Impact of Pre-existing Cardiovascular Disease and Risk Factors for Cardiovascular Disease in Pregnancy on Maternal Mortality

Abstract BackgroundCardiovascular disease (CVD) and risk factors for CVD are important indirect causes of maternal mortality in lower-middle-income countries (LMIC). The purpose of this research was to assess the prevalence of pre-existing CVD and risk factors for CVD in pregnant women and their relationship to maternal mortality in LMIC.ResultsThis was a cross-sectional study conducted on 3190 pregnant patients with pre-existing CVD and risk factors for CVD from 1st January 2018 through 31st December 2020 at a tertiary care hospital of Pakistan-a LMIC. A two-tailed Mann-Whitney two-sample rank-sum test, fisher’s exact test, and binary logistic regression were used for statistical analysis.Of 3190 patients, 517 (16.21%) individuals had risk factors for CVD, whereas 533 had pre-existing CVD (16.71 %). Diabetes mellitus type II was the most common risk factor for CVD, accounting for 238 (7.46 %) of all patients, followed by dyslipidemia in 162 (5.08 %), obesity in 153 (4.8 %), chronic hypertension in 151 (4.73 %), and family history (FH) of premature coronary artery disease (CAD) in 56 (1.76 %). Among patients with pre-existing CVD, 197 (6.18%) had ischemic heart disease (IHD), 182 (5.71%) had valvular heart disease (VHD), and 146 (4.58%) had cardiomyopathy. In this study majority of maternal deaths occurred in patients with diabetes (128(54%), p<.001) and ischemic heart disease (87(37%), p<.001). A one-unit rise in BMI increased maternal mortality by 13%. In contrast, the absence of Pre-existing CVD and risk factors for CVD conferred a protective effect from the adverse outcome i.e. maternal death. Maternal mortality was reduced by 66% in normoglycemic pregnant patients, 47% in patients without chronic HTN, 90% in patients without valvular heart disease, 97% without ischemic heart disease, and 99% without cardiomyopathy.ConclusionCVD and risk factors for CVD are major determinants of maternal mortality in pregnancy. Identifying such patients is imperative so that prompt measures can be taken beforehand to prevent adverse outcomes.

Download Full-text

Influence of Conventional Cardiovascular Risk Factors and Lifestyle Characteristics on Cardiovascular Disease After Hematopoietic Cell Transplantation

Journal of Clinical Oncology ◽

10.1200/jco.2013.52.6582 ◽

2014 ◽

Vol 32 (3) ◽

pp. 191-198 ◽

Cited By ~ 53

Author(s):

Eric J. Chow ◽

K. Scott Baker ◽

Stephanie J. Lee ◽

Mary E.D. Flowers ◽

Kara L. Cushing-Haugen ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Cardiovascular Risk Factors ◽

Cell Transplantation ◽

Hematopoietic Cell Transplantation ◽

Ischemic Heart

Purpose To determine the influence of modifiable lifestyle factors on the risk of cardiovascular disease after hematopoietic cell transplantation (HCT). Patients and Methods HCT survivors of ≥ 1 year treated from 1970 to 2010 (n = 3,833) were surveyed from 2010 to 2011 on current cardiovascular health and related lifestyle factors (smoking, diet, recreational physical activity). Responses (n = 2,362) were compared with those from a matched general population sample (National Health and Nutrition Examination Survey [NHANES]; n = 1,192). Results Compared with NHANES participants, HCT survivors (median age, 55.9 years; median 10.8 years since HCT; 71.3% allogeneic) had higher rates of cardiomyopathy (4.0% v 2.6%), stroke (4.8% v 3.3%), dyslipidemia (33.9% v 22.3%), and diabetes (14.3% v 11.7%; P < .05 for all comparisons). Prevalence of hypertension was similar (27.9% v 30.0%), and survivors were less likely to have ischemic heart disease (6.1% v 8.9%; P < .01). Among HCT survivors, hypertension, dyslipidemia, and diabetes were independent risk factors for ischemic heart disease and cardiomyopathy, and smoking was associated with ischemic heart disease and diabetes (odds ratios [ORs], 1.8 to 2.1; P = .02). Obesity was a risk factor for post-transplantation hypertension, dyslipidemia, and diabetes (ORs ≥ 2.0; P < .001). In contrast, lower fruit/vegetable intake was associated with greater risk of dyslipidemia and diabetes (ORs, 1.4 to 1.8; P ≤ .01), and lower physical activity level was associated with greater risk of hypertension and diabetes (ORs, 1.4 to 1.5; P < .05). Healthier lifestyle characteristics among HCT survivors attenuated risk of all cardiovascular conditions assessed. Conclusion Attention of clinicians to conventional cardiovascular risk factors and modifiable lifestyle characteristics offers hope of reducing serious cardiovascular morbidity after HCT.

Download Full-text

Association of Diabetes and Hypertension as risk factors with Ischemic Heart Disease among patients visiting a Public Sector Tertiary Care Hospital of Karachi, Pakistan

Pakistan Journal of Public Health ◽

10.32413/pjph.v10i4.509 ◽

2021 ◽

Vol 10 (4) ◽

pp. 215-219

Author(s):

Zulfiqar Ali Shaikh ◽

Javeria Shamim ◽

Akmal Khurshid Bhatti ◽

Sahar Soomro ◽

Zareen Kiran ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Family History ◽

Public Sector ◽

Ischemic Heart Disease ◽

Sedentary Lifestyle ◽

Tertiary Care ◽

Ischemic Heart ◽

P Value ◽

Care Hospital

Background: Ischemic Heart Disease (IHD) is a leading cause of morbidity and mortality worldwide. IHD results from myocardial ischemia, and occurs whenever perfusion outgrows the demand. Though lethal, but can be prevented by modification of predisposing conditions, most important are diabetes and hypertension. Almost fifty percent of IHD patients are found hypertensive with or without being diabetic. The objective of the study was to determine association of diabetes and hypertension as risk factors for IHD patients Methods: This was a hospital-based cross-sectional study that included 199 IHD patients of 35-70 years age, visiting Civil Hospital Karachi, a tertiary care public sector hospital, from September 2017 to January 2018 by using non-probability convenient sampling technique. The patients were approached in the hospital and briefed about the purpose of the study. A pre-tested, structured close ended questionnaire was used to collect the data. Data entry and analysis were done by using SPSS version 20.0. A p-value of <0.05 was considered as statistically significant. Results: Out of 199 participants, 156 (78%) were males while 43 (22%) were females; 119 60%) were 56-65 years of age. Family history of ischemic heart diseases was unremarkable in 126 (63%) patients. In total, 122 (61%) were diabetic; among them, 24 were of less than 40years and 98 of more than 40years of age. The older age of the diabetics had a direct association with the risk of IHD (p-value <0.05). About 83% had a non-significant family history for diabetes; and 83% of the total study participants were having a sedentary lifestyle. Out of 199, 166 (83%) had never checked their blood pressures earlier. The lifestyle, diet, addiction, and duration of hypertension had a strong association with IHD (p-value <0.05). Conclusion: IHD occurs more frequently in males of 56-65 years age, with insignificant family history for IHD and diabetes. The IHD is associated with hypertension and diabetes along with sedentary lifestyle, unhealthy diet and smoking/tobacco addiction.

Download Full-text

Psoriasis as an Independent Risk Factor for Cardiovascular Disease

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475415602842 ◽

2015 ◽

Vol 20 (4) ◽

pp. 327-333 ◽

Cited By ~ 17

Author(s):

Yi Chun Lai ◽

Yik Weng Yew

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Risk Factor ◽

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Cardiovascular Risk Factors ◽

Independent Risk Factor ◽

Ischemic Heart

Background: Psoriasis is known to be associated with metabolic syndrome, a well-established risk factor for ischemic heart disease and stroke. Emerging evidence indicates that psoriasis is an independent risk factor for cardiovascular disease and stroke. Objective: To evaluate whether psoriasis is independently associated with myocardial infarction (MI), ischemic heart disease (MI, angina pectoris, or coronary heart disease), and stroke, we conducted a cross-sectional study using the US National Health and Nutrition Examination Survey (NHANES) database. Methods: Data on clinical history of psoriasis, MI, angina pectoris, coronary heart disease, and stroke from the questionnaire as well as laboratory parameters on serum lipid and uric acid levels in the cycle years 2003-2006 and 2009-2012 were analyzed. Multivariate analysis with logistic regression modelling was performed with the aforementioned cardiovascular events or stroke as the dependent variables and with risk factors such as age, gender, ethnic group, current smoking status, alcohol consumption, metabolic syndrome, hyperuricemia, and psoriasis as independent variables. Results: There were 520 cases of psoriasis, and 108 of them had metabolic syndrome (20.8%). Well-established cardiovascular risk factors such as age, gender, ethnic group, smoking, alcohol consumption, metabolic syndrome, and hyperuricemia were also found to have significant associations with MI and ischemic heart disease (all P values <.001). Psoriatic patients were at significantly higher risks of developing MI (odds ratio [OR] 2.24; 95% CI: 1.27-3.95; P = .005) and ischemic heart disease (OR 1.90; 95% CI: 1.18-3.05; P = .008), but not stroke (OR 1.01; 95% CI: 0.48-2.16; P = .744), after adjustment was made for major cardiovascular risk factors. Conclusion: This study provides epidemiological evidence that psoriasis may be independently associated with the development of MI and ischemic heart disease. Physicians should be cognizant of any underlying cardiovascular risk factors, especially among psoriatic patients with metabolic syndrome, and manage them according to national guidelines.

Download Full-text

Epidemiological study of ischemic heart disease in patients admitted in intensive care unit in the tertiary care hospital

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20172074 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1892

Author(s):

Poonam Vijay Sancheti ◽

Suresh Konappa Mangulikar

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Ischemic Heart ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Care Hospital ◽

Epidemiological Factors

Background: The aim of the study was to assess the epidemiological factors of ischemic heart disease in patients admitted in intensive care unit in the tertiary care hospital. Socio demographic profile of ischemic heart disease patients along with behavioral risk factors, stress factors, dietary habits and associated comorbidities were studied.Methods: Present study was carried out in patients of IHD admitted in ICU of tertiary care hospital. History about epidemiological factors was obtained from patients or relatives by separate proformas.Results: Occurrence of disease had decreasing trend with the increase in literacy status of patients, which was statistically significant at p <0.0001. Maximum patients in the study were from socioeconomic class V i.e. 144 (36.64%). Study showed that household stress was more commonly associated with occurrence of disease which was significant statistically at p <0.001. Most common behavioral risk factor seen in patients was smokeless tobacco consumption. The occurrence of ischemic heart disease was seen more in the group of patients consuming mixed diet and consuming palm oil. Most common comorbidity in patients admitted for ischemic heart disease was hypertension, which was statistically significant at p <0.001.Conclusions: Age, literacy, socioeconomic status of the patient, history of behavioral risk factors in the patient, stress and comorbidities are related to the occurrence of ischemic heart disease.

Download Full-text

Validation of a model to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD: the rotterdam ischemic heart disease and stroke computer simulation (RISC) model

BMC Medicine ◽

10.1186/1741-7015-10-158 ◽

2012 ◽

Vol 10 (1) ◽

Cited By ~ 7

Author(s):

Bob JH van Kempen ◽

Bart S Ferket ◽

Albert Hofman ◽

Ewout W Steyerberg ◽

Ersen B Colkesen ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Computer Simulation ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Cvd Risk Factors ◽

Cvd Risk

Download Full-text

High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?

American Heart Journal ◽

10.1016/j.ahj.2010.05.016 ◽

2010 ◽

Vol 160 (2) ◽

pp. 230-236 ◽

Cited By ~ 20

Author(s):

Benjamín Acosta-Cázares ◽

Jorge Escobedo-de la Peña

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Ischemic Heart ◽

Cardiovascular Disease Risk Factors ◽

High Burden

Download Full-text

Cardiovascular disease after renal transplantation.

Journal of the American Society of Nephrology ◽

10.1681/asn.v71158 ◽

1996 ◽

Vol 7 (1) ◽

pp. 158-165 ◽

Cited By ~ 16

Author(s):

B L Kasiske ◽

C Guijarro ◽

Z A Massy ◽

M R Wiederkehr ◽

J Z Ma

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Renal Transplantation ◽

Ischemic Heart Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Density Lipoprotein ◽

Ischemic Heart ◽

Peripheral Vascular

Although cardiovascular disease is a major cause of morbidity and mortality after renal transplantation, its pathogenesis and treatment are poorly understood. We conducted separate analyses of risk factors for ischemic heart disease, cerebral, and peripheral vascular disease after 706 renal transplants, all of which functioned for at least 6 months. We used Cox proportional hazards analysis to examine the effects of multiple pretransplant and posttransplant risk factors and included time-dependent variables measured at 3, 6, and 12 months, and annually to last follow-up at 7.0 +/- 4.2 yr. The independent relative risk (RR) of diabetes was 3.25 for ischemic heart disease, 3.21 for cerebral vascular disease, and 28.18 peripheral vascular disease (P < 0.05). The RR of each acute rejection episode was 1.40 for ischemic heart disease and 1.24 for cerebral vascular disease. Among serum lipid levels, high-density lipoprotein cholesterol was the best predictor of ischemic heart disease (RR = 0.80 for each 10 mg/dL). Posttransplant ischemic heart disease was strongly predictive of cerebral (5.80) and peripheral vascular disease (5.22), whereas ischemic heart disease was predicted by posttransplant cerebral (8.25) and peripheral vascular disease (4.58). Other risk factors for vascular disease included age, gender, cigarette smoking, pretransplant splenectomy, and serum albumin. Hypertension and low-density lipoprotein cholesterol had no effect, perhaps because of aggressive pharmacologic treatment. Thus, the incidence of cardiovascular disease continues to be high after renal transplantation, and multiple risk factors suggest a number of possible strategies for more effective treatment and prevention.

Download Full-text