, Lauderdale DS, Khurana NR, Makoul G, Baker DW.

Northwestern University Feinberg School of Medicine, Chicago, IL 60611, [email protected]

BACKGROUND: Although South Asians are at higher risk for coronary heart disease(CHD) than most other U.S. racial/ethnic groups, very little research hasaddressed this disparity.PURPOSE: As a first step in developing culturally targeted CHD preventionmessages for this rapidly growing community, this study examined South Asians'knowledge and beliefs about CHD.METHODS: Analyses, conducted in 2009, were based on data collected from Januaryto July 2008 in a cross-sectional study population of 270 South Asian adults inIllinois. Interviews were conducted in English, Hindi, or Urdu using astandardized questionnaire. Multivariate regression models were used to examinethe associations between sociodemographics and CHD knowledge and attitudes about preventability.RESULTS: Eighty-one percent of respondents had one or more CHD risk factors. Mostparticipants (89%) said they knew little or nothing about CHD. Stress was themost frequently mentioned risk factor (44%). Few mentioned controlling bloodpressure (11%); cholesterol (10%); and diabetes (5%) for prevention. Fifty-three percent said that heart attacks are not preventable. Low education level, beinginterviewed in Urdu or Hindi, and low level of acculturation were associated withless knowledge and believing that CHD is not preventable.CONCLUSIONS: A majority of South Asians in this study believed that CHD is notpreventable and had low awareness of modifiable risk factors. As a first step,CHD education should target the knowledge gaps that may affect risk factorcontrol and behavior change. Educational messages may need to be somewhatdifferent for subgroups (e.g., by education and language) to be maximallyeffective.

PMCID: PMC2844724PMID: 20307813 [PubMed - indexed for MEDLINE]

4. J Pak Med Assoc. 2010 Mar;60(3):201-4.

Etiological patterns of stroke in young patients at a tertiary care hospital.

Samiullah S, Humaira M, Hanif G, Ghouri AA, Shaikh K.

Department of Medicine, Liaquat University of Medical and Health Sciences,Jamshoro, Hyderabad Sindh.

OBJECTIVE: To observe frequency of various causes of stroke in patients of young

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(15-35 years) age.METHODS: This Descriptive case series study was conducted in all Medical Units ofLiaquat University Hospital (LUH) Jamshoro, Hyderabad, from August 2006 toFebruary 2008 and included 50 patients of stroke aged 15-35 years, irrespectiveof sex and community. Data of these patients was collected through a pre-designedproforma by completing a comprehensive history, detailed examination and carryingout basic and relevant investigations. Patients suffering from hypoglycaemia,space occupying lesions, transient ischaemic attack or psychosis were excludedfrom the study. The collected data was analyzed on SPSS version 16.0.RESULTS: Out of total number of 113 acute strokes, 50 patients fulfillinginclusion criteria were selected, comprising 30 males and 20 females. Forty-three(86%) patients suffered from ischaemic strokes while seven (14%) had haemorrhagicstrokes. Infective meningitis including Tuberculosis meningitis and Bacterialmeningitis was the leading cause of stroke (34%). The second most common causewas cardio-embolism (20%) comprising Valvular heart diseases (14%),Cardiomyopathies (4%) and atrial myxoma (2%).Hypertension was found in 14% cases.Pregnancy related causes (including Pregnancy induced hypertension and puerperal sepsis) were 12%. Systemic lupus erythematous and nephritic syndrome was 4% each.Various causes which constitute 4% or less were grouped together as miscellaneousand they include hyperhomocysteinaemia, and hyperlipidaemias.CONCLUSIONS: Common cause of stroke detected was infective meningitis(Tuberculosis and Bacterial). Predominant cause of haemorrhagic stroke wasHypertension. Stroke in young age occurred predominantly in males. Cardioembolism, pregnancyinduced hypertension and puerperal sepsis were other majorcauses.

PMID: 20225778 [PubMed - indexed for MEDLINE]

5. Pak J Pharm Sci. 2009 Apr;22(2):230-3.

Report: frequency of aspirin resistance in patients with coronory artery disease in Pakistan.

Akhtar N, Junaid A, Khalid A, Ahmed W, Shah MA, Rahman H.

Department of Cardiology, Shifa International Hospital, H-8/4 Islamabad.

Aspirin resistance is an emerging clinical entity. However the data available on aspirin resistance in Asian population is scarce. This study was initiated toprospectively evaluate the frequency of aspirin resistance in patients withstable coronary artery disease (CAD) in Pakistan. A cross sectional prospectivestudy was conducted in cardiology and hematology departments at ShifaInternational Hospital, Islamabad from January to December 2007. Two hundred and fifty patients were enrolled from cardiology out patient department having metthe specific inclusion criteria. Details were entered on a pre-designedquestionnaire and aspirin response assay was performed on IMPACT-R (Dia Med AG

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1785 Cressier Morat, Switzerland). Data was analyzed using SPSS V12. Aspirinresistance was observed in 12% of patients. 73.2% of study population were maleand 26.8% were female, with a mean age of 57.2 years. There was no significantcorrelation of aspirin resistance with traditional risk factors like diabetesmellitus (DM), hypertension or dyslipidemia. 84% of aspirin non responders weretaking 75 mg per day and 16% were on 150 mg per day. A positive trend was notedbetween aspirin resistance and cigarette smoking. Aspirin resistance is a realphenomenon in Pakistani population with an estimated frequency of 12%. Largescale prospective randomized trials with long term follow up are needed to assessthe impact of different doses and the clinical significance of this biochemicalentity.

PMID: 19339237 [PubMed - indexed for MEDLINE]

6. J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21(2):56-9.

Oxidative stress and level of-iron indices in coronary heart disease patients.

Ahmad M, Khan MA, Khan AS.

Department of Biochemistry, Institute of Chemical Sciences, University ofPeshawar, Pakistan. [email protected]

OBJECTIVE: Oxidative stress is characterized by an increased concentration ofoxygen free radicals which can cause a critical, or even an irreversible, cellinjury. The study was designed to determine and compare the levels of oxidativestress and iron indices in Coronary Heart Disease and healthy individuals.MATERIAL AND METHODS: Blood malondialdehyde, iron, total iron-binding capacity,transferrin saturation and ferretin levels were determined in 140 Coronary Heart Disease and 100 healthy subjects.RESULTS: Values of blood malondialdehyde, iron, transferrin saturation andferretin were observed to be significantly increased with exception of totaliron-binding capacity, which was significantly decreased (p < 0.005) in Coronary Heart Disease patients when compared with normal healthy controls.CONCLUSION: Elevated serum malondialdehyde, iron concentration and body ironstores in patients reveal a possible role of iron indices in the development ofcoronary atherosclerosis. Therefore, it is suggested by this study that levels ofmalondialdehyde and biochemical markers of body iron stores can be used as anearly investigative tool for assessing the oxidative stress in coronary heartdisease.

PMID: 20524470 [PubMed - indexed for MEDLINE]

7. J Pak Med Assoc. 2009 Jan;59(1):3-5.

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Uncompensated tooth loss in cardiac patients of Punjab Institute of Cardiology,Lahore.

Bokhari SA, Khan AA, Azhar M, Shahbaz MQ.

Department of Oral Health Sciences, Federal Postgraduate Medical Institute,Sheikh Zayed Hospital Complex, Lahore.

OBJECTIVE: To observe replacement of missing teeth with artificial teeth insubjects with and with out cardiac diseases and find its possible associationwith coronary heart diseases (CHD).METHODOLOGY: Consecutive patients aged 20 and above with coronary heart diseaseand accompanied healthy subjects with tooth loss were examined for oralprosthesis after having a verbal consent, over a one month period in across-sectional study at Punjab Institute of Cardiology, Lahore. Chi-square andT- test were applied to analyze variables in subjects with and without coronaryheart disease.RESULTS: Among 1694 subjects found with tooth loss, 1473 (86.95) subjects had no oral prosthesis; 817 (87.37%) were among the 935 cardiac patients and 656(86.42%) among 759 healthy subjects. Oral prosthesis was found in 86 (8.05%)males and 32 (5.11%) females with coronary heart diseases. Of the healthypopulation, 46 (4.30%) males and 57 (9.10%) females had oral prosthesis.Statistical association for prosthesis was insignificant among cardiac patientsand healthy subjects.CONCLUSION: No association of uncompensated tooth loss with cardiac diseases was observed in this study. Although a large majority of cardiac patients and healthysubjects were observed with uncompensated tooth loss which was statisticallyinsignificant.

PMID: 19213367 [PubMed - indexed for MEDLINE]

8. J Ayub Med Coll Abbottabad. 2009 Jan-Mar;21(1):58-61.

Estimation of heritability of familial hypercholesterolemia among 335 familymembers of five hypercholesterolemic probands of Pakistani population.

Imtiaz F.

Department of Biochemistry, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan. [email protected]

BACKGROUND: Familial hypercholesterolemia is an autosomal dominant disorder,caused by mutation in Low-density lipoprotein receptor (LDL-R) gene.METHODS: Cross-sectional study conducted to recruit the population ofKarachi-Pakistan, screened for familial hypercholesterolemia. A total of 1523

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hypercholesterolemic individuals have taken part in the study, five were found tobe familial hypercholesterolemia. Their lipids profile was estimated and a familypedigree was drawn.RESULTS: Parent-offspring correlation, coefficient of linear regression, andheritability is calculated by using SPSS 12.0. A significant positive correlationof cholesterol was found among parents and their offspring (r = 0.511, p = 0.01, n = 76). Coefficient of linear regression analysis also showed thatparents-offspring relationship was highly significant at p < 0.01 with b = 0.438.Relationship between Father-Son, Father-Daughter, Mother-Son and Mother-Daughter were highly significant with b = 0.794, 0.41, 0.766 and 0.56 respectively.CONCLUSION: The heritability among the parents and their offspring showed thatgenetic factors are major determinant of the familial resemblance in serumcholesterol among the Pakistani population living in the metropolitan area ofKarachi.

PMID: 20364742 [PubMed - indexed for MEDLINE]

9. J Immigr Minor Health. 2009 Oct;11(5):415-21. Epub 2008 Sep 24.

Coronary artery diseases in South Asian immigrants: an update on high densitylipoprotein role in disease prevention.

Dodani S.

Medical College of Georgia, EC 4503 Health Sciences Building, 997 St SebastianWay, Augusta, GA 30812, USA. [email protected]

Over the past several years, the overall prevalence and incidence ofcardiovascular diseases (CVD) including coronary artery diseases (CAD) havedeclined in the United States (US) and in many developed countries. However,among South Asian in general and South Asian immigrants (SAIs) in particular, adisturbing trend toward high rates of CAD has been noted. This trend isassociated with a high prevalence of conventional risk factors and metabolicsyndrome in this population, yet these conventional risk factors may not account for the greater CAD risk among SAIs. A search for additional markers iswarranted, to enable early detection and prevention of CAD in this high riskgroup. High density lipoprotein (HDL) is one of the predictor of CAD and isconsidered to be cardio-protective. However, some of the recent studies haveshown that HDL is not only ineffective as an antioxidant but, paradoxically,appears to be pro-oxidant, and has been found to be associated with CAD. Such HDLis called dysfunctional HDL. We present here an overview CAD and CAD risk factorsin general and dyslipidemias in particular in SAIs. In addition, the evolvingtheories on dysfunctional HDL and its impact on CAD are also briefly presented.

PMID: 18814029 [PubMed - indexed for MEDLINE]

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10. J Coll Physicians Surg Pak. 2008 May;18(5):270-3.

Triglyceride profile in dyslipidaemia of type 2 diabetes mellitus.

Khan SR, Ayub N, Nawab S, Shamsi TS.

Department of Biochemistry, Karachi Medical and Dental College, Karachi,Pakistan. [email protected]

OBJECTIVE: To evaluate ratios of serum triglycerides and cholesterol levels whichmay indicate postprandial lipid handling and to assess their role as prospective markers of dyslipidaemia in type 2 diabetes mellitus.STUDY DESIGN: Comparative, observational study.PLACE AND DURATION OF STUDY: Bismillah Taqee Hospital, Karachi from July 2002till December 2003.PATIENTS AND METHODS: The study comprised 160 subjects, including 83 known type 2diabetics (45 males, 38 females) and 77 age-matched controls (45 males, 32females). Fasting blood samples were analysed for serum triglycerides and totalcholesterol, using automated chemistry analyzer. HDL-C was determined byprecipitation method and LDL-C and VLDL-C were estimated by Friedewalds formula. LDL/HDL ratio and TG/HDL ratios were also calculated. The mean values for maleand female diabetics were compared with that for the male and femalenon-diabetics respectively and tested for significance by paired t-test.RESULTS: Serum triglycerides and VLDL were raised in both male and femalediabetics. No significant differences were observed in levels of serum totalcholesterol, LDL, HDL and the LDL/HDL ratio. The mean value of the TG/HDL ratiofor male diabetics was higher than that for the male non-diabetics (p=0.39). Astatistically significant difference was found in the TG/HDL ratios for thefemale diabetics and non-diabetics (p<0.05).CONCLUSION: In this study, type 2 diabetics showed marked hypertriglyceridaemiaand raised TG/HDL ratio. The dyslipidaemia of diabetes predisposes to developmentof coronary heart disease and, therefore, evaluation of the TG:HDL ratio mayprovide a good tool to monitor and manage the lipid abnormalities in diabetics.

PMID: 18541079 [PubMed - indexed for MEDLINE]

11. Heart Lung. 2008 Mar-Apr;37(2):91-104.

Causal attributions, lifestyle change, and coronary heart disease: illnessbeliefs of patients of South Asian and European origin living in the UnitedKingdom.

Darr A, Astin F, Atkin K.

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Centre for Research in Primary Care, Institute of Health Sciences and PublicHealth Research, University of Leeds, Leeds, United Kingdom.

Comment in Evid Based Nurs. 2008 Oct;11(4):127.

OBJECTIVE: We examined and compared the illness beliefs of South Asian andEuropean patients with coronary heart disease (CHD) about causal attributions andlifestyle change.METHODS: This was a qualitative study that used framework analysis to examinein-depth interviews.SAMPLE: The study comprised 65 subjects (20 Pakistani-Muslim, 13 Indian-Hindu, 12Indian-Sikh, and 20 Europeans) admitted to one of three UK sites within theprevious year with unstable angina or myocardial infarction, or to undergocoronary artery bypass surgery.RESULTS: Beliefs about CHD cause varied considerably. Pakistani-Muslimparticipants were the least likely to report that they knew what had caused theirCHD. Stress and lifestyle factors were the most frequently cited causes for CHDirrespective of ethnic grouping, although family history was frequently cited by older European participants. South Asian patients were more likely to stopsmoking than their European counterparts but less likely to use audiotapestress-relaxation techniques. South Asian patients found it particularlydifficult to make dietary changes. Some female South Asians developed innovative indoor exercise regimens to overcome obstacles to regular exercise.CONCLUSION: Misconceptions about the cause of CHD and a lack of understandingabout appropriate lifestyle changes were evident across ethnic groups in thisstudy. The provision of information and advice relating to cardiac rehabilitationmust be better tailored to the context of the specific needs, beliefs, andcircumstances of patients with CHD, regardless of their ethnicity.

PMID: 18371502 [PubMed - indexed for MEDLINE]

12. Int J Cardiol. 2008 Aug 1;128(1):5-16. Epub 2008 Feb 5.

Vascular risk factors in South Asians.

Tziomalos K, Weerasinghe CN, Mikhailidis DP, Seifalian AM.

Department of Clinical Biochemistry, Vascular Prevention Clinic, Royal FreeHospital, Royal Free University College Medical School, University of London,London, UK.

South Asians originate from the Indian sub-continent (India, Pakistan,Bangladesh, Sri Lanka and Nepal) and represent one fifth of the world'spopulation. Several studies suggested that South Asians have an increased risk ofdeveloping coronary heart disease (CHD) when compared with European populations.

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We review the role of traditional and emerging risk factors in the increased CHD risk in South Asians. The high prevalence of insulin resistance and type 2diabetes mellitus in South Asians may be a major cause for their elevatedvascular risk. However, other established and emerging risk factors are alsooverrepresented in South Asians. Large-scale prospective studies could determine the relative contribution of established and emerging vascular risk factors inSouth Asians. There is an urgent need for trials in South Asians that willevaluate clinical outcomes following treatment of these risk factors.

PMID: 18252267 [PubMed - indexed for MEDLINE]

13. J Public Health (Oxf). 2008 Mar;30(1):45-53. Epub 2007 Nov 27.

Using routine data to measure ethnic differentials in access to coronaryrevascularization.

Mindell J, Klodawski E, Fitzpatrick J.

London Health Observatory, London SW1E 6QT, UK. [email protected]

BACKGROUND: Ethnic inequalities in access to health services are difficult tomonitor and address because of limited data. Within the health service, ethnicitydata have been poor quality, partly because they are not seen as useful.METHODS: The analysis related age- and sex-standardized coronaryrevascularization procedures to defined measures of need, using proportionalratios derived from Hospital Episode Statistics records for London residentsadmitted to any hospital nationally in 2002-03 or 2003-04.RESULTS: Although 2001 Ethnicity Categories were mandatory for the NHS from April2001, by 2003-04 >20% of coronary heart disease (CHD) records still had no ethniccategory coded. Hospital admission for CHD and revascularization by ethnicityvaried widely, following known patterns of CHD incidence and mortality. There is much less variation between ethnic groups when comparing revascularization raterelative with CHD admission rates (whether all or emergencies). However,Bangladeshi patients had only two-thirds [proportional ratio 66.8, 95% confidenceinterval (CI) 60.7-73.3] and Black Caribbean and Black African patientsfour-fifths (proportional ratios 80.5, 72.0-89.9 and 80.7, 68.0-95.2,respectively) the revascularization rate in comparison with apparent need as the general population.CONCLUSION: Even with imperfect data, the analysis of routine data can identifyinequalities that warrant further investigation.

PMID: 18042654 [PubMed - indexed for MEDLINE]

14. J Invasive Cardiol. 2007 Oct;19(10):417-23.

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Outcomes of primary percutaneous coronary intervention at a joint commissioninternational accredited hospital in a developing country -- can good results,possibly similar to the west, be achieved?

Jafary FH, Ahmed H, Kiani J.

Department of Medicine, Section of Cardiology, Aga Khan University Hospital, P.O.Box 3500, Stadium Road, Karachi 74800, Pakistan. [email protected]

BACKGROUND: Primary percutaneous coronary intervention (PCI) is the treatment of choice following ST-elevation myocardial infarction (STEMI). There is limitedadoption and a paucity of data on outcomes following primary PCI in developingcountries. The objective of this study was to describe the procedural andclinical outcomes of patients undergoing PCI for STEMI at a Joint CommissionInternational Accreditation (JCIA) certified hospital in Pakistan and make acomparison with outcomes from the West.METHODS: We conducted a retrospective cohort study at a tertiary care university hospital in Karachi, Pakistan. A total of 277 consecutive patients undergoingprimary PCI between January 2001 and December 2005 were reviewed. Exclusioncriteria included preceding fibrinolytic therapy and STEMI due to stentthrombosis. Cox proportional hazards models were constructed. The primary outcomewas mortality.RESULTS: Procedural success was 97.1%. Inhospital mortality was 8.3% (43.9% incardiogenic shock, 2.1% in non-shock patients), comparing very favorably with thepublished literature from developed countries. Multivariate predictors of deathincluded (hazards ratio, 95% confidence interval) age (1.42 [1.14-1.76]),mechanical ventilation (8.35 [2.82-24.73]), cardiogenic shock (2.80 [1.04-7.55]),prior CABG (9.78 [1.15-83.13]) and ejection fraction (0.96 [0.92-0.99]).CONCLUSIONS: We conclude that excellent outcomes for a critical illness likeSTEMI can be achieved in a developing country at a JCIA-certified hospital,possibly similar to those seen in the West. There is a strong need for making thepractice of primary PCI more widespread in developing nations. More outcomes dataare needed from similar hospitals in the region to determine whether our results are generalizable.

PMID: 17906343 [PubMed - indexed for MEDLINE]

15. Int J Cardiol. 2008 Aug 1;128(1):77-82. Epub 2007 Aug 8.

Waist circumference, metabolic syndrome and coronary artery disease in aPakistani cohort.

Wierzbicki AS, Nishtar S, Lumb PJ, Lambert-Hammill M, Crook MA, Marber MS, GillJ.

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Department of Chemical Pathology, St Thomas' Hospital, Lambeth Palace Road,London SE1 7EH, United Kingdom. [email protected]

BACKGROUND: Metabolic syndrome (M-IRS) is common in Asians. This studyinvestigated the relationship of two definitions of M-IRS to atherosclerosis inIndian Asians with suspected coronary arterial disease (CAD).METHODS: 400 patients with chest pain selected for the presence or absence ofangiographic disease were recruited from a tertiary referral centre in Pakistaninto a prospective case-control study. Patients were categorized by the National Cholesterol Education Program adult treatment panel 3 (NCEP) and InternationalDiabetes Federation (IDF) definitions of the metabolic syndrome and therelationship of these to the presence of CAD and extent of atheroma burden wasinvestigated.RESULTS: M-IRS was present in 53% by IDF criteria and in 44% using the Asiancriteria for NCEP. The 2 populations identified were only 69% concordant. Norelationship existed between the presence of NCEP M-IRS and atheroma burden. Incontrast, the presence of IDF M-IRS was associated with CAD (65 vs. 34%; RR=1.88;p<0.001) and angiographic disease burden (28 [0-224] vs. 0 (0-198); RR=1.83;p<0.001). This association persisted (beta=18.4; p<0.001) after correction forC-reactive protein (beta=8.67; p<0.001), lipoprotein (a) (beta=8.14; p=0.002),and estimated glomerular filtration rate (beta=-0.22; p=0.01). Differences inpresumed underlying factors were found in the 2 populations identified by thedefinitions though both agreed on the separate weightings given to blood pressureand HDL-C/apolipoprotein A1.CONCLUSIONS: The specific Asian IDF and NCEP definitions of M-IRS show limitedconcordance in Pakistanis. The IDF criteria in contrast to the NCEP criteria are associated with the presence of CAD even after allowing for other risk factorsidentified in this population.

PMID: 17689739 [PubMed - indexed for MEDLINE]

16. Heart. 2008 Apr;94(4):408-13. Epub 2007 Jul 23.

Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men.

Jafar TH, Qadri Z, Chaturvedi N.

Clinical Epidemiology Unit, Department of Community Health Sciences and Medicine,Aga Khan University, Stadium Road, Karachi, Pakistan. [email protected]

Indo-Pakistani populations have one of the highest risks of coronary arterydisease (CAD) in the world. A population-based, cross-sectional survey wasconducted on 3143 adults aged >or=40 years from 12 randomly selected communities in Karachi, Pakistan. Apart from smoking, women had more CAD risk factors(diabetes, hypertension, obesity, dyslipidaemia) than men. Definite CAD (history

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and Q waves on ECG) was more prevalent in men than in women (6.1% vs 4.0%; p =0.009). In contrast, ischaemic and major ECG changes were twice as prevalent inwomen as in men (29.4% vs 15.6%, and 21.0% vs 10.5%; p<0.001 for each,respectively). All measures of CAD were strongly predicted by the metabolicsyndrome, but that failed to account for the greater prevalence of ECGabnormalities in women than in men. The findings indicate that one in fivemiddle-aged adults in urban Pakistan may have underlying CAD. Women are atgreater risk than men. Trial registration number: NCT00327574.

PMCID: PMC2565583PMID: 17646192 [PubMed - indexed for MEDLINE]

17. Br J Community Nurs. 2007 Jan;12(1):13-8.

Engaging women from South Asian communities in cardiac rehabilitation.

Vishram S, Crosland A, Unsworth J, Long S.

Northumbria University, Newcastle-upon-Tyne. [email protected]

This study sought to describe experiences and perceptions of cardiacrehabilitation among a sample of women from South Asian communities. Data werecollected via eight semi-structured interviews with staff and a focus groupdiscussion with nine clients from a community-based, culturally sensitive cardiacrehabilitation service. A number of individual, cultural and practical barriersto participation were identified. Facilitators centred on whether the format and content of the sessions could be considered "appropriate". For example, a women'sdance group proved to be successful through the selection of a familiar localvenue, supportive session leader, and activity that was felt to be both enjoyableand beneficial. This study has shown that it is possible to engage hard-to-reach groups in cardiac rehabilitation and physical activity. Further work is needed toexplore whether this research is applicable in other ethnic groups and whetherthe lessons learned could be successfully incorporated into mainstream healthservices.

PMID: 17353806 [PubMed - indexed for MEDLINE]

18. J Pak Med Assoc. 2007 Jan;57(1):46-8.

Shall we become vegetarian to minimize the risk of coronary heart disease?

Shiwani AH, Aziz A, Shiwani MH.

PMID: 17319423 [PubMed - indexed for MEDLINE]

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19. Can J Cardiol. 2006 Aug;22(10):841-7.

Use of cardiovascular medical therapy among patients undergoing coronary arterybypass graft surgery: results from the ROSETTA-CABG registry.

Okrainec K, Pilote L, Platt R, Eisenberg MJ.

Department of Epidemiology and Biostatistics, McGill Univeristy, Montreal,Quebec.

INTRODUCTION: Secondary prevention is needed following coronary artery bypassgraft (CABG) surgery to reduce the subsequent risk of unstable angina, myocardialinfarction and death. However, little research exists on the use ofcardiovascular medical therapy in CABG surgery patients. The objective of thepresent study is to describe the use of cardiovascular medical therapy amongpatients discharged after CABG surgery.METHODS: The use of acetylsalicylic acid, clopidogrel, warfarin, antilipidagents, beta-blockers, calcium channel blockers, nitrates andangiotensin-converting enzyme (ACE) inhibitors was examined among 320 patientsenrolled in the Routine versus Selective Exercise Treadmill Testing AfterCoronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry. Logistic regressionidentified the determinants of medication use at 12 months following CABGsurgery.RESULTS: Most patients were male, hyperlipidemic and underwent CABG surgery forrelief of angina symptoms. At admission, discharge and at 12 months,acetylsalicylic acid was used in 71%, 92% and 87% of cases, respectively, andsome form of antiplatelet agent was used in 74%, 94% and 89% of cases,respectively. The use of antilipid agents remained constant, from 55% atadmission to 57% at discharge. However, 24% of patients were not receivingantilipid agents at 12 months. The use of beta-blockers was 57% at admission, 71%at discharge and 64% at 12 months. The use of calcium channel blockers andnitrates decreased modestly from admission to discharge and remained stable atapproximately 20% and 22%, respectively, at 12 months. ACE inhibitor use remainedstable, from 33% at admission to 38% at 12-months. Hyperlipidemia, hypertension, obesity and pre-CABG surgery left ventricular ejection fraction less than 40%were all found to be important determinants of 12-month medication use.Importantly, the use at discharge was an important determinant of 12-month use offor each medication examined in the present study.CONCLUSIONS: The use of antilipid agents, beta-blockers and ACE inhibitors wasfound to be too low among post-CABG surgery patients, who are known to benefitfrom their use, and the use of nitrates was too high. Discharge from hospitalprovides a unique opportunity for physicians to modify the use of cardiovascular medical therapy among patients undergoing CABG surgery.

PMCID: PMC2569013

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PMID: 16957801 [PubMed - indexed for MEDLINE]

20. J Pak Med Assoc. 2006 Jun;56(6):282-5.

Hyperhomocysteinemia and coronary artery disease in Pakistan.

Iqbal MP.

Department of Biological and Biomedical Sciences, Aga Khan University Hospital,Karachi.

The relative risk of developing coronary artery disease (CAD) in Pakistani men ishighest in early ages. Majority of those suffering from CAD belong to the lowermiddle socioeconomic stratum of the society. Mild hyperhomocysteinemia(concentration of plasma homocysteine between 15-25 micromol/l) is very commonly seen in Pakistani patients with acute myocardial infarction (AMI) as well as innormal healthy subjects. There appears to be a lack of association betweenhyperhomocysteinemia and CAD in Pakistani population. There is also no evidenceof association of methylenetetrahydrofolate reductase 677C>T mutation with CAD inthis population. High prevalence of deficiency of folate and vitamin B6 appearsto be the major causes of hyperhomocysteinemia in Pakistani population.Deficiencies of micronutrients (folate, vitamin B6 and possibly vitamin B12)along with mild hyperhomocysteinemia, perhaps, act synergistically with otherclassical risk factors in Pakistani population to further increase the risk ofCAD.

PMID: 16827253 [PubMed - indexed for MEDLINE]

21. East Mediterr Health J. 2005 May;11(3):258-72.

Coronary heart disease risk-factor profile in a lower middles class urbancommunity in Pakistan.

Aziz K, Aziz S, Patel N, Faruqui AM, Chagani H.

Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi,Pakistan. [email protected]

Erratum in East Mediterr Health J. 2006 Jan-Mar;12(1-2):80.

We determined the risk-factor profile and prevalence of coronary heart disease inMetroville, a lower middle class urban community in Karachi, and compared them tothe Pakistan health survey PNHS 1990-94, and the US health and nutrition survey1988-94 NHANES111. Subjects < 18 years and pregnant women were excluded as were

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people with extreme ranges BMI [corrected] heart rate, height and waist. Theprevalence of hypertension was 23% in men and women, hypercholesterolaemia was17% in men and 22% in women (P < 0.001). Hyperglycaemia was present in 5% of men and women and obesity in 33% of men and 47% of women (P < 0.001). Compared toPNHS, the prevalences of obesity, hypertension, hypercholesterolaemia and WHRwere higher in our population. Mean values of BMI [corrected] cholesterol, WHRwere higher in the US population while mean values were lower for diastolic bloodpressure and blood glucose.

PMID: 16602445 [PubMed - indexed for MEDLINE]

22. BMC Public Health. 2005 Nov 25;5:124.

Cardiovascular health knowledge and behavior in patient attendants at fourtertiary care hospitals in Pakistan--a cause for concern.

Jafary FH, Aslam F, Mahmud H, Waheed A, Shakir M, Afzal A, Qayyum MA, Akram J,Khan IS, Haque IU.

Department of Medicine, Aga Khan University Hospital, Karachi, [email protected]

BACKGROUND: Knowledge about coronary heart disease (CHD) and its risk factors is an important pre-requisite for an individual to implement behavioral changesleading towards CHD prevention. There is scant data on the status of knowledgeabout CHD in the general population of Pakistan. The objective of this study was to assess knowledge of CHD in a broad Pakistani population and identify thefactors associated with knowledge.METHODS: Cross sectional study was carried out at four tertiary care hospitals inPakistan using convenience sampling. Standard questionnaire was used to interview792 patient attendants (persons accompanying patients). Knowledge was computed asa continuous variable based on correct answers to fifteen questions.Multivariable linear regression was conducted to determine the factorsindependently associated with knowledge.RESULTS: The mean age was 38.1 (+/- 13) years. 27.1% had received no formaleducation. The median knowledge score was 3.0 out of a possible maximum of 15.Only 14% were able to correctly describe CHD as a condition involving limitation in blood flow to the heart. Majority of respondents could identify only up to tworisk factors for CHD. Most commonly identified risk factors were stress (43.4%), dietary fat (39.1%), smoking (31.9%) and lack of exercise (17.4%). About 20% werenot able to identify even a single risk factor for CHD. Factors significantlyassociated with knowledge included age (p = 0.023), income (p < 0.001), educationlevel (p < 0.001), residence (p < 0.001), a family history of CHD (p < 0.001) anda past history of diabetes (p = 0.004). Preventive practices were significantlylacking; 35%, 65.3% and 84.6% had never undergone assessment of blood pressure,glucose or cholesterol respectively. Only a minority felt that they would modify

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their diet, stop smoking or start exercising if a family member was to developCHD.CONCLUSION: This is the first study assessing the state of CHD knowledge in arelatively diverse non-patient population in Pakistan. There are striking gaps inknowledge about CHD, its risk factors and symptoms. These translate to inadequatepreventive behavior patterns. Educational programs are urgently required toimprove the level of understanding of CHD in the Pakistani population.

PMCID: PMC1318493PMID: 16309553 [PubMed - indexed for MEDLINE]

23. Diabetes Res Clin Pract. 2006 Jan;71(1):101-2. Epub 2005 Aug 19.

High prevalence of obesity and associated risk factors in urban children in Indiaand Pakistan highlights immediate need to initiate primary prevention program fordiabetes and coronary heart disease in schools.

Misra A, Vikram NK, Sharma R, Basit A.

PMID: 16112243 [PubMed - indexed for MEDLINE]

24. Ethn Dis. 2005 Summer;15(3):429-35.

Distribution and determinants of coronary artery disease in an urban Pakistanisetting.

Dodani S, MacLean DD, LaPorte RE, Joffres M.

Department of Epidemiology; University of Pittsburgh, Pittsburgh, PA 15101, USA. [email protected]

Erratum in Ethn Dis. 2006 Winter;16(1):309. MacLean, David D [added]; LaPorte, Ronald E[added]; Joffres, Michel [added].

OBJECTIVE: We assessed the distribution of coronary artery disease (CAD) and its association with the major biological risk factors and behaviors among Pakistanispresenting at a tertiary care hospital in Karachi, Pakistan.METHOD: An epidemiologic cross-sectional study was conducted at the Aga KhanUniversity Hospital (a teaching hospital) in Karachi, Pakistan. A total of 600adult (> or =18 years of age) patients visiting family practice clinics forgeneral check-up were included. The association of biological risk factors withCAD (smoking, obesity [body mass index (BMI)], hypertension, family history ofischemic heart diseases [IHD], sedentary lifestyle, diabetes mellitus, totalcholesterol, low density lipoprotein [LDL] levels, high density lipoprotein [HDL]

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levels, and triglycerides) were assessed.RESULTS: On univariate analysis, age > or =40 years, early menopause, BMI > or=29.9 kg/m2, diabetes, high cholesterol, and positive family history of IHD were independently associated with CAD. We found age > or =40 years, diabetes, andpositive family history of IHD strongly related with CAD on multivariateanalysis.CONCLUSION: Looking at the strong association of major risk factors with CAD, theunique characteristics of Pakistanis must be studied in depth, with focus onhigh-risk groups.

PMID: 16108303 [PubMed - indexed for MEDLINE]

25. J Pak Med Assoc. 2004 Dec;54(12):642.

Coronary heart disease risk factor profile of children in a country withdeveloping economy--an issue that needs prompt attention.

Khuwaja AK, Nasir A.

Comment on J Pak Med Assoc. 2004 Jul;54(7):364-71.

PMID: 16104497 [PubMed - indexed for MEDLINE]

26. Am Heart J. 2005 Aug;150(2):221-6.

Heart disease epidemic in Pakistan: women and men at equal risk.

Jafar TH, Jafary FH, Jessani S, Chaturvedi N.

Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. [email protected]

OBJECTIVE: We conducted this study to determine the prevalence of coronary arterydisease (CAD) and its risk factors in Karachi, Pakistan.BACKGROUND: Migrant South Asians residing in the West have one of the highestrates of CAD in the world. Estimates of disease in nonmigrant populations areconflicting.METHODS: We conducted a population-based cross-sectional survey on 320 randomlyselected adults aged > or = 40 years. Coronary artery disease was defined as the composite outcome of (1) abnormalities indicative of definite or probable CADbased on the Minnesota classification of electrocardiogram or (2) past history ofheart attack.RESULTS: The overall prevalence of CAD (95% CI) was 26.9% (22.3%-32.0%): 23.7%(17.8%-30.9%) in men vs 30.0% (23.4-37.5%) in women (P = .12). Risks did not

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differ substantially by age group. The factors (odds ratio, 95% CI) independentlyassociated with CAD were current tobacco use (2.12, 1.21-3.73), systolic bloodpressure (1.08, 1.02-1.15, for each 5 mm Hg increase), and proteinuria (2.49,1.04-5.95). Coronary artery disease odds for women vs men (1.38, 0.84-2.62)increased to 1.60 (0.93-2.75), when adjusted for key risk factors.CONCLUSIONS: One in 4 middle-aged adults in Pakistan has prevalent CAD. Risks areuniformly high in the young and in women. Concerted efforts are needed to preventthe epidemic of cardiovascular disease in South Asia, focusing on hypertension,diabetes, smoking, and dyslipidemia.

PMID: 16086922 [PubMed - indexed for MEDLINE]

27. Heart. 2005 Aug;91(8):1003-7.

Metabolic syndrome and risk of coronary heart disease in a Pakistani cohort.

Wierzbicki AS, Nishtar S, Lumb PJ, Lambert-Hammill M, Turner CN, Crook MA, MarberMS, Gill J.

Department of Chemical Pathology, St Thomas's Hospital, London SE1 7EH, [email protected]

OBJECTIVE: To assess the relation of the metabolic insulin resistance syndrome(M-IRS) with coronary heart disease (CHD) in Pakistani patients.SUBJECTS: 200 patients with angiographic disease (CHD(+)) matched with 200patients with chest pain without occlusive disease (CHD(-)).DESIGN: Prospective case-control study.SETTING: Tertiary referral cardiology unit in Pakistan.RESULTS: M-IRS was present in 37% of CHD(+) versus 27% of CHD(-) patients bycriteria for white patients or 47% versus 42%, respectively, by Asian criteria (p< 0.001). After adjustment for other risk factors, M-IRS was not a significantpredictor for CHD or angiographic disease. Age (p = 0.03), smoking (p < 0.001),diabetes-years (p = 0.003), sialic acid (p = 0.01), and creatinine (p = 0.008)accounted for the excess risk of CHD. Similarly, age (p = 0.005), creatinine (p <0.001), cigarette pack-years (p = 0.02), diabetes-years (p = 0.003), and sialicacid (p = 0.08) were predictors of greater angiographic disease. M-IRS differedbetween Pakistani and white patients, as waist circumference correlated weakly (r= -0.03-0.08, p = 0.45-0.52) with triglycerides, high density lipoproteincholesterol, systolic blood pressure, or glucose. Sialic acid was the onlyinflammatory marker associated with M-IRS.CONCLUSIONS: Despite strong associations between individual risk factorsassociated with M-IRS and a univariate association between M-IRS and CHD innative Pakistanis, the principal discriminant risk factors in this group are age,smoking, inflammation, diabetes-years, and impaired renal function. The poorsensitivity of M-IRS for CHD reflects the high underlying prevalence of M-IRS,thus reducing sensitivity, confounding by other urban lifestyle traits, or a lack

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of association of waist circumference with M-IRS risk factors. The definition of M-IRS may have to be revised to increase its power as a discriminant risk factor for CHD in Pakistani populations.

PMCID: PMC1769029PMID: 16020583 [PubMed - indexed for MEDLINE]

28. J Pak Med Assoc. 2004 Dec;54(12 Suppl 3):S14-25.

The National Action Plan for the Prevention and Control of Non-communicableDiseases and Health Promotion in Pakistan--Cardiovascular diseases.

Nishtar S, Faruqui AM, Mattu MA, Mohamud KB, Ahmed A.

Armed Forces Institute of Cardiology, Rawalpindi.

The National Action Plan for Non-Communicable Disease Prevention, Control andHealth Promotion in Pakistan (NAP-NCD) incorporates prevention and control ofcardiovascular diseases (CVD) as part of a comprehensive and integratednon-communicable Disease (NCD) prevention effort. In this programme, surveillanceof cardiovascular risk factors is part of an integrated population-based NCDsurveillance system. The population approach to CVD prevention is a priority areain this programme with a focus on broad policy measures and behavioural changecommunication. The former include revision of the current policy on diet andnutrition to expand its focus on under-nutrition; the development of a physicalactivity policy; strategies to limit the production of, and access to, ghee as a medium for cooking and agricultural and fiscal policies that increase the demand for, and make healthy food more accessible. The programme focuses attention onimproving the quality of prevention programmes within primary and basic healthsites and integrates concerted primary and secondary prevention programmes intohealth services as part of a comprehensive and sustainable, scientifically valid,and resource-sensitive programme for all categories of healthcare providers. Itpromotes screening for raised blood pressure at the population level andscreening for dyslipidaemia and diabetes in high-risk groups only. It highlights the need to ensure the availability of aspirin, beta blockers, thiazides, ACEinhibitors, statins and penicillin at all levels of healthcare. The programmepoints out the need to conduct clinical end-point trials in the native Pakistani setting to define cost-effective therapeutic strategies for primary and secondaryprevention of CVDs. Emphasis is laid on building capacity of health systems insupport of CVD prevention and control and building a coalition or network oforganizations to add momentum to CVD prevention and control efforts.

PMID: 15745323 [PubMed - indexed for MEDLINE]

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29. J Public Health (Oxf). 2004 Sep;26(3):250-8.

How physically active are South Asians in the United Kingdom? A literaturereview.

Fischbacher CM, Hunt S, Alexander L.

Public Health Sciences, University of Edinburgh, Edinburgh EH8 [email protected]

BACKGROUND: Moderate physical activity is protective against coronary heartdisease (CHD) and diabetes, both important public health problems among UK South Asian (Indian, Pakistani and Bangladeshi) ethnic groups. We assessed the evidencethat physical activity is lower in South Asian groups than in the generalpopulation.METHODS: We carried out a systematic literature review of studies describinglevels of physical activity and fitness in UK South Asians using MEDLINE, EMBASE,the Cochrane databases, hand searching of relevant journals and review ofreference lists.RESULTS: We identified 12 studies in adults and five in children. Various methodswere used to assess physical activity and fitness, but all the studies reportedlower levels among South Asian groups. The differences were substantial,particularly among women and older people. For example, the Health Survey forEngland found that Indian, Pakistani and Bangladeshi men were 14, 30 and 45 percent less likely than the general population to meet current guidelines forphysical activity. Limited information was provided about translation andadaptation of questionnaires.CONCLUSION: Levels of physical activity were lower in all South Asian groups thanthe general population and patterns of activity differed. No studies usedvalidated measures. Insufficient attention has been paid to issues ofcross-cultural equivalence. With these caveats, low levels of physical activityamong UK South Asian ethnic groups may contribute to their increased risk ofdiabetes and CHD. Closer attention to validity, translation and adaptation isnecessary to monitor changes and assess the effectiveness of interventions toincrease physical activity.

PMID: 15454592 [PubMed - indexed for MEDLINE]

30. J Public Health (Oxf). 2004 Sep;26(3):245-9.

Prevalence and awareness of risk factors and behaviours of coronary heart diseasein an urban population of Karachi, the largest city of Pakistan: a communitysurvey.

Dodani S, Mistry R, Khwaja A, Farooqi M, Qureshi R, Kazmi K.

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Department of Epidemiology, Graduate School of Public Health, University ofPittsburgh, Room 309, 3512, Fifth Avenue, Pittsburg, PA 15213, USA. [email protected]

Comment in J Public Health (Oxf). 2005 Sep;27(3):309-10.

OBJECTIVES: To estimate the prevalence and awareness of risk factors and riskbehaviours of coronary heart disease (CHD) in the lower middle class residing in urban localities of Karachi, a mega city of Pakistan.METHODS: The design consisted of a cross-sectional community based survey in the lower middle class urban localities of Karimabad, Garden and Kharardar inKarachi, Pakistan. One thousand four hundred adults (18 years and above)registered with the Aga Khan Development Network (AKDN) participated in thesurvey. Life style, self-reported risk variables, blood pressure andanthropometric measurements were recorded.RESULTS: Prevalence of hypertension, high cholesterol and diabetes were 38.5,10.7 and 9.1 per cent, respectively. 52.2 per cent of the sample was overweightor obese; 64.8 per cent never exercised; 11.9 per cent had two or more major riskfactors of CHD.CONCLUSION: The communities studied showed a very high prevalence ofhypertension, obesity and a sedentary life style. Despite a high literacy rate,awareness regarding CHD risk factors was low. This underlines the need formeasures to increase awareness regarding CHD and its risk factors and a healthylifestyle in the developing countries.

PMID: 15454591 [PubMed - indexed for MEDLINE]

31. J Pak Med Assoc. 2004 Jul;54(7):364-71.

Evaluation and comparison of coronary heart disease risk factor profiles ofchildren in a country with developing economy.

Aziz K, Aziz S, Faruqui AM, Patel N, Chagani H, Hafeez SA, Ghuari SA, Memon MF,Ashraf T, Sultana H.

Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi.

Comment in J Pak Med Assoc. 2004 Dec;54(12):642.

OBJECTIVE: To define the risk factors (RF) profile and prevalence rates of highrisk factors in an urban Pakistani community and compare it to the RF profile andprevalence rates of Pakistan National Health Survey.METHODS: The present study included RF relevant data of 400 house hold childrenselected by open invitation as a part of Metroville Health Study (MHS), a riskfactor modification study which was a cooperation between National Heart Lung

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Blood institute (NHLBI) USA and National Institute of Cardiovascular DiseasesPakistan. The base line data of 389 girls and 417 boys age 5-17 was included.PMRC data of 5067 and NHANES III survey data of 10,252 US children was used forcomparison with MHS. RF analyzed were height weight, SBP, DBP, BMI and serumcholesterol. Comparisons between MHS and PMRC and US were made by using twotailed student t test and of high RF were defined as those exceeding US standardsand expressed as percentages.RESULTS: The RF factor profile of urban Metroville children was worse than thenational average of PMRC children. Except for diastolic blood pressure in bothboys and girls and SBP in PMRC boys, all other RF were less than US children.Prevalence rates were higher in urban Metroville community, i.e., MHS compared tothe PMRC which represents national average data.CONCLUSION: RF profile of Pakistani children has been presented and effect ofurbanization demonstrated by comparing the PMRC and MHS RF profile. Hypertension in Pakistani children has emerged as a single most important RF requiring urgent prevention.

PMID: 15449919 [PubMed - indexed for MEDLINE]

32. Acta Cardiol. 2004 Aug;59(4):417-24.

CAD risk factors and acute myocardial infarction in Pakistan.

Saleheen D, Frossard P.

Department of Biological and Biomedical Sciences, The Aga Khan University,Stadium road, Karachi, Pakistan. [email protected]

OBJECTIVE: Acute myocardial infarction (AMI) in adult patients under the age of45 is relatively unusual. Recent studies have shown a higher prevalence of AMI inyoung South Asian migrants. Data on South Asians in South Asia on cardiovascular disease (CVD) patients is lacking. The purpose of this study is to look at theclassical risk factors of coronary artery disease (CAD) in young men and womenand their older counterparts who presented to the emergency service of the AgaKhan university hospital (AKUH) and were diagnosed with AMI.METHODS: 976 consecutive patients admitted to AKUH with AMI between January2000-December 2002 were divided into two groups: < 45 years (young) and > 45years (old). Demographic factors, clinical symptoms and presence of risk factors for CAD were recorded with the help of pre-tested data extraction forms.RESULTS: Young patients represented 16.1% of all patients with AMI. 93.1% of the young patients were men. Young male patients were more likely to be smokers andhave high cholesterol levels as compared to their young female counterparts.Young AMI patients when compared to old AMI patients, were more likely to havehypertension, positive family history of coronary artery disease, highcholesterol, high LDL and high triglycerides.CONCLUSION: In this study, the risk factor profile between young and old patients

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and between the two genders was found to be different. Thus adult managementprotocols for AMI should be different from the ones for older patients and genderdifference should also be considered.

PMID: 15368804 [PubMed - indexed for MEDLINE]

33. J Pak Med Assoc. 2004 May;54(5):261-6.

Risk factors and behaviours for coronary artery disease (CAD) among ambulatoryPakistanis.

Iqbal SP, Dodani S, Qureshi R.

Department of Family Medicine, The Aga Khan University, Karachi.

OBJECTIVE: To determine the frequency and distribution of various risk factorsand behaviours for coronary artery disease (CAD) among ambulatory Pakistanis.METHODS: It is a cross-sectional descriptive study carried out at the Aga KhanUniversity Hospital, a teaching hospital in Karachi. All the subjects were adults(18-60 years) presenting at the general checkup clinic with no history orevidence of CAD by convenient sampling method. Demographic variables includedrisk factors and behaviors including diabetes, hypertension, dyslipidemia, familyhistory of heart disease, obesity, smoking and sedentary lifestyle.RESULTS: Among 370 ambulatory Pakistanis, the proportions of major risk factorsfor CAD were: sedentary life style 72%, family history 42%, dyslipidemia 31%,obesity 24%, hypertension 19% and diabetes mellitus 15%. Diabetes, hypertensionand dyslipidemia were poorly controlled in the study population. Proportions ofthe three major risk factors (smoking, hypertension and dyslipidemia) occurringsingly, doubly and all three together in the study population were found to be39%, 11% and 1%, respectively. Data were also analyzed for risk factors bycomparing those with and without family history of CAD to eliminate any bias. Theresults were not statistically significant except for the sedentary life style(P=0.016).CONCLUSION: There is a high prevalence of CAD risk factors in this studypopulation. Modifiable risk factors like diabetes, hypertension and highcholesterol need better control. Preventive screening programs and healthylifestyle behaviours need to be emphasized upon in the community.

PMID: 15270186 [PubMed - indexed for MEDLINE]

34. Curr Med Res Opin. 2004 Jan;20(1):55-62.

Waist-hip ratio and low HDL predict the risk of coronary artery disease inPakistanis.

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Nishtar S, Wierzbicki AS, Lumb PJ, Lambert-Hammill M, Turner CN, Crook MA, Mattu MA, Shahab S, Badar A, Ehsan A, Marber MS, Gill J.

Heartfile, 1 Park Road, Chak Shahzad, Islamabad, Pakistan. [email protected]

OBJECTIVE: To establish risk factor causal associations for coronary arterydisease (CAD) in the native Pakistani population.METHODS: We conducted a hospital-based, case-control study of 200 cases withangiographically documented CAD and 200 age- and sex-matched controls withoutangiographic evidence of CAD. Patients on lipid lowering therapy were excluded.Lifestyle, anthropometric and biochemical risk factors were assessed in bothgroups.RESULTS: The presence of CAD was associated with current, past or passivesmoking, a history of diabetes and high blood pressure, a positive family riskfactors in this study; levels were below history of CAD, body fat percentage,waist-hip ratio (WHR), low apolipoprotein A1 or low HDL, lipoprotein (a),glucose, insulin, insulin resistance, C-reactive protein (CRP), total cholesterolto HDL ratio (TC/HDL) and creatinine on univariate conditional logisticregression analysis. In multiple regression analysis, significant independentassociations were found with low HDL (OR 0.11; 95% CI 0.04-0.34; p < 0.001)positive family history (OR 1.79; 95% CI 1.09-2.93; p = 0.02), CRP (OR 1.45; 95% CI 1.19-1.75; p < 0.001) and WHR (OR 1.04; 95% CI 1.01-1.08; p = 0.01).Angiograms were also quantified for the extent and severity of CAD by the Gensiniscoring system. Quantitative angiographic data showed associations with age (p = 0.01), the duration of diabetes (p = 0.04), WHR (p = 0.06), low HDL (p < 0.001), lipoprotein (a) (p = 0.001), creatinine (p < 0.001) and CRP (p = 0.007). Results indicate that total and LDL cholesterol were not significant currently acceptedthresholds for treatment.CONCLUSIONS: The cardiovascular risk profile in this population is consistentwith metabolic syndrome where low HDL and WHR can be used to predict the risk of CAD. Results suggest the need to redefine the currently practised approach to CADmanagement in this population to fit local needs.

PMID: 14741073 [PubMed - indexed for MEDLINE]

35. J Pak Med Assoc. 2003 Sep;53(9):396-400.

Risk factors for cardiovascular disease in school children--a pilot study.

Khuwaja AK, Fatmi Z, Soomro WB, Khuwaja NK.

Department of Community Health Sciences, Aga Khan University, Karachi.

OBJECTIVE: To assess the frequencies of risk factors for cardiovascular diseasein school children. The information may help in designing interventions aimed at

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modifying unhealthy lifestyle in children, which may reduce the later incidenceof cardiovascular disease in adults.METHODS: A cross-sectional study was conducted on 206 students (ages 14-18years), enrolled in higher secondary school. Students were interviewed abouttheir lifestyles, family history of cardiovascular disease and its risk factors. Moreover, they were assessed for height, weight and blood pressure.RESULTS: Twenty nine percent of the children were physically inactive, 31% weretaking unhealthy diet daily, 21% were overweight (BMI > or = 25) and 6% weresmokers. History of paternal smoking was reported by 36% of the children, andamong them 76% of fathers smoked in the presence of their children. Familyhistory of cardiac disease, hypertension and diabetes were positive in 4%, 23%and 16% of the children respectively. Overall, 58% of the children had at leastone modifiable risk factor.CONCLUSION: Majority of the children had modifiable risk factors forcardiovascular disease. Prevention efforts are required early in life, usingstrategies for behavioral modification and health promotion.

PMID: 14620313 [PubMed - indexed for MEDLINE]

36. Eur J Clin Invest. 2003 Aug;33(8):686-92.

Predictors of lipoprotein(a) levels in a European and South Asian population inthe Newcastle Heart Project.

Tavridou A, Unwin N, Bhopal R, Laker MF.

Department of Pharmacology, ELPEN Pharmaceutical Co. Inc., Pikermi, Attika,Greece. [email protected]

BACKGROUND: Understanding of the higher susceptibility of South Asians tocoronary heart disease is limited. One explanation is the combination of highprevalence of insulin resistance with higher lipoprotein(a) levels.MATERIALS AND METHODS: Lipoprotein(a) levels and genotypes in three South Asiangroups aged 25-74 years (Indian, Pakistani, Bangladeshi) were compared with aEuropean population in a cross-sectional study. Biochemical measurements includedlipids, apolipoprotein A1 and B, glucose, insulin and fibrinogen. Insulinsensitivity was calculated using the homoeostasis model assessment method (HOMA).RESULTS: There was no significant difference in lipoprotein(a) levels betweenSouth Asian and European men. South Asian women combined had higherlipoprotein(a) levels than European women, a difference probably resulting fromhigher lipoprotein(a) levels in Pakistani women compared with Indian andBangladeshi women. Fasting insulin and HOMA were negatively associated with Lp(a)in South Asians though the associations were statistically significant only inmen. There were only modest associations between most cardiovascular risk factorsand Lp(a). Twenty-seven apolipoprotein(a) size alleles were detected in the threeSouth Asian groups ranging from 16 to 43 kringle-IV repeats. The

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apolipoprotein(a) size polymorphism explained 23% of the variability inlipoprotein(a) levels in South Asians.CONCLUSIONS: There were few nongenetic predictors of lipoprotein(a) levels inSouth Asians and Europeans. The lack of difference in Lp(a) between the SouthAsian and European men and the fact that differences between the women seemed to be confined to the Pakistani group offer little support to the hypothesis thathigher Lp(a) levels contribute to the increased risk of heart disease in SouthAsians. Our findings do not support the hypothesis that susceptibility to heartdisease in South Asians results from a combination of high insulin resistance andhigh Lp(a) levels.

PMID: 12864778 [PubMed - indexed for MEDLINE]

37. J Pak Med Assoc. 2002 Sep;52(9):436-9.

Prevalence of depression in patients with coronary artery disease in a tertiarycare hospital in Pakistan.

Bokhari SS, Samad AH, Hanif S, Hadique S, Cheema MQ, Fazal MA, Gul M, Bukhari SS,Khan AS.

Aga Khan University.

OBJECTIVE: To determine the prevalence of depression in patients with coronaryartery disease (CAD) in a tertiary care hospital setting in Pakistan.METHODS: One hundred and fifty four patients of CAD (115 males and 39 females)were randomly selected from the outpatient department and wards of the NationalInstitute of Cardiovascular Diseases, Karachi and were scored for depression via the Hospital Anxiety and Depression Scale. Basic demographic data and diseasevariables were also collected.RESULTS: The point prevalence of depression in the sample was 37% (31.3% malesand 53.8% females). Female sex, income level below Rs. 5000 per month, loweducation level, outpatient, single earning family member and hypertension werefew variables associated positively with depression (p < 0.05). Only one patient was receiving treatment for depression by his cardiologist.CONCLUSION: Depression is prevalent in CAD patients in Pakistan. Economicconditions may pose an additional threat on these patients. Treating physicians(especially cardiologists) need to be aware of this co-morbidity so as to be ableto diagnose and adequately manage such patients.

PMID: 12532585 [PubMed - indexed for MEDLINE]

38. J Pak Med Assoc. 2002 Sep;52(9):402-7.

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Urbanisation and activity pattern of south Asian children.

Hakeem R, Thomas J, Badruddin SH.

Department of Food and Nutrition, RLAK Government College of Home Economics,Karachi.

OBJECTIVE: To compare the physical activity level and total energy expenditure of10-12 year old school children living at different levels of urbanization.METHOD: All the participating children kept a three-day record of theiractivities, for every fifteen-minutes, in specially designed diaries. Activities were grouped according to intensity that was determined on the basis of Physical Activity Ratio (PAR). After calculating the average time spent in a day, inactivities of varying intensity, overall Physical Activity Level (PAL) of eachsubject was calculated by factorization method. After measuring bodyweight using a standard equation Basal Metabolic Rate (BMR) of the subjects was calculated.Total Energy Expenditure (TEE) was assessed on the basis of PAL and BMR of eachchild.SUBJECTS: Physical activity level of six groups of 10-12 year old children,representing various urbanization categories, was studied. Three groups ofchildren were recruited from Punjab, Pakistan: rural, middle income urban andhigh income urban, and they were assigned urbanization rank (UR) 1, 2 and 3.Another three groups of children were recruited from Slough, UK: BritishPakistani, British Indian, and British Caucasian and they were assignedurbanization rank 4, 5 and 6 respectively.RESULTS: Physical activity level decreased significantly with the urbanizationrank only among girls of Pakistani origin (UR 1-4). Pattern of gender differencesin activity level was different in rural and urban children. Rural girls wereslightly more active than rural boys, whereas in urban areas boys weresignificantly more active than girls. Because of lower bodyweight the lessurbanized children in spite of having higher PAL had a lower mean TEE as comparedto the more urbanized groups.CONCLUSION: The activity level of rural children having access to formaleducation and television could not be expected to be very different from theirurban counterparts. Inactivity of urban girls needs particular attention. Becauseof lower caloric requirements, on similar diets, less urbanized groups maysuccumb to overweight more easily than the urbanized groups. Participation inactive games may present a substitute to decreased involvement in moderatelyactive work and play activities.

PMID: 12532574 [PubMed - indexed for MEDLINE]

39. BMJ. 2002 Oct 19;325(7369):903.

Heterogeneity among Indians, Pakistanis, and Bangladeshis is key to racialinequities.

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Bhopal RS.

Comment on BMJ. 2002 Mar 2;324(7336):511-6.

PMCID: PMC1124394PMID: 12386051 [PubMed - indexed for MEDLINE]

40. J Public Health Med. 2002 Jun;24(2):95-105.

Ethnic and socio-economic inequalities in coronary heart disease, diabetes andrisk factors in Europeans and South Asians.

Bhopal R, Hayes L, White M, Unwin N, Harland J, Ayis S, Alberti G.

University of Edinburgh, Medical School. [email protected]

BACKGROUND: The aim of this study was to test the hypothesis that in Europeansand South Asians (Indians, Pakistanis, Bangladeshis) alike, worse socio-economic status is associated with a higher prevalence of coronary heart disease (CHD),glucose intolerance (impaired glucose tolerance and diabetes) and related riskfactors (the predicted direction of association).METHODS: Cross-sectional data were analysed from a community-based prevalencestudy seeking associations between social class, education and Townsenddeprivation score and ECG evidence of CHD, glucose tolerance test and 12cardiovascular risk factors. The study population consisted of South Asians (n = 684) comprising Indians (n = 259), Pakistanis (n = 305) and Bangladeshis (n =120), and Europeans (n = 825), aged 25-74 years in Newcastle. The analysisexamined up to 84 associations for each ethnic group. Interactions betweenethnicity and socio-economic variables were examined using regression analysis.The main outcome measure was the number of associations in the predicteddirection.RESULTS: Europeans fared better in some indicators of socio-economic position,South Asians in others. Indians were socio-economically advantaged compared with Pakistanis and Bangladeshis. Most measures of socio-economic position wereassociated with health measures in the predicted direction in Europeans [71/84(85 per cent) associations, 25 statistically significant] and less so in theSouth Asians combined [58/84 (69 per cent) associations, 12 statisticallysignificant]. In South Asian men 25/42 (60 per cent) of associations were aspredicted, seven significantly so, in women 33/42 (79 per cent) were, five being statistically significant. There were apparent differences between Indians 152/78(67 per cent) of associations as predicted, seven statistically significant],Pakistanis [41/84 (49 per cent), four statistically significant] and Bangladeshis[39/79 (49 per cent), one statistically significant]. In Indians, Townsenddeprivation score was mostly associated as predicted [23/27 (85 per cent), fiveassociations statistically significant], more so than social class [14/27 (52 per

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cent), none statistically significant]. In South Asian men and women combined,associations with anthropometric [18/24 (75 per cent)], biochemical [15/18 (83per cent)], and lifestyle 114/18 (78 per cent)] measures were often as predicted,but those with blood pressure (4/12, 33 per cent) and CHD and glucose intolerance(7/12, 58 per cent) were less often so. Interactions between socio-economicposition and ethnicity were found.CONCLUSIONS: The European pattern of inequalities is being established in SouthAsian men and women, possibly at a different pace in different subgroups. Future studies of inequalities should be large, separate Indian, Pakistani andBangladeshi populations, study men and women separately and track changes overtime.

PMID: 12141592 [PubMed - indexed for MEDLINE]

41. Ann Behav Med. 2002 Spring;24(2):113-21.

Cardiovascular stress responses among Asian Indian and European American womenand men.

Stoney CM, Hughes JW, Kuntz KK, West SG, Thornton LM.

Department of Psychology, The Ohio State University, Columbus 43210-1222, [email protected]

Asian Indians have approximately 3 times the rate of coronary artery disease asdo age-matched European Americans, but the increased risk cannot be explained by the presence of known physiological and behavioral risk factors. One previousstudy suggested that Asian Indians have diminished vasoactive responses toisoproterenol, but no published study has examined responses to psychologicalstressors. The purpose of this study was to test the hypothesis that thevasomotor response to stress, as indexed by hemodynamic measures, would beexaggerated in Asian Indian men and women, relative to European Americanindividuals. Thirty-seven Asian Indian and 43 European American men and womenwere tested in a standard reactivity protocol, whereas heart rate, bloodpressure, and cardiac impedance measures were assessed. Asian Indian men andwomen had significantly smaller changes in systolic blood pressure and meanarterial pressure during the stressors, relative to European American men andwomen. Asian Indian women, but not men, had significantly smaller diastolic bloodpressure and total peripheral-resistance index changes to the stressors, relativeto the other 3 groups. These data are in contrast to our expectation of decreasedtendency of Asian Indians to vasodilate during psychological stress but dosuggest that sex and Asian Indian ethnicity interact to influence vascularreactivity to stressors.

PMID: 12054316 [PubMed - indexed for MEDLINE]

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42. Atherosclerosis. 2001 Jun;156(2):457-61.

Impaired fibrinolysis and increased fibrinogen levels in South Asian subjects.

Kain K, Catto AJ, Grant PJ.

Academic Unit of Molecular Vascular Medicine, G-Floor, Martin Wing, Leeds GeneralInfirmary, LS1 3EX, Leeds, UK. [email protected]

The potential role of haemostatic risk markers is largely unexplored in SouthAsians, who have increased morbidity and mortality from cardiovascular diseaseand an increased prevalence of insulin resistance. To investigate differences in thrombotic risk markers between South Asian and White populations, 42 Asian and50 White males and 96 Asian and 80 White females, clinically free from vasculardisease, were recruited. Venous blood samples were taken for measures ofhaemostasis and determination of blood lipids. South Asian females showed lowerfasting blood glucose than White females (4.6 vs. 4.8 mmol/l, P<0.008). In theSouth Asian population, total cholesterol was lower in females, with a similartrend in males (females 5.0 vs. 5.5 mmol/l, P<0.001; males 5.1 vs. WM 5.5 mmol/l,P=0.09), but no difference in triglyceride levels. South Asian subjects of bothgenders had markedly higher levels of fibrinogen (females 3.3 vs. 2.8 mg/dl,P<0.0005; males 3.0 vs. 2.5 mg/dl P<0.002) and PAI-1 activity (females 14.6 vs.8.7 ng/ml, P<0.0005, males 21.3 vs. 12.2 ng/ml, ) P<0.0005). Factor VII:C waslower in both South Asian groups (females 110.9 vs. 122.4%, P<0.005; males 103.3 vs. 125%, P<0.0005). Factor XII was lower in South Asian females and there wereno differences in Factor XII levels in male populations. These results suggestthat elevated PAI-1 and fibrinogen in Asians of both genders may contribute tothe increased vascular risk experienced in this population; however, the role of dyslipidaemia and Factor VII are not clear in these processes.

PMID: 11395044 [PubMed - indexed for MEDLINE]

43. J Pak Med Assoc. 2001 Jan;51(1):22-8.

Urbanisation and coronary heart disease risk factors in South Asian children.

Hakeem R, Thomas J, Badruddin SH.

Department of Food and Nutrition, RLAK Government College of Home Economics,Karach.

BACKGROUND: Coronary Heart Disease (CHD) and other Non Communicable Diseases(NCDs) are increasing globally. Comparison of various sections of the South Asianpopulations living at different levels of urbanization can help in understanding

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the role of demographic transition in the increased prevalence of these diseases in urbanized populations.OBJECTIVE: To compare the prevalence of certain CHD risk factors in 10-12 yearold school children living at different levels of urbanization.METHOD: Differences in height, Body Mass Index (BMI), Waist Hip Ratio (WHR),Fasting Blood Glucose (FBG) and Total Blood Cholesterol (TBC) were studied.SUBJECTS: Anthropometric and biochemical measurements of six groups of 10-12 yearold children, representing various urbanization categories, were studied. Threegroups of children were recruited from Punjab, Pakistan: rural, middle incomeurban and high income urban and they were assigned urbanization rank (UR) 1, 2and 3. Another three groups of children were recruited from Slough, UK: BritishPakistani, British Indian, and British Caucasian and they were assignedurbanization rank 4, 5 and 6 respectively.RESULTS: Proportion of children having high CHD risk increased with urbanization rank. Increase in BMI and TBC with urbanization status was steadier than theincrease in FBG and WHR. Stunting which have been found to have a positiveassociation with obesity and increased risk of CHD was higher among the lessurbanized groups. BMI and TBC of the urbanized South Asian groups were lower, butFBG was higher than the British Caucasian, who served as controls.CONCLUSION: These findings support the hypothesis that high CHD death rate among South Asians in UK may have its origin in the genetic predisposition to diabetes but are not likely to be solely due to this factor. The environmental factorslike under nourishment in early life, adoption of urbanized life style or acombination of both could be the major determinants of CHD morbidity andmortality.

PMID: 11255994 [PubMed - indexed for MEDLINE]

44. J Public Health Med. 2000 Sep;22(3):375-85.

What is the risk of coronary heart disease in South Asians? A review of UKresearch.

Bhopal R.

Department of Epidemiology and Public Health, School of Health Sciences,University of Newcastle upon Tyne. [email protected]

OBJECTIVE: The aim of this study was to systematically review the evidence thatcoronary heart disease risk is higher in South Asians than in comparative 'white'populations, particularly seeking studies of incidence.METHODS: A systematic literature review was carried out using a personal researchliterature collection, MEDLINE 1966-1998 and citations from references.RESULTS: Of 19 studies, none reported disease incidence. Most studies reportedprevalence, mortality rates or health care utilization data. Most studies were onpeople born on the Indian subcontinent, thus omitting the British-born. Several

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did not report on women. The strongest evidence of an excess of CHD in SouthAsians came from mortality data comparing those born in the Indian subcontinentwith the whole population of England and Wales. In South Asians coronary heartdisease is common and important, but neither the actual disease rates nor theexcess risk in relation to the 'white' population are known. Both prevalence and mortality data suggested that the frequency of coronary heart disease in Indians,Pakistanis and Bangladeshis differed.CONCLUSION: Estimates of South Asians' excess risk of coronary heart disease are imprecise and may be too high (if there are data errors) or too low (forcomparison with the general population blunts ethnic variations). South Asiansare a heterogeneous group yet most studies of CHD report on Bangladeshis, Indiansand Pakistanis combined. Indians probably have less CHD than Bangladeshis andPakistanis. Cohort studies on CHD in South Asians are needed and these should be designed so that data can be combined for future systematic reviews.

PMID: 11077913 [PubMed - indexed for MEDLINE]

45. Am J Clin Nutr. 1999 Dec;70(6):1112-3.

Coronary artery disease risk factors in south Asian and American premenopausalwomen.

Singh RB.

Comment on Am J Clin Nutr. 1999 Apr;69(4):621-31.

PMID: 10584059 [PubMed - indexed for MEDLINE]

46. BMJ. 1999 Jul 24;319(7204):215-20.

Heterogeneity of coronary heart disease risk factors in Indian, Pakistani,Bangladeshi, and European origin populations: cross sectional study.

Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KG, Harland J, Patel S,Ahmad N, Turner C, Watson B, Kaur D, Kulkarni A, Laker M, Tavridou A.

Department of Epidemiology and Public Health, Medical School, University ofNewcastle, Newcastle upon Tyne NE2 4HH.

OBJECTIVE: To compare coronary risk factors and disease prevalence among Indians,Pakistanis, and Bangladeshis, and in all South Asians (these three groupstogether) with Europeans.DESIGN: Cross sectional survey.SETTING: Newcastle upon Tyne.

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PARTICIPANTS: 259 Indian, 305 Pakistani, 120 Bangladeshi, and 825 European menand women aged 25-74 years.MAIN OUTCOME MEASURES: Social and economic circumstances, lifestyle, selfreported symptoms and diseases, blood pressure, electrocardiogram, andanthropometric, haematological, and biochemical measurements.RESULTS: There were differences in social and economic circumstances, lifestyles,anthropometric measures and disease both between Indians, Pakistanis, andBangladeshis and between all South Asians and Europeans. Bangladeshis andPakistanis were the poorest groups. For most risk factors, the Bangladeshis(particularly men) fared the worst: smoking was most common (57%) in that group, and Bangladeshis had the highest concentrations of triglycerides (2.04 mmol/l)and fasting blood glucose (6.6 mmol/l) and the lowest concentration of highdensity lipoprotein cholesterol (0.97 mmol/l). Blood pressure, however, waslowest in Bangladeshis. Bangladeshis were the shortest (men 164 cm tall v 170 cm for Indians and 174 cm for Europeans). A higher proportion of Pakistani andBangladeshi men had diabetes (22.4% and 26.6% respectively) than Indians (15.2%).Comparisons of all South Asians with Europeans hid some important differences,but South Asians were still disadvantaged in a wide range of risk factors.Findings in women were similar.CONCLUSION: Risk of coronary heart disease is not uniform among South Asians, andthere are important differences between Indians, Pakistanis, and Bangladeshis formany coronary risk factors. The belief that, except for insulin resistance, SouthAsians have lower levels of coronary risk factors than Europeans is incorrect,and may have arisen from combining ethnic subgroups and examining a narrow range of factors.

PMCID: PMC28170PMID: 10417082 [PubMed - indexed for MEDLINE]

47. Lancet. 1998 Apr 11;351(9109):1105.

Folate deficiency, neural tube defects, and cardiac disease in UK Indians andPakistanis.

Michie CA, Chambers J, Abramsky L, Kooner JS.

Comment in Lancet. 2000 Jan 8;355(9198):147.

PMID: 9660590 [PubMed - indexed for MEDLINE]

48. Diabetes Care. 1997 Jul;20(7):1093-100.

The relationship of concentrations of insulin and proinsulin-like molecules with coronary heart disease prevalence and incidence. A study of two ethnic groups.

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Yudkin JS, Denver AE, Mohamed-Ali V, Ramaiya KL, Nagi DK, Goubet S, McLarty DG,Swai A.

Department of Medicine, University College London Medical School, U.K.

OBJECTIVE: To define the potential role of proinsulin-like molecules as riskfactors for cardiovascular disease.RESEARCH DESIGN AND METHODS: Fasting concentrations of proinsulin,des-31,32-proinsulin, and insulin, and of insulin 2 h after a 75-g glucose load, were measured in 1,034 nondiabetic europid subjects and 257 south Asian subjects and related to prevalent coronary heart disease (Minnesota-codedelectrocardiographic criteria or ischemic chest pain). In 137 south Asiansubjects, the fasting concentrations were related to incident coronary heartdisease over a 6.5-year follow-up.RESULTS: The standardized odds ratios for prevalent coronary heart disease wereas follows: fasting insulin, 1.29 (1.11-1.49), P = 0.0006; 2-h insulin, 1.25(1.08-1.45), P = 0.003; proinsulin, 1.23 (0.99-1.53), P = 0.058; anddes-31,32-proinsulin, 1.32 (1.03-1.69), P = 0.026. The odds ratios were similarin the two ethnic groups. These relationships became insignificant whencontrolling for age, sex, and BMI. The standardized odds ratios for incidentcoronary heart disease were as follows: fasting insulin, 0.99 (0.63-1.55), P =0.97; proinsulin, 1.13 (0.72-1.78), P = 0.59; and des-31,32-proinsulin, 1.00(0.61-1.63), P = 1.00.CONCLUSIONS: We have found similar relationships between concentrations ofproinsulin-like molecules and prevalent coronary heart disease, as are observedfor insulin in these nondiabetic subjects, although these molecules comprise onlyapproximately 10% of all insulin-like molecules. It appears biologicallyimplausible that these relationships represent cause and effect.

PMID: 9203443 [PubMed - indexed for MEDLINE]

49. Ciba Found Symp. 1996;201:54-64; discussion 64-7, 188-93.

Metabolic consequences of obesity and body fat pattern: lessons from migrantstudies.

McKeigue PM.

Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, UK.

Prevalence of non-insulin-dependent diabetes mellitus and mortality from coronaryheart disease are higher in people of South Asian (Indian, Pakistani andBangladeshi) descent living in urban societies than in other ethnic groups. Thehigh prevalence of diabetes is one manifestation of a pattern of metabolic

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disturbances related to central obesity and insulin resistance, which includesraised plasma very low density lipoprotein triglyceride and low plasma highdensity lipoprotein-cholesterol. Average waist/hip circumference ratios arehigher in South Asians than in Europeans of similar body mass index: in thisrespect South Asians differ from other populations such as Pima Indians wherehigh prevalence of non-insulin-dependent diabetes mellitus occurs in association with generalized obesity. The high rates of coronary heart disease in SouthAsians are most easily explained by the effects of this central obesity/insulinresistance syndrome, although ethnic differences in fasting lipids are unlikelyto account fully for the excess risk. In Afro-Caribbean migrants, the prevalence of diabetes is almost as high as in South Asians but the lipid disturbancescharacteristic of the insulin resistance syndrome do not occur to the sameextent. This may account for the low rates of coronary heart disease in thisgroup.

PMID: 9017274 [PubMed - indexed for MEDLINE]

50. Int J Cardiol. 1995 Mar 3;48(3):287-93.

Dietary fat purchasing habits in whites, blacks and Asian peoples inEngland--implications for heart disease prevention.

Lip GY, Malik I, Luscombe C, McCarry M, Beevers G.

University Department of Medicine, City Hospital, Birmingham, England.

The mortality and morbidity from coronary heart disease (CHD) is higher in peopleof South Asian origin than in whites, but is significantly lower in the black(Afro-Caribbean origin) community in the United Kingdom. To investigate whetherthis may be related to differences in fatty food intake, we performed aquestionnaire survey of the weekly food purchasing habits and preparation methodsin white, black (Caribbean) and Asian households in Birmingham. We interviewed224 housewives from three ethnic groups (84 white, 76 black/Afro-Caribbean and 72Asian). The highest quantity of fat in foods purchased per week was found in the Asian population (median 1409 g/week per person, interquartile range (IQR)850-1952), which was significantly greater than black subjects, who had thelowest quantity of fat in foods purchased (1012 g/week per person, IQR 835-1388) (Mann-Whitney test:median differences 300.5, 95% C.I. 23.3-600.4, P = 0.029). Themedian quantity of fat in foods purchased by the white households wasintermediate, at 1186 g/week per person (IQR 861-1711). There was a higherquantity of fat in foods purchased in the lower social classes (IV and V) in boththe white and Asian populations. Butter, egg and milk consumption wassignificantly greater in Asians; with ghee consumption almost exclusive amongstthis group (98%). Amongst whites and blacks, the commonest food preparationmethods were grilling, boiling or poaching; whilst amongst Asians, frying wasmore common (chi 2 = 81.25, d.f. = 4, P < 0.0001).(ABSTRACT TRUNCATED AT 250

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WORDS)

PMID: 7782144 [PubMed - indexed for MEDLINE]

51. Am J Clin Nutr. 1994 May;59(5):1069-74.

Relationship of hyperinsulinemia to dietary intake in south Asian and Europeanmen.

Sevak L, McKeigue PM, Marmot MG.

Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, UK.

In South Asians (Indians, Pakistanis, and Bangladeshis) settled overseas, highrates of coronary disease and non-insulin-dependent diabetes occur in associationwith central obesity and insulin resistance. To examine whether thesedisturbances were related to diet, we measured 7-d weighed intakes in 173 SouthAsian and European men aged 40-69 y in London. In South Asians compared withEuropeans, respectively, mean energy intake was lower (9.5 vs 10.8 MJ/day, P <0.001), total fat intake was lower (36.5% vs 39.2% of energy intake, P = 0.007), starch intake was higher (28.0% vs 21.5% of energy, P < 0.001), polyunsaturatedfatty acid intake was higher (8.2% vs 7.0% of energy, P = 0.02), and dietaryfiber intake was higher (3.2 vs 2.0 g/MJ, P < 0.001). Elevated serum insulinconcentrations at 2 h postglucose were associated positively with carbohydrateintake (P = 0.001) and inversely with alcohol intake (P = 0.006), but not withsaturated fatty acid intake. The high coronary risk in South Asian people is not explained by any unfavorable characteristic of South Asian diets.

PMID: 8172093 [PubMed - indexed for MEDLINE]

52. Postgrad Med J. 1994 May;70(823):315-8.

Are Indo-origin people especially susceptible to coronary artery disease?

Shaukat N, de Bono DP.

University Department of Cardiology, Glenfield General Hospital, Leicester, UK.

PMCID: PMC2397609PMID: 8016000 [PubMed - indexed for MEDLINE]

53. Br Heart J. 1993 Jun;69(6):572.

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Coronary heart disease in Indians, Pakistanis, and Bangladeshis: aetiology andpossible prevention.

Singh RB, Niaz MA.

Comment on Br Heart J. 1992 May;67(5):341-2.

PMCID: PMC1025176PMID: 8343328 [PubMed - indexed for MEDLINE]

54. Br Heart J. 1992 May;67(5):341-2.

Coronary heart disease in Indians, Pakistanis, and Bangladeshis: aetiology andpossibilities for prevention.

McKeigue PM.

Comment in Br Heart J. 1993 Jun;69(6):572.

PMCID: PMC1024851PMID: 1389723 [PubMed - indexed for MEDLINE]

55. J Clin Epidemiol. 1989;42(7):597-609.

Coronary heart disease in south Asians overseas: a review.

McKeigue PM, Miller GJ, Marmot MG.

Department of Community Medicine, University College, London, England.

Coronary heart disease rates have been reported in several parts of the world to be unusually high in people originating from the Indian subcontinent. Highcoronary disease rates appear to be common to South Asian groups of differentgeographical origin, religion, and language. This presents a challenge to theunderstanding of coronary heart disease: the high rates in South Asians are notexplained on the basis of elevated serum cholesterol, smoking or hypertension.Low plasma HDL cholesterol, high plasma triglyceride levels and high prevalenceof non-insulin-dependent diabetes have been consistently found in South Asiansoverseas: this probably reflects an underlying state of insulin resistance.Further studies are needed to determine whether this metabolic disturbance canaccount for the high rates of coronary heart disease in South Asians, and toidentify possibilities for prevention.PMID: 2668448 [PubMed - indexed for MEDLINE]

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Search results for cardiac bimarkers and Pakistan:

1. J Pak Med Assoc. 2010 Jun;60(6):423-8.

Correlation of cardiac troponin I levels (10 folds upper limit of normal) andextent of coronary artery disease in non-ST elevation myocardial infarction.

Qadir F, Farooq S, Khan M, Hanif B, Lakhani MS.

Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan.

OBJECTIVE: To determine the correlation of cardiac troponin I (cTnI) 10 foldsupper limit of normal (ULN) and extent of coronary artery disease (CAD) inNon-ST-elevation myocardial infarction (NSTEMI).METHODS: A cross-sectional study was conducted on 230 consecutive NSTEMI patientsadmitted in Tabba Heart Institute, Karachi between April to December 2008. cTnIwas measured using MEIA method. All patients underwent coronary angiography inthe index hospitalization. Stenosis > or = 70% in any of the three majorepicardial vessels was considered significant CAD. Extent of CAD was defined assignificant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent.RESULTS: Out of 230 patients, in 111 patients with cTnI levels < or = 10 foldsupper limit of normal (ULN), 25 (22.52%) had single vessel, 40 (36%) had twovessel and 34 (30.6%) had three vessel significant CAD, whereas in 119 patientswith cTnI levels > 10 folds ULN, 23 (19.3%) had single vessel, 37 (31.1%) had twovessel and 55 (46.2%) had three vessel significant CAD. The results suggest that there was an insignificant association between the cTnI levels and single vessel,two vessel and the overall CAD extent (p = 0.35, p = 0.21 and p= 0.13respectively), however there was a statistically significant association between the cTnI levels and three vessel CAD (p < 0.04).CONCLUSION: Higher cTnI levels are associated with an increased proportion ofsevere three vessel CAD involvement. Prompt identification and referral of thispatient subset to early revascularization strategies would improve clinicaloutcomes.

PMID: 20527635 [PubMed - indexed for MEDLINE]

2. J Ayub Med Coll Abbottabad. 2009 Jul-Sep;21(3):46-50.

Baseline leukocyte count and acute coronary syndrome: predictor of adversecardiac events, long and short-term mortality and association with traditionalrisk factors, cardiac biomarkers and C-reactive protein.

Munir TA, Afzal MN, Habib-ur-Rehman.

Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan.

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[email protected]

BACKGROUND: The elevated WBC count has been accepted as part of healing response following myocardial infarction as well as a predictor of adverse cardiovascular events. The study was designed to find out correlation between WBC count andcoronary risk factors, cardiac biomarkers, C-reactive protein (CRP), incidence ofadverse cardiac events and mortality in patients of ACS in Pakistan.METHODS: One hundred and thirty-three patients of ACS were stratified accordingto WBC categories, WBC1 (< 7000/mm3), WBC2 (7100-10,000/mm3) and WBC3 (>10,000/mm3). The WBCs were counted on admission by Sysmex cell counter, CRP byimmunoturbidimetric method, and CK-MB and Trop-I by enzyme immunoassay. Adversecardiac events and mortality were recorded for 12 months of follow up period.RESULTS: Long-term mortality in patients with ACS was 6.4% in WBC1, 18.2% in WBC2and 40.9% in WBC3 categories, while short term mortality was 2.6%, 3.0% and 18.2%in WBC1, WBC2, and WBC3 categories respectively. Relative to patients in lower 2 WBC categories, patients in the highest category were 7 times more likely to die during 30 days (HR 7.83, p = 0.017) and more than 9 times during the total followup period (HR 9.42, p < 0.001). Cox regression analysis showed WBC3 a strongindependent predictor of mortality (HR 6.36, p = 0.016). WBC count showed apositive correlation with coronary risk factors, cardiac biomarkers and CRP.CONCLUSION: WBC count is a strong independent predictor of mortality in patients with ACS and has positive correlation with coronary risk factors, cardiacbiomarkers and CRP.

PMID: 20929011 [PubMed - indexed for MEDLINE]

3. Eur J Epidemiol. 2009;24(6):329-38. Epub 2009 Apr 30.

The Pakistan Risk of Myocardial Infarction Study: a resource for the study ofgenetic, lifestyle and other determinants of myocardial infarction in South Asia.

Saleheen D, Zaidi M, Rasheed A, Ahmad U, Hakeem A, Murtaza M, Kayani W, FaruquiA, Kundi A, Zaman KS, Yaqoob Z, Cheema LA, Samad A, Rasheed SZ, Mallick NH, AzharM, Jooma R, Gardezi AR, Memon N, Ghaffar A, Fazal-ur-Rehman, Khan N, Shah N, Ali Shah A, Samuel M, Hanif F, Yameen M, Naz S, Sultana A, Nazir A, Raza S, Shazad M,Nasim S, Javed MA, Ali SS, Jafree M, Nisar MI, Daood MS, Hussain A, Sarwar N,Kamal A, Deloukas P, Ishaq M, Frossard P, Danesh J.

Center for Non-Communicable Diseases, Karachi, Pakistan. [email protected]

The burden of coronary heart disease (CHD) is increasing at a greater rate inSouth Asia than in any other region globally, but there is little direct evidenceabout its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS)is an epidemiological resource to enable reliable study of genetic, lifestyle andother determinants of CHD in South Asia. By March 2009, PROMIS had recruited over5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over

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5,000 matched controls aged 30-80 years. For each participant, information hasbeen recorded on demographic factors, lifestyle, medical and family history,anthropometry, and a 12-lead electrocardiogram. A range of biological samples hasbeen collected and stored, including DNA, plasma, serum and whole blood. Duringits next stage, the study aims to expand recruitment to achieve a total of about 20,000 cases and about 20,000 controls, and, in subsets of participants, toenrich the resource by collection of monocytes, establishment of lymphoblastoidcell lines, and by resurveying participants. Measurements in progress includeprofiling of candidate biochemical factors, assay of 45,000 variants in 2,100candidate genes, and a genomewide association scan of over 650,000 geneticmarkers. We have established a large epidemiological resource for CHD in SouthAsia. In parallel with its further expansion and enrichment, the PROMIS resource will be systematically harvested to help identify and evaluate genetic and other determinants of MI in South Asia. Findings from this study should advancescientific understanding and inform regionally appropriate disease prevention andcontrol strategies.

PMCID: PMC2697028PMID: 19404752 [PubMed - indexed for MEDLINE]

4. Angiology. 2007 Jun-Jul;58(3):269-74.

Plasma levels of B-type natriuretic Peptide in patients with unstable anginapectoris or acute myocardial infarction: prognostic significance and therapeutic implications.

Ahmed W, Zafar S, Alam AY, Ahktar N, Shah MA, Alpert MA.

Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan.

Plasma B-type natriuretic peptide (BNP) levels were obtained from 146 patientswith unstable angina pectoris, non-ST-segment elevation myocardial infarction(MI), or ST-segment elevation MI to determine their value in predicting thepresence of new heart failure, recurrent MI or ischemia, or death 1 month afterthe index event. Patients with elevated plasma BNP levels (>80 pg/mL) had asignificantly higher incidence of new heart failure and all-cause mortality than those with a normal plasma BNP level (<or=80 pg/mL). Early revascularization withpercutaneous intervention or coronary artery bypass grafting significantlyreduced the incidence of new heart failure and all-cause mortality in patientswith an elevated plasma BNP level, but had no effect on individual outcomes inthe normal plasma BNP subgroup.

PMID: 17626979 [PubMed - indexed for MEDLINE]

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1. J Pak Med Assoc. 2009 Dec;59(12):819-22.

Admission creatine kinase as a prognostic marker in acute myocardial infarction.

Kazmi KA, Iqbal SP, Bakr A, Iqbal MP.

Department of Medicine, Aga Khan University, Karachi, Pakistan.

OBJECTIVES: To investigate the prognostic significance of creatine kinase (CK) inPakistani patients suffering from acute myocardial infarction (AMI) and to findout if CK combined with troponin T (TnT) could be a better predictor forlong-term adverse cardiac event.METHODS: One hundred and eighty six consecutive patients with AMI who wereeligible for streptokinase (SK) treatment were included in this prospectivecohort study. The relationship between their serum/plasma CK and TnT levels atthe time of admission and clinical outcome was investigated over a mean follow upof 24.12 +/- 3.75 months.RESULTS: Admission CK was found to be associated with subsequent cardiac eventand mortality (P < 0.01 and P < 0.04 respectively). Admission CK was also mildly associated with time interval between onset of symptoms to SK treatment(correlation coefficient 'r' = 0.23). Odds of encountering a cardiac event in AMIpatients with above-normal CK levels (adjusted for gender) were 3.46 times higherthan the odds in patients with normal CK levels. Similarly, odds of mortality in patients with positive TnT were 4.6 times the odds in patients with negative TnT.The two biochemical markers, CK and TnT, together did not provide any furtherinformation about prognosis of the disease.CONCLUSION: Admission CK is a better prognostic marker for a subsequent cardiacevent, while TnT is a better predictor of mortality over a mean follow up ofnearly 2 years. Together, they do not improve predictability of an adversecardiac event.

PMID: 20201171 [PubMed - indexed for MEDLINE]

2. Heart. 2005 Aug;91(8):1003-7.

Metabolic syndrome and risk of coronary heart disease in a Pakistani cohort.

Wierzbicki AS, Nishtar S, Lumb PJ, Lambert-Hammill M, Turner CN, Crook MA, MarberMS, Gill J.

Department of Chemical Pathology, St Thomas's Hospital, London SE1 7EH, [email protected]

OBJECTIVE: To assess the relation of the metabolic insulin resistance syndrome(M-IRS) with coronary heart disease (CHD) in Pakistani patients.SUBJECTS: 200 patients with angiographic disease (CHD(+)) matched with 200

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patients with chest pain without occlusive disease (CHD(-)).DESIGN: Prospective case-control study.SETTING: Tertiary referral cardiology unit in Pakistan.RESULTS: M-IRS was present in 37% of CHD(+) versus 27% of CHD(-) patients bycriteria for white patients or 47% versus 42%, respectively, by Asian criteria (p< 0.001). After adjustment for other risk factors, M-IRS was not a significantpredictor for CHD or angiographic disease. Age (p = 0.03), smoking (p < 0.001),diabetes-years (p = 0.003), sialic acid (p = 0.01), and creatinine (p = 0.008)accounted for the excess risk of CHD. Similarly, age (p = 0.005), creatinine (p <0.001), cigarette pack-years (p = 0.02), diabetes-years (p = 0.003), and sialicacid (p = 0.08) were predictors of greater angiographic disease. M-IRS differedbetween Pakistani and white patients, as waist circumference correlated weakly (r= -0.03-0.08, p = 0.45-0.52) with triglycerides, high density lipoproteincholesterol, systolic blood pressure, or glucose. Sialic acid was the onlyinflammatory marker associated with M-IRS.CONCLUSIONS: Despite strong associations between individual risk factorsassociated with M-IRS and a univariate association between M-IRS and CHD innative Pakistanis, the principal discriminant risk factors in this group are age,smoking, inflammation, diabetes-years, and impaired renal function. The poorsensitivity of M-IRS for CHD reflects the high underlying prevalence of M-IRS,thus reducing sensitivity, confounding by other urban lifestyle traits, or a lackof association of waist circumference with M-IRS risk factors. The definition of M-IRS may have to be revised to increase its power as a discriminant risk factor for CHD in Pakistani populations.

PMCID: PMC1769029PMID: 16020583 [PubMed - indexed for MEDLINE]

3. Clin Cardiol. 2004 Mar;27(3):144-50.

Myoglobin--a marker of reperfusion and a prognostic indicator in patients withacute myocardial infarction.

Iqbal MP, Kazmi KA, Mehboobali N, Rahbar A.

Department of Biological & Biomedical Sciences, The Aga Khan University, Karachi,Pakistan. [email protected]

BACKGROUND: Early noninvasive identification of patients with occludedinfarct-related arteries after thrombolysis has important prognostic andtherapeutic implications. Recent reports indicate that plasma kinetics of cardiacmarker proteins could be very useful in diagnosis of myocardial reperfusion.Although angiographic assessment remains the ideal procedure for determiningpatency, it is expensive, invasive, not within the reach of most patients indeveloping countries, and the long-term follow-up data are still sparse.HYPOTHESIS: The present study was undertaken to investigate whether plasma

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kinetics of myoglobin in conjunction with clinical markers and anotherbiochemical marker, creatine kinase, could be used to predict myocardialreperfusion more accurately and to investigate the correlation between myoglobin release after thrombolysis and mortality in patients with acute myocardialinfarction (AMI) over a follow-up period of 18 months.METHODS: Eighty-three consecutive patients with AMI receiving streptokinasetreatment were studied for plasma kinetics of myoglobin in conjunction withclinical markers and creatine kinase to predict reperfusion and were followed fora period of 18 months.RESULTS: Increased baseline mean +/- standard deviation levels of myoglobin were observed among "nonresponders" to streptokinase treatment compared with"responders" (469 +/- 386 microg/l vs. 270 +/- 211 microg/l). There wassignificantly more release of myoglobin following thrombolytic treatment amongthe responders than among the nonresponders (mean ratio of myoglobin levels at 90min to 0 min 6.01 +/- 9.2 vs. 1.03 +/- 0.64). In a follow-up of 61 patients over a period of 18 months, 31% mortality was observed in the nonresponder groupcompared with 11.7% in the responder group. In responders, the mean ratio ofmyoglobin levels at 90 and 0 min was significantly less among those who died (p =0.019) than among those who survived.CONCLUSION: A myoglobin release profile in combination with other clinicalmarkers offers inexpensive, noninvasive, and a reasonably reliable way ofassessing coronary artery patency after thrombolytic treatment.

PMID: 15049381 [PubMed - indexed for MEDLINE]

4. Trop Doct. 2003 Jan;33(1):18-22.

Admission troponin T as a prognostic marker and it relationship to streptokinase treatment patients with acute myocardial infarction.

Kazmi KA, Iqbal MP, Rahbar A, Mehboobali N.

Department of Medicine, The Aga Khan University, Stadium Road, Karachi 74800,Pakistan.

The relationship between the admission troponinT (TnT) level and the response to streptokinase (SK) was examined in 76 patients with acute myocardial infarction(AMI). Of 27 TnT positive patients, 10 (37%) showed a response to SK as suggestedby a non-invasive criterion for reperfusion, while 24 (49%) were 'responders'among 49 TnT negative patients. There appeared to be a trend towards a betterresponse to SK in the TnT negative group but the difference lacked statisticalpower due to the small sample size. The mean time-interval between the onset ofsymptoms and thrombolytic treatment among TnT positive 'non-responders' wassignificantly (P < 0.005) higher than the TnT negative 'non-responders' (5.23 +3.42 h versus 2.38 +/- 1.37 h). An 18 month follow up on 61 patients revealed ahigher mortality (33%) among TnT positive patients than TnT negative patients

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(10%). Mortality among TnT positive 'non-responders' was significantly higher (P = 0.0494) than mortality among TnT-negative 'non-responders' (43% versus 9%),indicating that TnT positive patients, non-responsive to SK were at a greaterrisk of cardiac death. The data suggest that the admission TnT level can be ofvalue in risk stratification of patients with AMI.

PMID: 12568514 [PubMed - indexed for MEDLINE]

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These are the results of MeSh search for the terms “Troponin I” and “Coronary artery disaease” and “Coronary disease”.

1. J Coll Physicians Surg Pak. 2010 Feb;20(2):74-8.

Emergency evaluation of acute chest pain.

Almas A, Parkash O, Hameed A, Islam M.

Department of Medicine, The Aga Khan University, Karachi. [email protected]

OBJECTIVE: To determine the sensitivity and specificity of initial clinicalassessment about the diagnosis of acute coronary syndrome (ACS) in patientspresenting with acute chest pain by a cardiology resident in the emergency roomand assess the 30-day outcome of patients with ACS and non ACS.STUDY DESIGN: Cohort study.PLACE AND DURATION OF STUDY: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.METHODOLOGY: A total of 202 patients, who presented to the emergency room withchest pain, were given an initial ECG and troponin check. Patients were assigned to initial ACS and non-ACS groups by the cardiology resident. After cardiacworkup, patients were assigned to final ACS/final non ACS group. They werefollowed for outcome after 30 days of initial presentation. Sensitivity andspecificity, if initial workup was determined, keeping final assessment aftercardiac workup as the gold standard.RESULTS: Out of the 202 patients, 61.9% were males. Their mean age was 54.05+13years. Sixty eight percent were placed in the initial ACS group and 30.7% wereplaced in the initial non ACS group. After workup, 36% were placed in the finalACS group and 28.7% in the final non-ACS group and 35% were undecided. Thesensitivity of initial assessment of ACS by the cardiology resident was 100%.However, the specificity was 54.2%. In the 30-day outcome, one patient (1.3%)died in the ACS group due to myocardial ischemia while no patient died from thenon ACS group.CONCLUSION: Initial assessment about ACS by cardiology resident based oncharacter of chest pain, ECG and troponin I is highly sensitive. However, thespecificity is low.

PMID: 20378030 [PubMed - indexed for MEDLINE]

2. Clin Chim Acta. 2010 Jun 3;411(11-12):812-7. Epub 2010 Feb 24.

High-sensitive cardiac troponin I (hs-cTnI) values in patients with stablecardiovascular disease: an initial foray.

Schulz O, Reinicke M, Berghoefer GH, Bensch R, Kraemer J, Schimke I, Jaffe AS.

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Interventionelle Kardiologie Spandau, Berlin, Germany.

Erratum in Clin Chim Acta. 2010 Sep 6;411(17-18):1395-6.

BACKGROUND: How to use the information from novel high sensitivity troponinassays in stable cardiac patients is unclear. Preliminary data from randomizedcontrolled trial analyses suggest it helps with risk stratification. Weinvestigated the determinants, diagnostic impact and prognostic value of a novel high-sensitive cardiac troponin I (hs-cTnI) assay in patients with stable cardiacdisease.METHODS: hs-cTnI was measured with a pre-commercial assay in 222 outpatientsafter clinical testing before cardiac catheterization. Mean follow-up was1103+/-299 days.RESULTS: hs-cTnI was detectable in all patients (median (interquartile range)6.20 (4.85;8.25) ng/l). Creatinine (p<0.001), systolic wall stress (p=0.004), thepresence of myocardial impairment (p=0.049) and coronary artery stenosis > or =70% (p=0.050) were predictors of hs-cTnI concentration. hs-cTnI values could not distinguish elevations due to myocardial abnormalities from those related tocoronary artery abnormalities. Patients with elevations above the 99th percentilehad a higher rate of hospitalizations but otherwise prognosis was not predictedrobustly by hs-cTnI values.CONCLUSION: Stable cardiovascular patients have detectable hs-cTnI concentrationsirrespective of their underlying disease. In this heterogeneous group of patientswith diverse etiologies for cardiac disease, values were not helpful indistinguishing the etiology of the elevations or in predicting prognosis.

PMID: 20188720 [PubMed - indexed for MEDLINE]

3. Coron Artery Dis. 2010 Mar;21(2):78-86.

Impact of multivessel coronary artery disease on early ischemic injury, lateclinical outcome, and remodeling in patients with acute myocardial infarctiontreated by primary coronary angioplasty.

Tarantini G, Napodano M, Gasparetto N, Favaretto E, Marra MP, Cacciavillani L,Bilato C, Osto E, Cademartiri F, Musumeci G, Corbetti F, Razzolini R, Iliceto S.

Department of Cardiac, Thoracic and Vascular Sciences, University of Padua,Padua, Italy. [email protected]

OBJECTIVE: The mechanism through which multivessel coronary artery disease (MVD) adversely affects the outcome of patients with ST-elevation myocardial infarction(STEMI) is poorly characterized. We assessed whether the impact of MVD on outcomeof STEMI patients is because of ischemic damage after primary percutaneouscoronary intervention (PPCI) or to late ischemic events.

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METHODS: From August 2005 to 2007, 288 STEMI patients treated by (bare metal)stent-PPCI were prospectively enrolled. The ischemic injury early after PPCI(evaluated by multiparametric approach) and the incidence of late adversecardiovascular events were compared between the two groups.RESULTS: Compared with single vessel coronary artery disease, MVD patients(n=134) were older, with higher prevalence of diabetes, prior MI, anterior MI andhigher collateral score. Myocardial perfusion as assessed by myocardial blush andSigmaST-segment resolution was similar in the two groups as well as the infarctsize and microvascular obstruction as assessed by Troponin I and by the delayedenhancement of cardiac magnetic resonance. At clinical (98% complete) andechocardiogaphic (94% complete) follow-up (median 32 months) MVD patients showed a higher incidence of re-MI (6.1 vs. 1.3%), and urgent revascularization (8.3 vs.2.7%) and worse left ventricular remodeling than single vessel disease patients. At propensity adjusted analysis MVD was an independent predictor of re-MI (oddsratio: 5.7) and ventricular remodeling (odds ratio: 2.2).CONCLUSION: The impact of MVD on clinical outcome and remodeling of STEMIpatients is not because of the extent of ischemic damage observed after PPCI, butto recurrent ischemic events during follow-up.

PMID: 20071979 [PubMed - indexed for MEDLINE]

4. Am J Cardiol. 2009 Nov 1;104(9):1210-5.

Relation of troponin I levels following nonemergent percutaneous coronaryintervention to short- and long-term outcomes.

Feldman DN, Minutello RM, Bergman G, Moussa I, Wong SC.

New York Presbyterian Hospital, Weill Cornell Medical College, New York, [email protected]

Increases of creatine kinase (CK) and CK-MB cardiac enzymes after nonemergentpercutaneous coronary intervention (PCI) have been associated with an increasedrisk of cardiovascular events during follow-up. However, there are limited dataabout the incidence and prognostic significance of an isolated increase ofcardiac troponin I (cTnI) without an increase in CK-MB after PCI. The aim of thisstudy was to evaluate the impact of an isolated cTnI increase on long-termsurvival in patients undergoing nonemergent PCI with normal CK-MB levels afterPCI. Using the 2004/2005 Cornell Angioplasty Registry, we evaluated the clinical outcomes in 1,601 patients (undergoing elective or urgent PCI) with normalpreprocedure cTnI and CK-MB and normal CK-MB levels after the procedure. Patientswere divided into 2 groups based on the presence of cTnI increase after PCI. The mean follow-up period was 24.6 +/- 7.6 months. An increase in cTnI was observedin 831 patients (51.9%). Drug-eluting stents were used in 87% of patients andglycoprotein IIb/IIIa inhibitors were administered in 48% of patients. Incidence of in-hospital major adverse cardiovascular events was low, 0.1% versus 0% (p =

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1.000), in patients with versus without cTnI increases, respectively. By 2 years of follow-up, Kaplan-Meier survival rates were 94.1% versus 96.4% (log-rank p =0.020) in those with versus without cTnI increases, respectively. By multivariateCox regression analysis, an increase in cTnI after PCI (hazard ratio 1.62, 95%confidence interval 1.01 to 2.59, p = 0.047) was an independent predictor ofincreased long-term mortality. In conclusion, an isolated increase in cTnI after nonemergent PCI is common, not associated with more frequent adverse in-hospital outcomes compared to patients with normal cTnI, and provides long-term prognosticinformation regarding mortality.

PMID: 19840564 [PubMed - indexed for MEDLINE]

5. Cardiology. 2009;114(4):292-7. Epub 2009 Aug 20.

Prediction of hemodynamically significant coronary artery disease using troponin I in hemodialysis patients presenting with chest pain: A case-control study.

Badero OJ, Salifu MO.

Division of Cardiology, SUNY Downstate Medical Center Brooklyn, Brooklyn, NY11203, USA.

OBJECTIVES: Controversy exists regarding utility of cardiac troponin I (cTnI) in predicting significant coronary artery disease (CAD) in hemodialysis (HD)patients with chest pain and no acute ischemia on electrocardiogram (non-STsegment elevation myocardial infarction, non-STEMI). We sought to determine ifcTnI elevation predicts significant CAD (>70% stenosis) in these patients.METHODS: Ninety patients with non-STEMI referred for cardiac catheterization wereincluded, divided equally into HD and non-HD groups.RESULTS: Mean age and baseline characteristics were not significantly differentbetween groups, except for left ventricular hypertrophy which was higher in HDpatients (56 vs. 27%, p = 0.012). Initial cTnI correlated with obstructive CADand was stratified into <0.3 and >0.3 ng/ml. By logistic regression, cTnI >0.3ng/ml was not predictive of CAD in HD patients [odds ratio = 0.87 (95% CI0.19-4.0), p = 0.8], while non-HD patients had an increased risk of CAD if first cTnI was >0.3 ng/ml [odds ratio = 1.461 (95% CI 1.01-2.11), p = 0.04] asexpected. Sensitivity, specificity, negative and positive predictive values ofcTnI in predicting obstructive CAD were better in non-HD patients.CONCLUSION: cTnI in these patients had no predictive value for obstructive CAD.This contrasts with the general population, suggesting a higher index ofsuspicion for high-grade CAD irrespective of cTnI levels in HD patients.

PMID: 19696481 [PubMed - indexed for MEDLINE]

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6. W V Med J. 2009 Jul-Aug;105(4):29-32.

Elevated cardiac troponins in sepsis: what do they signify?

Smith A, John M, Trout R, Davis E, Moningi S.

Robert C. Byrd Health Sciences Center, WVU, Charleston, USA.

Serum troponins are sensitive markers used to diagnose acute coronary syndrome inassociation with signs and symptoms of chest pain and EKG changes. Cardiactroponins are elevated in 85% of patients with sepsis in the absence of acutecoronary syndrome. Small studies have shown that elevated troponin levelsidentify patients with sepsis who are at increased risk of mortality. The purposeof this study was to (1) identify the outcome of cardiac troponin positive sepsispatients in our hospital, (2) determine whether the traditional cardiac riskfactors predispose septic patients for positive troponin and (3) evaluate thecardiac interventions done for troponin positive patients. CONCLUSION: In ourstudy, patients with elevated troponins had a higher mortality. Hypertension(HTN) and Coronary Artery Disease (CAD) increased the risk of mortality introponin positive patients. Several interventions were performed includingmedications, echocardiogram, and cardiology consultation. Treatment medicationsdid not improve mortality rates.

PMID: 19585902 [PubMed - indexed for MEDLINE]

7. Am J Cardiol. 2009 Jun 1;103(11):1622-3.

Prognostic significance of small troponin I rise after a successful electivepercutaneous coronary intervention of a native artery.

Testa L, Latini RA, Agostoni P, Banning AP, Bedogni F.

Comment on Am J Cardiol. 2009 Mar 1;103(5):639-45.

PMID: 19463526 [PubMed - indexed for MEDLINE]

8. Coron Artery Dis. 2009 May;20(3):245-50.

Combination of C-reactive protein and cardiac troponin I for predicting adversecardiac events after sirolimus-eluting stent implantation.

Huang W, Lei H, Liu Q, Ma KH, Qin S, Chang J, Jia FP, He Q, Zuo Z.

Department of Cardiology, First Affiliated Hospital, Chongqing Medical

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University, Chongqing, China.

AIMS: We assessed the predictive value of a combination of C-reactive protein(CRP) and cardiac troponin I (cTnI) in a 2-year prospective study in patientsundergoing sirolimus-eluting stents (SES) implantation.METHODS AND RESULTS: CRP and cTnI levels were examined 1 day before and after SESimplantation in 322 patients. CRP level greater than 3.0 mg/l (defining the high serum CRP levels) and cTnI level greater than 1.0 microg/l (defining the highserum cTnI levels) were considered abnormal. Major adverse cardiac events weredefined as nonfatal myocardial infarction (MI), target vessel revascularization(TVR), and cardiac death. After 2+/-0.2 years of follow-up, there were 11 MI, 19 TVR, and 11 cardiac deaths. After adjustment for relevant risk factors, thecombination of high CRP and cTnI remained predictive of adverse cardiac events,with the presence of both elevated CRP and cTnI associated with the highest risksof MI [relative risk (RR): 4.0, 95% confidence interval (CI): 2.3-6.4], TVR (RR: 3.3, 95% CI: 2.8-5.3), and cardiac death (RR: 4.2, 95% CI: 2.6-6.0). The presenceof either a high CRP or cTnI was associated with an intermediated risk of MI (RR:1.7, 95% CI: 1.2-2.2), TVR (RR: 1.5, 95% CI: 1.2-2.7), and cardiac death (RR:2.8, 95% CI: 2.2-3.6).CONCLUSION: The combination of elevated CRP and cTnI increased the risk ofadverse cardiac events, demonstrating the additive impacts of active inflammationand myocardial injury on prognosis after SES implantation.

PMID: 19387251 [PubMed - indexed for MEDLINE]

9. Am J Cardiol. 2009 Mar 1;103(5):639-45. Epub 2009 Jan 17.

Prognostic significance of small troponin I rise after a successful electivepercutaneous coronary intervention of a native artery.

De Labriolle A, Lemesle G, Bonello L, Syed AI, Collins SD, Ben-Dor I, PintoSlottow TL, Xue Z, Torguson R, Suddath WO, Satler LF, Kent KM, Pichard AD,Lindsay J, Waksman R.

Department of Internal Medicine, Division of Cardiology, Washington HospitalCenter, Washington, DC, USA.

Comment in Am J Cardiol. 2009 Jun 1;103(11):1622-3. Rev Cardiovasc Med. 2009 Summer;10(3):178-9.

Cardiac troponin I is a sensitive marker of myonecrosis. Data regarding theprognostic value of troponin I increase after percutaneous coronary intervention (PCI) are conflicting. A recent American College of Cardiology/American HeartAssociation statement defined a troponin I increase >3 times the 99th percentile as periprocedural myocardial infarction (MI). We sought to evaluate whether or

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not, in patients with a successful elective PCI judged on angiographic andclinical criteria, the postprocedural increase of troponin I could predict 1-yearoutcomes. A cohort of 3,200 consecutive patients with successful elective PCI wasstudied. End points included death/MI and major adverse cardiac events at 1 year.A troponin I increase >97.5th percentile was observed in 1,402 patients (43.8%,mean 0.32 ng/ml, range 0.01 to 4.94). A total of 751 patients (23.4%) had atroponin I increase >3 x 99th percentile. Troponin I status was associated withmore complex coronary disease (19.6% vs 16.4%, p <0.005) and multivessel PCI (2.1vs 1.6, p <0.001). At 1 year, there was no difference in death/MI (2.8% vs 3.5%, p = 0.3) or in major adverse cardiac events (9.6% vs 10.4%, p = 0.5) according tothe level of troponin I increase. The lack of association between troponin Iincrease after PCI and outcome was found when troponin I increase was used as acontinuous or a categorical variable. Logistic regression models failed to findany threshold from which troponin I increase could affect outcome. In conclusion,a small troponin I increase after a successful elective PCI was not infrequentand did not affect outcome in our study. The definition of periprocedural MI may be too strict. Measurement of troponin I after a successful PCI is questionable.

PMID: 19231326 [PubMed - indexed for MEDLINE]

10. Clin Chem. 2009 Jan;55(1):109-16. Epub 2008 Nov 6.

Clinical performance of two highly sensitive cardiac troponin I assays.

Venge P, James S, Jansson L, Lindahl B.

Department of Medical Sciences, Clinical Chemistry, University of [email protected]

BACKGROUND: The aim of this study was to compare the clinical performance of 2sensitive cTnI assays with 10% CV imprecision below the 99th percentile upperreference limit.METHODS: We measured cardiac troponin and N-terminal pro-brain natriureticpeptide (NT-proBNP) concentrations in a random sample of the Global Use ofStrategies To Open Occluded Coronary Arteries (GUSTO) IV cohort (n = 1251).Outcome data of 1-year mortality and the composite endpoint DMI [death and/ormyocardial infarction (MI) within 30 days] were available in all patients. The99th percentile of a healthy population was estimated from the Sweden Women andMen and Ischemic Heart Disease (SWISCH) cohort (n = 442). We measured cardiactroponin I (cTnI) using the Access AccuTnI (Beckman Coulter) and Centaur TnIUltra (Siemens Healthcare Diagnostics) and NT-proBNP using the Elecsys 2010(Roche Diagnostics).RESULTS: Applying the 10% CV cutoff, the sensitivity of the Access AccuTnI assay in identifying DMI and death was higher than that of the Centaur TnI Ultra (P =0.02 and P < 0.001), and the AccuTnI assay also identified more patients at risk (P < 0.001) and with poor outcome. Applying the 99th percentile cutoffs, AccuTnI

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identified more patients at risk than the Centaur TnI (P < 0.001) and withsignificant differences in outcome. Significantly more patients with cardiactroponins below the cutoffs as measured by Centaur TnI had increased NT-proBNPconcentrations (P < 0.001) compared with AccuTnI.CONCLUSIONS: The AccuTnI assay identified more patients at risk than the Centaur cTnI Ultra assay. Our results demonstrate the clinical potential ofhigh-sensitivity cardiac troponin assays for the identification of patients atrisk of dying from cardiovascular disease.

PMID: 18988756 [PubMed - indexed for MEDLINE]

11. Ren Fail. 2008;30(4):357-62.

Cardiac findings in asymptomatic chronic hemodialysis patients with persistently elevated cardiac troponin I levels.

Katerinis I, Nguyen QV, Magnin JL, Descombes E.

Dialysis Unit, Hopital Cantonal, Fribourg, Switzerland.

BACKGROUND: The prevalence and significance of higher than normal cardiactroponin I (cTnI) levels in asymptomatic chronic hemodialysis (HD) patientsremains a source of discussion. The aim of the present study was to evaluate the prevalence of higher than normal cTnI levels in asymptomatic HD patients, asdetermined by the last generation of immunoassay, and to perform furthercardiological investigations in those patients with persistently elevated cTnIlevels.METHODS: All chronic HD patients in our center who had exhibited no symptoms ofcoronary artery disease (CAD) during the previous four weeks were screened. cTnI levels were determined before dialysis in all patients using the last generation AccuTnI assay (UniCel DxI 800, Beckman Coulter). The cTnI levels of thosepatients with elevated cTnI at the screening evaluation were then measuredmonthly for six months. We were thus able to identify a group of patients withpersistently elevated cTnI levels (> 3 consecutive months) who subsequentlyunderwent cardiac echography and dipyridamole-exercise (D-E) thallium testing. Ifstress myocardial ischemia was detected, a coronary angiography was thenperformed.RESULTS: Fifty patients (32 males) were included: mean age 62.8 +/- 13.6 years,20 (40%) with a history of CAD, and 21 (42%) diabetic. At the initial screening, the mean cTnI concentration was 0.05 +/- 0.06 microg/L and the cTnI levels werehigher than normal (> 0.09 microg/L) in six patients (12%). In the follow-up, thecTnI normalized immediately in two patients but remained persistently elevated(range, 0.10-0.48 microg/L) in four (8%). These four patients (all males, onediabetic) had a mean age of 70.2 +/- 6.6 years, and all had heart failure with a history of severe CAD with previous myocardial infarction (n = 4), coronarystenting (n = 3), and/or bypass (n = 2). D-E thallium imaging showed reversible

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myocardial ischemia in all. The stress ischemia involved one to four cardiacsegments and was slight to moderate in three patients and severe in the diabetic patient. A coronary angiogram was performed in all patients, and showed lesionsof variable severity: severe three-vessel CAD with severe systolic dysfunction intwo patients (including the diabetic), and non-critical/peripheral coronarystenosis in the other two.CONCLUSIONS: Among the asymptomatic HD patients in our center, we identified four(8%) with persistently elevated cTnI levels, as determined using the lastgeneration AccuTnI assay. All of them had a history of severe CAD with heartfailure and exhibited reversible myocardial ischemia upon D-E thallium imaging;coronary angiography revealed coronary lesions of variable severity. Overall, ourdata indicate that persistent low-grade cTnI elevation occurs in HD patientshaving longstanding severe cardiac disease, but, from our data, it is difficultto reach a conclusion as to the best clinical approach for this group ofpatients.

PMID: 18569907 [PubMed - indexed for MEDLINE]

12. J Thromb Thrombolysis. 2008 Oct;26(2):132-7. Epub 2007 Dec 7.

Postmortem cardiac troponin-I levels predict intramyocardial damage at autopsy.

Vargas SO, Grudzien C, Tanasijevic MJ.

Department of Pathology, Children's Hospital, Harvard Medical School, Boston, MA,USA.

Serum cardiac troponin levels are now widely used in the diagnosis of myocardial infarct (MI) and injury in living patients, but their utility in postmortemdiagnosis has not been established. We evaluated postmortem cardiac troponin-I(cTnI) levels in serum from 53 hospital patients undergoing autopsy andcorrelated the levels with anatomic findings at postmortem examination. Amongpatients with nonischemic cardiac disease, those with intramyocardial disease(e.g., cardiac transplant rejection, intramyocardial tumor) had significantlyhigher cTnI levels than those with disease confined to the pericardium (e.g.,epicardial tumor implants, pericarditis) (p = 0.004). No correlation was foundbetween recent MI and cTnI level. There was also no correlation between cTnIlevel and the presence of chronic ischemic features, a history of cardiopulmonaryresuscitation, or postmortem interval. We conclude that cTnI is detectable inpostmortem serum samples and, although its levels did not correlate specifically with ischemia or infarction in our series, its levels appear to correlatesignificantly with intramyocardial injury. Use of cardiac troponin in thepostmortem diagnosis of cardiac disease may be warranted.

PMID: 18064406 [PubMed - indexed for MEDLINE]

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13. Circulation. 2007 Oct 23;116(17):1907-14. Epub 2007 Oct 1.

Persistent cardiac troponin I elevation in stabilized patients after an episodeof acute coronary syndrome predicts long-term mortality.

Eggers KM, Lagerqvist B, Venge P, Wallentin L, Lindahl B.

Department of Medical Sciences, Cardiology, University Hospital Uppsala, S-751 85Uppsala, Sweden. [email protected]

BACKGROUND: In patients with non-ST-elevation acute coronary syndrome, anytroponin elevation is associated with an increased risk for cardiovascularevents. However, the prevalence and prognostic importance of persistent troponin elevation in stabilized patients after an episode of non-ST-elevation acutecoronary syndrome are unknown and were therefore assessed in this study.METHODS AND RESULTS: Cardiac troponin I (cTnI) was measured in 1092 stabilizedpatients at 6 weeks and 3 and 6 months after enrollment in the FRagmin and FastRevascularization during InStability in Coronary artery disease (FRISC-II) trial.cTnI was analyzed with the Access AccuTnI assay with the application of differentprognostic cutoffs. Outcomes were assessed through 5 years. Elevated cTnI levels >0.01 microg/L were found in 48% of the study patients at 6 weeks, in 36% at 6months, and in 26% at all 3 measurements. cTnI elevation was associated withincreased age and other cardiovascular high-risk features. The lowest tested cTnIcutoff (0.01 microg/L) was prognostically most useful and was independentlypredictive of mortality (hazard ratio, 2.1 [95% confidence interval, 1.3 to 3.3];P=0.001) on multivariable analysis adjusted for cardiovascular risk factors andrandomization to an invasive versus noninvasive treatment strategy, whereas itwas related to myocardial infarction only on univariate analysis.CONCLUSIONS: Persistent minor cTnI elevation can be detected frequently inpatients stabilized after an episode of non-ST-elevation acute coronary syndrome with the use of a sensitive assay. Elevated cTnI levels >0.01 microg/L predictmortality during long-term follow-up. Our results emphasize the importance offurther troponin testing in non-ST-elevation acute coronary syndrome patientsafter hospital discharge.

PMID: 17909103 [PubMed - indexed for MEDLINE]

14. J Card Surg. 2007 Sep-Oct;22(5):394-400.

Evaluation by cardiac troponin I: the effect of ischemic preconditioning as anadjunct to intermittent blood cardioplegia on coronary artery bypass grafting.

Ji B, Liu M, Liu J, Wang G, Feng W, Lu F, Shengshou H.

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Department of Cardiopulmonary Bypass, Cardiovascular Institute & Fuwai Hospital, PUMC & CAMS, Beijing, China. [email protected]

OBJECTIVE: Ischemic preconditioning (IPC) is commonly regarded as having apowerful internal protective effect on the organs. The mechanism of IPC is notclear yet, and the controversy over the benefits and protocol of IPC stillcontinues. In this study, we used the sensitive and specific biochemical marker: cardiac troponin-I (CTnI) to evaluate whether IPC as an adjunct to intermittentcold blood cardioplegia (CBC) could reduce myocardial injury, as opposed tosimple CBC during coronary artery bypass grafting (CABG).METHODS: From May 2003 to December 2003, 40 patients with three vessel coronaryartery disease (CAD) and stable angina, receiving first-time elective CABG, were randomly divided into two equal groups: IPC plus CBC (IPC + CBC group, n = 20);and CBC (CBC group, n = 20). The patients in IPC + CBC group received two cycles of ischemia (two min) and reperfusion (three min) before myocardial arrestinduced by CBC. The patients in CBC group received 10-minute normothermiccardiopulmonary bypass (CPB) before CBC arrest. Clinical outcomes were observedduring and after the operation. Serial venous blood samples were obtained before induction, after CPB, and postoperatively 6, 12, 24, and 72 hours. Hemodynamicindexes were obtained before and after the bypass by the radial catheter andSwan-Ganz catheter.RESULTS: In both groups, there were no differences regarding operativeparameters. Compared to the baseline, the level of CTnI increased after CPB,peaked 6-12 hours (p < 0.01). Compared to IPC + CBC group, plasma concentrations of CTnI in CBC group were significantly higher at 6 and 12 hours (p < 0.05). CIrecovery in IPC + CBC group was more significant than CBC group at 12 and 24hours (p < 0.05). IPC + CBC also shortened the time of postoperative mechanicalventilation (p < 0.05) after surgery.CONCLUSION: Compared to the simple CBC in lower-risk CABG patients, IPC as anadjunct to CBC reduced CTnI release, improved heart function after surgery, andshortened the time of recovery in CAD patients.

PMID: 17803575 [PubMed - indexed for MEDLINE]

15. J Thromb Thrombolysis. 2008 Jun;25(3):239-46. Epub 2007 Jun 16.

Effects of persistent platelet reactivity despite aspirin therapy on cardiactroponin I and creatine kinase-MB levels after elective percutaneous coronaryinterventions.

Gulmez O, Yildirir A, Kaynar G, Konas D, Aydinalp A, Ertan C, Ozin B,Muderrisoglu H.

Department of Cardiology, Baskent University Faculty of Medicine, Ankara, [email protected]

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BACKGROUND: Creatinine kinase-MB (CK-MB) and cardiac troponin I (cTnI) elevationsare highly specific for myonecrosis after percutaneous coronary intervention(PCI). Aspirin is used to prevent thrombotic complications. Several studies have shown that some individuals exhibit a reduced or completely missing antiplatelet response to aspirin. The aim of this study is to investigate the effects ofplatelet reactivity despite aspirin therapy on CK-MB and cTnI levels afterelective percutaneous coronary interventions despite 600 mg loading dose ofclopidogrel.METHODS: One hundred fourteen (mean age 61.2+/-9.3 years, 78.1% male) patientsreceiving 300 mg daily enteric coated aspirin for at least 7 days with documentedcoronary artery disease were included in the study. Platelet reactivity despiteaspirin was measured by platelet function analyzer (PFA)-100 collagen/epinephrinecartridge. Blood samples for CK-MB and cTnI were obtained before and at 6, 24,and 36 h after the PCI. Persistent platelet reactivity was defined whencollagen/epinephrine closure time<165 s.RESULTS: A total of 87 (76.4%) patients were noted to have normal plateletreactivity (Group A), and 27 (23.6%) had persistent platelet reactivity (GroupB). The elevations of CK-MB and cTnI levels were statistically significant withinthe groups (both P<0.001). However, there were no significant differences in the CK-MB and cTnI levels of the groups at baseline and after PCI for all studiedhours.CONCLUSION: Persistent platelet reactivity was not associated with increased riskof CK-MB, cTnI elevations in low-to-intermediate risk PCI patients.

PMID: 17574519 [PubMed - indexed for MEDLINE]

16. Clin Chem Lab Med. 2006;44(8):1022-9.

Evaluation of the analytical performance of the advanced method for cardiactroponin I for the AxSYM platform: comparison with the old method and the Access system.

Storti S, Prontera C, Parri MS, Iervasi A, Vittorini S, Emdin M, Zucchelli GC,Longombardo G, Migliorini P, Clerico A.

CNR Institute of Clinical Physiology, University of Pisa, Pisa, Italy.

BACKGROUND: The determination of cardiac troponins is routinely used for rulein/out, risk stratification, and follow-up of patients with acute coronary arterysyndrome. We evaluated the analytical and clinical performance of the advancedimmunoassay for troponin I (cTnI) carried out on an AxSYM platform (AbbottDiagnostic Division) and compared these characteristics to those of the previous version of this assay and to cTnI on the Access 2 immunoassay system (BeckmanCoulter, Inc.).METHODS: We assayed plasma samples from healthy subjects (n=66) and cardiacpatients (n=132) using AxSYM Plus system assays called the old (OLD AxSYM) and

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advanced TnI (ADV AxSYM) methods and using an Access system.RESULTS: An improvement in analytical sensitivity (detection limit) was observed for the advanced cTnI AxSYM compared to the previous method (0.014 vs. 0.31microg/L), while the cTnI value for the 10% CV (i.e., functional sensitivity) was0.41 microg/L for the ADV and 1.9 microg/L for the OLD method. The kinetics ofcTnI release was similar, as evaluated in 25 patients with typical acutemyocardial infarction (AMI). A close linear relationship was found between thetwo methods on the AxSYM system (OLD cTnI=7.436+6.858 ADV cTnI; R=0.968, n=214)and with the Access system (OLD AxSYM=7.154+7.9 Access, R=0.876, n=158; ADVAxSYM=0.23+1.209 Access, R=0.927, n=160). However, wide bias was found betweenthe OLD and ADV AxSYM methods (mean difference 118.4 microg/L, p<0.0001), whilemore similar results were found between the ADV AxSYM and Access methods (meandifference 2.6 microg/L, corresponding to a mean percentage difference of 17%,p<0.0001). In 106 patients with symptomatic rheumatoid arthritis with highrheumatoid factor (RF) concentration, the mean cTnI measured by the ADV AxSYMmethod was 0.009+/-0.031 mug/L (range 0-0.23 microg/L) with a significantcorrelation (R=0.316, p=0.001) between cTnI and RF values. Furthermore, in 60 of these serum samples the cTnI concentration was also measured using the Accessmethod; significant correlation with the values found by the ADV AxSYM method wasobserved (R=0.468, p=0.0002).CONCLUSIONS: The present study indicates that the AxSYM Troponin-I ADVimmunoassay shows improved analytical sensitivity compared to the OLD AxSYMmethod, as well as very similar clinical results to those determined using theAccess method.

PMID: 16879072 [PubMed - indexed for MEDLINE]

17. Coron Artery Dis. 2006 May;17(3):249-53.

Prognostic factors in patients with minor troponin-I elevation but without acute myocardial infarction.

Lee SH, Yoon SB, Jung JH, Choi SH, Lee N, Cho GY, Oh DJ, Rhim CY, Lee KH.

Cardiology Division, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea. [email protected]

OBJECTIVES: Although cardiac troponin I is widely used as a marker for myocardialinfarction, its minor elevations are also observed in other clinical situations, and the prognostic factors in such clinical settings have not been wellestablished. The aim of this study was to identify predictors of mortality inpatients with minor troponin elevations without an acute myocardial infarction.METHODS: We consecutively enrolled 134 patients from the emergency departmentwith a peak troponin I level greater than the lower limit of detectability (0.04 ng/ml) but less than the 10% coefficient of variation cutoff value for diagnosis of myocardial infarction (0.26 ng/ml). These patients had chest pain or

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nonspecific symptoms of a circulatory abnormality but lacked the traditionalfeatures of an acute myocardial infarction. End point was defined as death fromall causes. Cox regression analysis was used to test relations between clinicaland biochemical variables and the outcome.RESULTS: During the follow-up of 7.6+/-7.4 months, 12 patients died. Age, logcreatine kinase myocardial isoform, and log C-reactive protein were found to besignificantly correlated with death. After adjusting for possible confounders in the multivariate model, age (hazard ratio 1.09, confidence interval 1.02-1.16,P=0.012), log creatine kinase myocardial isoform (hazard ratio 13.11, confidence interval 2.01-85.52, P=0.007), and log C-reactive protein (hazard ratio 1.64,confidence interval 1.02-2.56, P=0.041) were identified as independent predictorsof mortality.CONCLUSIONS: Creatine kinase myocardial isoform and C-reactive protein levels andage can be integrated to risk-stratify patients with minor troponin I elevationfor reasons other than acute myocardial infarction.

PMID: 16728875 [PubMed - indexed for MEDLINE]

18. Eur Heart J. 2006 Mar;27(5):547-52. Epub 2006 Jan 13.

Effects of metoprolol therapy on cardiac troponin-I levels after electivepercutaneous coronary interventions.

Atar I, Korkmaz ME, Atar IA, Gulmez O, Ozin B, Bozbas H, Erol T, Aydinalp A,Yildirir A, Yucel M, Muderrisoglu H.

Department of Cardiology, Faculty of Medicine, University of Başkent, Ankara,Turkey. [email protected]

AIMS: Beta-blockers (BBs) have been shown to improve survival and reduce the riskof re-infarction in patients following myocardial infarction. There areconflicting data about the effects of BB therapy on cardiac biomarkers afterpercutaneous coronary interventions (PCIs). The aim of the study was toinvestigate the effects of BB use on cardiac troponin-I (cTnI) levels in patientswho had undergone elective PCI.METHODS AND RESULTS: In this prospective study, 287 patients with coronary arterydisease were included. Patients were randomized either to BB or control groupsprior to the intervention. Blood samples for cTnI were obtained before and at 6, 24, and 36 h after the procedure. Of the 287 patients included, 143 receivedmetoprolol succinate 100 mg/day, and 144 received no BB and served as the controlgroup. Baseline clinical characteristics of both groups, except for history ofcoronary artery bypass graft surgery, were similar. We observed no significantdifference in the elevation of cTnI levels between the two groups after PCI (BBgroup, 17 patients, 11.9%; control group, 10 patients, 6.9%; P=0.2).CONCLUSION: Metoprolol succinate therapy seems to have no cardioprotective effectin limiting troponin-I rise after PCI.

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PMID: 16415095 [PubMed - indexed for MEDLINE]

19. Atherosclerosis. 2005 Sep;182(1):161-7. Epub 2005 Mar 5.

Association of inflammatory biomarkers and cardiac troponin I with multifocalactivation of coronary artery tree in the setting of non-ST-elevation acutemyocardial infarction.

Zairis MN, Lyras AG, Bibis GP, Patsourakos NG, Makrygiannis SS, Kardoulas AD,Glyptis MP, Prekates AA, Cokkinos DV, Foussas SG.

Department of Cardiology, Tzanio Hospital, Afentouli Street, Piraeus 18536,Greece. [email protected]

We evaluated the possible association of the serum levels of C-reactive protein(CRP), serum amyloid A (SAA), fibrinogen, and cardiac troponin I (cTnI) with the presence of complex angiographic characteristics throughout the coronary arterytree in 519 consecutive patients with non-ST-elevation acute myocardialinfarction (NSTEMI). Blood samples were obtained in the first 12h of NSTEMIinvasion and all patients underwent in-hospital coronary angiography. Coronarylesions were classified as complex lesion (CL) or non-CL according to Ambrosecriteria. Serum levels of CRP (p<0.001), SAA (p<0.001), or fibrinogen (p=0.001), but not of cTnI (p=0.9), were significantly related to the presence of multiple(> or =2) CLs. On the contrary, serum levels of cTnI (p<0.001), but not of CRP(p=0.5), SAA (p=0.9), or fibrinogen (p=0.9), were significantly associated withthe severity of coronary artery disease. The results of the present study suggestthat elevated levels of inflammatory biomarkers are associated with a generalizedactivation of coronary artery tree while elevated cTnI levels are associated withthe severity of coronary artery disease in the setting of NSTEMI. It seems thatinflammatory biomarkers and cTnI reflect different aspect of the process involvedin unstable coronary artery disease.

PMID: 16115487 [PubMed - indexed for MEDLINE]

20. Scand Cardiovasc J. 2004 May;38(2):75-9.

Troponin must be measured before and after PCI to diagnose procedure-relatedmyocardial injury.

Gustavsson CG, Hansen O, Frennby B.

Department of Cardiology, University Hospital, S-205 02 Malmö, [email protected]

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OBJECTIVE: To evaluate troponin I >99th percentile of normal as a criterion formyocardial injury after percutaneous coronary intervention (PCI).DESIGN: Troponin I and creatine kinase monobasic (CK-MB) were measured in 327patients before and after percutaneous transluminal coronary angioplasty (PTCA)with stent implantation.RESULTS: Troponin I was elevated before PCI in 100 of a total of 222 patientswith acute coronary syndrome (ACS). In 91 of these 100 patients, troponin I waselevated also after PCI but actual increases in troponin I concentrations frombefore to after PCI were found in only 32 patients. The increase of troponin Icorrelated with post-procedural CK-MB whereas post-procedural troponin I levelsdid not correlate. In the 122 patients with ACS but normal/normalized troponin I before PCI and in 105 patients with stable coronary artery diseasepost-procedural troponin I appeared to be a reliable indicator of myocardialinfarction (MI), however more sensitive than CK-MB.CONCLUSION: Troponin I after PCI is sensitive to pre-procedural concentrations.To avoid false positive MI diagnoses we thus suggest that troponin I should bemeasured before as well as after the procedures and only actual increases should be regarded as indicating procedure-related MI.

PMID: 15204231 [PubMed - indexed for MEDLINE]

21. Clin Nephrol. 2004 Jan;61(1):40-6.

Single and serial measurements of cardiac troponin I in asymptomatic patients on chronic hemodialysis.

Roberts MA, Fernando D, Macmillan N, Proimos G, Bach LA, Power DA, Ratnaike S,Ierino FL.

Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia.

AIMS: Coronary artery disease is the major cause of death in patients withend-stage renal failure on dialysis. This study aimed to assess the predictivevalue of a single cardiac troponin I (cTnI), and also the kinetics of serialvalues.METHODS: Since cTnI is a potential biomarker of cardiac outcome, the presentstudy examined single cTnI measurements (n = 88 patients) and its predictivevalue for future cardiac events, and a kinetic substudy of serial weekly cTnImeasured for 8 weeks (n = 57) in a group of patients on hemodialysis.RESULTS: Single cTnI measurements: 9 patients (10.2%) had a detectable cTnI atbaseline and 79 patients (89.8%) had a negative baseline cTnI. There were nosignificant differences in age, sex, history of ischemic heart disease, diabetes,smoking or dyslipidemia between patients with detectable and negative cTnI. Atthe end of 9 months, the rate of combined primary endpoints, which includedmyocardial infarction, cardiac death and cardiac revascularization, was

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significantly higher in the patients with a detectable baseline cTnI (55.6%),compared to patients with a negative cTnI (6.3%) (p = 0.0007). Serial weekly cTnImeasurements: significant fluctuations in cTnI were noted over time; 27% ofpatients with an undetectable cTnI measured at baseline had subsequent detectablelevels in the serial follow-up.CONCLUSION: A single detectable cTnI in asymptomatic patients on hemodialysisdefines patients at high risk of future cardiac events. However, the incidence ofdetectable cTnI levels is markedly increased when serial weekly measurements are performed. The clinical significance of detectable serial measurements of cTnI isthe focus of ongoing studies.

PMID: 14964456 [PubMed - indexed for MEDLINE]

22. Med Sci Monit. 2003 Dec;9(12):CR519-22.

Severity of coronary artery disease in patients with acute coronary syndromewithout ST segment elevation is related to baseline troponin I and ST-segmentdepression.

Gil M, Zarebiński M, Adamus J.

Medical Department, Eli Lilly Polska, Warsaw, Poland.

BACKGROUND: Risk assessment for patients admitted with acute coronary syndrome(ACS) is usually based on the past medical history, along with several clinicaland biochemical criteria. We hypothesised that stratification of patients withACS according to the presence of ST-segment depression and results of aqualitative troponin I test would identify subjects with more severe disease who may benefit from an earlier, more aggressive strategy.MATERIAL/METHODS: The study group consisted of 115 patients hospitalized fortypical chest pain (>5 min) occurring within the last 24 hours, with coronaryangiography. Blood was drawn for routine biochemistry and qualitative troponin I testing, and ECG was performed on admission.RESULTS: Patients were classified according to the presence of ST segmentdepression (ST) and the troponin I test results (T) into three categories: group A, consisting of 34 patients with ST+/T+; group B, consisting of 84 patients witheither ST+/T- or ST-/T+; and group C, consisting of 7 subjects with ST-/T-. This stratification correlated significantly with the extent of coronary arterydisease (p=0.0004). Significant coronary artery stenosis was significantly moreprevalent in patients from groups A and B than in C (p<0.002). No difference inthe patients' medical history, apart from more frequent AMI within the past 10days in group A (p=0.009) was found between groups.CONCLUSIONS: Admission assessment of ECG and troponin I tests in patients withACS may identify subjects with significant coronary artery disease, who are athigh risk and could benefit from aggressive therapy.

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PMID: 14646974 [PubMed - indexed for MEDLINE]

23. J Am Coll Cardiol. 2003 Nov 19;42(10):1767-76.

Heart rate variability and cardiac troponin I are incremental and independentpredictors of one-year all-cause mortality after major noncardiac surgery inpatients at risk of coronary artery disease.

Filipovic M, Jeger R, Probst C, Girard T, Pfisterer M, Gürke L, Skarvan K,Seeberger MD.

Department of Anesthesia, University of Basel/Kantonsspital, [email protected]

OBJECTIVES: The aim of this study was to determine whether perioperativemeasurements of heart rate variability (HRV) and cardiac troponin I (cTnI) addadditional prognostic information to established risk scores for first-yearmortality in patients at risk of coronary artery disease (CAD) undergoing majornoncardiac surgery.BACKGROUND: In cardiac-risk patients undergoing major noncardiac surgery, theshort- and long-term prognoses are mainly influenced by perioperative cardiaccomplications. Heart rate variability and cTnI are important prognostic markersin patients with congestive heart failure and myocardial infarction.METHODS: In a prospective study, 173 patients with CAD or at high risk of CADundergoing major noncardiac surgery were followed up for one year. The mainoutcome measure was all-cause mortality. In addition to clinical parameters andestablished risk scores, HRV and cTnI were assessed perioperatively.RESULTS: Twenty-eight (16%) patients died within one year. Multivariate logistic regression analysis revealed three findings that were independently associatedwith death within the first year after surgery: the revised cardiac risk index(odds ratio 6.2 [95% confidence interval 1.6 to 25], depressed HRV beforeinduction of anesthesia (16.2 [2.8 to 94]), and elevation of cTnI onpostoperative day 1 or 2 (9.8 [3.0 to 32]).CONCLUSIONS: Depressed HRV before induction of anesthesia and elevated cTnIpostoperatively are independent and powerful predictors of one-year mortality forpatients at risk of CAD undergoing major noncardiac surgery and add incrementalprognostic information to established risk scores that only consider preoperativeinformation.

PMID: 14642686 [PubMed - indexed for MEDLINE]

24. Clin Chem. 2003 Jun;49(6 Pt 1):880-6.

Clinical and analytical performance of the liaison cardiac troponin I assay in

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unstable coronary artery disease, and the impact of age on the definition ofreference limits. A FRISC-II substudy.

Venge P, Johnston N, Lagerqvist B, Wallentin L, Lindahl B; FRISC-II Study Group.

Department of Medical Sciences, University of Uppsala, SE-751 85 Uppsala, [email protected]

Comment in Clin Chim Acta. 2007 Jun;381(2):182-3.

BACKGROUND: Measurements of cardiac troponins are currently used as the standard for the detection of myocardial injury. None of the current assays complies with the new requirements on assay imprecision as proposed by the European Society of Cardiology/American College of Cardiology. Our aim was to evaluate the clinicaland analytical performance of the Liaison cardiac troponin I (cTnI) assay.METHODS: EDTA-plasma was used, and cardiac troponins were assayed with thefirst-generation AxSYM assay, the second-generation AccuTnI assay, thethird-generation Elecsys assay, and the first-generation Liaison assay.RESULTS: In a 6-day imprecision study, the Liaison cTnI assay had mean CV < or=10% at 0.027 microg/L and < or =20% at 0.015 microg/L. The 99th percentile ofthe upper reference limit (URL) of a reference population was 0.041 microg/L (agerange, 41-76 years). Individuals <60 years had a significantly (P = 0.001) lower 99th percentile, 0.022 microg/L. The FRISC-II study participants with cTnI > or=0.041 microg/L had a poorer outcome relating to death/acute myocardialinfarction than those with cTnI <0.041 microg/L (P <0.001). Treatment withlow-molecular-weight heparin (dalteparin) or an invasive strategy reduced cardiacevents only in patients with concentrations >0.041 microg/L (P = 0.002 and 0.02, respectively). Comparison with the AccuTnI assay showed that a large cohort ofthe patients with poor prognosis was identified by the AccuTnI assay but not bythe Liaison cTnI assay.CONCLUSION: The Liaison cTnI assay is a sensitive assay with a CV < or =10% atthe 99th percentile URL. The ability to detect age-related differences amongapparently healthy individuals is unique among today's commercial assays. Theresults indicate that different assays seem to identify different patient cohortsfor cardiac risk in the lower range of cTnI concentrations.

PMID: 12765983 [PubMed - indexed for MEDLINE]

25. Heart Dis. 2002 Jul-Aug;4(4):216-9.

Does the serum cardiac troponin I level increase with stress test-inducedmyocardial ischemia?

Choragudi NL, Aronow WS, Prakash A, Kurup SK, Chiaramida S, Lucariello R.

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Division of Cardiology, Westchester Medical Center, Valhalla, New York, USA.

To evaluate the sensitivity of the serum cardiac troponin I level in detectingstress test-induced myocardial ischemia, the authors conducted a prospectivestudy including patients admitted for chest pain to the telemetry floor of OurLady of Mercy Medical Center at Bronx, NY. Consecutive 134 telemetry patientsthat agreed to participate in this study were included. All of these patients hada nuclear stress test and were divided into various groups based on the prestresstest probability of having coronary artery disease. To assess serum cardiactroponin I levels, blood samples were drawn before and after stress testing andcompared with the stress test results. Overall, 30 patients (22%) had reversible perfusion defects on stress images, and none (0%) had increased serum cardiactroponin I levels. One patient of 18 patients (6%) in group C with negativestress test results had an elevated serum cardiac troponin I level after thestress test, but none of group A or group B patients had elevated troponin Ilevels. These data show that serum cardiac troponin I levels do not increase withstress test-induced myocardial ischemia.

PMID: 12147181 [PubMed - indexed for MEDLINE]

26. Am J Cardiol. 2002 May 1;89(9):1111-3.

Intravascular ultrasound findings in patients with acute coronary syndromes with and without elevated troponin I level.

Fuchs S, Stabile E, Mintz GS, Pappas CK, Maehara A, Gruberg L, Satler LF, PichardAD, Kent KM, Weissman NJ.

Cardiovascular Research Institute and the Cardiac Catheterization Laboratories,Washington Hospital Center, Washington, DC 20010, USA. [email protected]

PMID: 11988203 [PubMed - indexed for MEDLINE]

27. Int J Cardiol. 2002 Apr;83(1):43-6.

Plasma fibrinogen and troponin I in acute coronary syndrome and stable angina.

Gil M, Zarebiński M, Adamus J.

Registrar, Department of Cardiology, Military Hospital, Warsaw, [email protected]

We aimed to determine whether there is a stratification among patients withdifferent stages of coronary artery disease with respect to plasma fibrinogenlevels, and to assess diagnostic value of plasma fibrinogen in comparison to

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troponin I in patients with acute coronary syndrome. Fifty-one consecutivepatients presenting to our department with acute coronary syndrome within thelast 24 h and 52 patients with stable angina with no episode of unstable disease within the last month were analysed. Forty-nine patients with acute coronarysyndrome in which both troponin I and fibrinogen levels were present were furtherevaluated. Blood was collected on admission for routine laboratory tests.Statistical analysis was done using Student's t-test, Pearson correlation andchi-square test, P<0.05 being considered statistically significant. Plasmafibrinogen levels (g/l) were significantly higher in patients presenting withunstable than with stable angina (3.87+/-1.2 vs. 3.26+/-0.65 P=0.002). We havefound significant correlation between fibrinogen and troponin I levels inunstable patients (r=0.43, P=0.0015). In patients with acute coronary syndrome anincreased inflammation and cardiac injury seem to coexist and correlate. Theseresults seem to confirm the role of this acute phase protein in thepathophysiology of acute coronary syndrome.

PMID: 11959383 [PubMed - indexed for MEDLINE]