scholarly journals INTERACTION OF TOBACCO ABUSE WITH OTHER CONVENTIONAL RISK FACTORS OF CARDIOVASCULAR RISK - SYNERGISTIC IMPACT OR AN INDEPENDENT MENACE?

2022 ◽  
Vol 54 (4) ◽  
pp. 352-356
Author(s):  
Arslan Masood ◽  
Noor Dastgir ◽  
Inam Ur Rehman ◽  
Junaid Rehman ◽  
Aleena Khan ◽  
...  

Objectives: To determine the prevalence, patterns and behavioural attributes of tobacco abuse in patients of acute coronary syndrome (ACS). Furthermore, to assess the interaction of tobacco abuse with other conventional risk factors of cardiovascular disease (CVD). Methodology: This observational study included 230 consecutive patients with ACS. Data was collected regarding total duration and extent of tobacco consumption, “tobacco addiction” and various behavioural patterns related to it. Risk factors profile was acquired for hypertension, diabetes, obesity, family history of premature CVD and dyslipidemia. Odds ratios (OR) with 95% confidence intervals (CI) for these risk factors were calculated for tobacco abusers compared to non-abusers. Results: Among the study population, 63(27.4%) were active tobacco users. Urban residents had lesser odds of being tobacco abusers compared to non-urban residents (0.49, [0.27 – 0.89]). Tobacco abusers had a lower prevalence of hypertension compared to non-abusers (0.44 [0.24 – 0.81]). A similar trend was observed for diabetes, obesity and dyslipidemia, however, the differences could not reach significance thresholds. Cigarette smoking was the commonest mode of tobacco consumption (90.5%). “Tobacco addiction” could be attributed to 84.1% of abusers. Most (82.5%) were willing to give up tobacco abuse and 63.3% had already made attempts at quitting. Conclusion: About one-third of ACS patients were tobacco abusers with the majority being tobacco addicts. Tobacco abuse was observed to be independently implicated as a risk factor in ACS patients. Furthermore, tobacco abuse was inversely related to hypertension translating into a sub-multiplicative / additive impact of hypertension as a risk factor.

2016 ◽  
Vol 64 (4) ◽  
pp. 922.2-923
Author(s):  
H Alkhawam ◽  
M Mariya Fabisevich ◽  
R Sogomonian ◽  
JJ Lieber ◽  
R Madanieh ◽  
...  

BackgroundTobacco abuse and alcohol dependence have been established as risk factors for atherosclerotic heart disease (ASHD). Their potential synergistic effect, however, have not been previously evaluated.Abstract ID: 12 Table 1Alcohol abuse/ DependenceAlcoholic abuse (n=172)Alcoholic- Smoker (n=51)Alcoholic Non-Smoker (n=121)Mean age (years)55.151.156.195% CI(52–58)(48–54.2)(54.6–57.6)Non-Alcohol abuse/DependenceNon-Alcoholic (n=7904)Non-Alcoholic Smoker (n=909)Non-alcoholic Non-smoker (n=6995)Mean age (years)63.856.371.395% CI(63.6–63.9)(55–57.7)(71–71.6)p Value<0.0010.02<0.001Objective/PurposeTo investigate the synergistic role of alcohol abuse/dependence and tobacco use in the early incidence of ACS.MethodsA retrospective chart analyses of 8076 patients diagnosed with ACS between 2000 to 2014, defined by ICD-9 codes for acute MI, alcohol abuse/dependence and tobacco use. Average age of ACS was calculated for the general population. Patients were then divided into 4 subgroups based on alcohol abuse/dependence and tobacco use status as follows: non-alcoholic non-smokers, non-alcoholic smokers, alcoholic non-smokers and alcoholic smokers.ResultsThe mean age of our 8076 ACS patients population was ∼59.5 (95% CI 59.2–59.8). Patients with history of alcohol abuse/dependence appeared to develop ACS ∼8.7 years younger than their non-alcoholic counterparts. When tobacco use is incorporated as a risk factor, those with both alcohol abuse/dependence and tobacco use seemed to develop ACS ∼5 years earlier than those with history of either alone, and ∼20 years earlier when compared to those with neither alcohol abuse/dependence nor tobacco use.(table 1 summarizes mean age of ACS incidence in our study subgroups).ConclusionsAlcohol abuse/dependence appears to be a risk factor for earlier ACS. In our population, the average age of ACS incidence in alcoholic patients was significantly earlier than non-alcoholic patients. Furthermore, alcoholic patients who also used tobacco developed ACS at an even younger age when compared to those who had history of either alcohol abuse/dependence or tobacco use alone, suggesting a possible synergistic effect of these two risk factors in developing early ACS. Healthcare intervention in this population through screening, counseling and education regarding alcohol abuse/dependence and smoking cession is warranted to reduce early ACS.


2023 ◽  
Vol 83 ◽  
Author(s):  
R. Muzaffar ◽  
M. A. Khan ◽  
M. H. Mushtaq ◽  
M. Nasir ◽  
A. Khan ◽  
...  

Abstract The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.


2017 ◽  
Vol 9 (2) ◽  
pp. 13-16
Author(s):  
Gopi Prasad Hirachan ◽  
R Hirachan ◽  
BB Thapa ◽  
KB Thapa

Background: Out of the total number of patients admitted in coronary care unit (CCU) with acute coronary syndrome (ACS), 75 - 85% presented with conventional risk factors. On the other hand, lipid profile modification after a cardiovascular event related to acute coronary syndrome has also been recognized. But there are controversies regarding the temporary changes in lipid profile after ACS. In our country, there are limited studies about the basal characteristics of lipid profile and the variability of its components after an ACS.Objectives: 1) To analyze the changes in lipoprotein levels in a group of patients hospitalized with ACS. 2) To describe the basal lipid profile. 3) To find out the prevalence of conventional risk factors of ACS patients.Methods: A total of 300 patients with the diagnosis of ACS were studied and the presence of conventional risk factors including smoking, hypertension, dyslipidemia and diabetes were recorded. In addition, we also analyzed the lipid profile within the first 24 hours of admission and body mass index (BMI) of all the patients included in the study.Results: Among a total of 300 patients, the mean age of men was 45 – 75 years and women 50 – 65 years. There were 47.5% patients with non-STEMI and 52.5% with ST-elevated myocardial infaraction (STEMI). In patients with BMI <24, 23.9% were males and 32.2% females; in patients with BMI 25 - 29, 55.4% were males and 48.7% females and in patients with BMI >30, 20.7% were males and 19.1% females. Among the study population, prior myocardial infaraction (MI) was seen in 29%, prior CABG in 4.2% and 10.5% had family history of CAD. In this study, diabetes and dyslipidemia were more in STEMI whereas dyslipidemia was common in non-STEMI. Among the conventional risk factors, smoking and hypertension were more common in STEMI in both men and women.Conclusions: In all patients admitted in CCU, basal lipid profile should be evaluated at the time of admission for choosing the most adequate treatment.Journal of Gandaki Medical College Volume, 09, Number 2, July December  2016, page: 13-16


2021 ◽  
Vol 14 (1) ◽  
pp. 24-29
Author(s):  
Md Mahfuzur Rahman ◽  
Farid Uddin Ahmed ◽  
Sanjida Sharmin ◽  
Tanvir Hyder ◽  
Saifuddin Nehal

Background: Coronary artery disease (CAD) is the single largest cause of death in the developed countries and is one of the leading causes of disease burden in developing countries. The prevalence of dyslipidemia and conventional risk factors profile at the time of admission in patients with Acute Coronary Syndrome (ACS) is not well described in our context. The aim of this study was to investigate the prevalence of dyslipidemia and conventional risk factors profiles of patients with ACS in a tertiary care center of Bangladesh. Methods: This descriptive cross-sectional study included 96 admitted patients of ACS [30 cases of Unstable Angina, 25 cases of Non ST segment Elevation Myocardial Infarction and 41 cases of ST segment Elevation Myocardial Infarction] from the Department of Cardiology, Abdul Malek Ukil Medical College Hospital, Noakhali, Bangladesh from January 2019 to June 2019. Fasting serum lipid profile was obtained within 24 hours of hospitalization and demographic and other cardiovascular risk factors were documented. Results: The mean age of the subjects were 57.7±14.4 years with majority (71.9%) being male. The most frequent reported risk factor was smoking, present in 55.2% of patients, followed by hypertension (47.9%), diabetes (37.5%), dyslipidemia (27.1%) and family history of CAD (15.6%). Based on Body Mass index 50% patients were obese (≥25kg/m2) and 69.8% had central obesity based on waist circumference. The lipid profile analysis revealed that 99% of patients had some type of dyslipidemia, and the most frequent was high level of triglyceride and low levels of high-density lipoprotein cholesterol (68.8% of cases in each). Conclusion: Dyslipidemia is a significant risk factor in patients with ACS and high TG and low HDL-C were more prevalent. Careful attention to its management may help to reduce further events. Cardiovasc j 2021; 14(1): 24-29


Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Arbia A Gorrab ◽  
Asma Abed Bouaziz ◽  
Linda Spigelblatt ◽  
Anne Fournier ◽  
Nagib Dahdah

Background: The real incidence of Kawasaki disease (KD) in the Maghreb countries (Morocco, Algeria, and Tunisia) is unknown. It is estimated low according to the literature. However, the number of Maghrebi children living in Quebec (Qc) affected by KD seems important. We sought to determine the incidence of KD among Maghrebi children in Qc, Canada, and to study its epidemiological and clinical features and to clarify possible risk factors related or superimposed to their immigration. Methods: A retrospective study of KD in Maghrebi children living in Qc (n=24) (1996-2013), compared to reports from Fes, Morocco (n=23) a doctoral thesis published in 2010 (2001-2009) and from Tunisia (n=31) collected in five university hospitals with four from the Great Tunis and one from Nabeul city (1996-2013). There are no reports available from Algeria. The “country of origin” specific population in the Province of Qc was obtained from Statistics Canada. Results: The annualized incidence rate (AIR) of KD among Maghrebi children in Qc was 9.58/100,000 children under 5 years(Standard-Denominator (SD)).This is 6 times higher in Qc (5.57/SD and 19.02/SD among Tunisian and Moroccan descents) vs Tunisia (Nabeul Governorate) and Morocco (Fes) (0.95/SD and 3.15/SD). Personal and family history of allergy were significantly higher in Qc 42% (10/24) and 75% (18/24), respectively, whereas these features were reported near 0% in both reports from Morocco and Tunisia. The prevalence of incomplete KD criteria was relatively high in the 3 series 46% (11/24) in Qc vs 43% (10/23) and 35% (11/31); (p=NS). Diagnosis was late (gt day 10 of fever) in 1/24(4%) in Qc vs 7/23 (30%) in Morocco and 11/31 (35%) in Tunisia; (p 0.01). IVIG were administered in the acute phase to all patients in Qc, 5/23 in Morocco and 28/31 in Tunisia. However coronary complications were more common in Qc 42% (10/24) vs 22% (5/23) vs 19% (6/31) (p=0.02). Aneurysms were significantly associated with the incomplete form in the 3 groups (p=0.01). Conclusions: The observed AIR of KD in the Maghreb community in Qc is higher than the countries of origin where underdiagnosis is possible. Atopy may still be a risk factor in Qc. The coronary artery disease seems linked not only to therapeutic delay but also to the underlying terrain.


Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rakhee Lalla ◽  
Ryan Dunlow ◽  
Karen L Yarbrough ◽  
Prachi Mehndiratta ◽  
Michael S Phipps ◽  
...  

Introduction: The AHA notes that more than 76% of strokes are the first occurrence. There are class 1 recommendations for the management of common risk factors such as atrial fibrillation (AF), hyperlipidemia (HLD), hypertension (HTN), diabetes (DM), and vascular disease. The purpose of this study is to investigate the percentage of large vessel strokes that are potentially preventable with adequate management of vascular risk factors. Methods: A retrospective chart review was conducted on all patients undergoing endovascular therapy (EVT) from 2012-2019. Data was collected on vascular risk factors present prior to admission including HTN, DM, HLD, AF, and smoking. Preventable stroke was defined as having at least one of the following: untreated AF, untreated HLD, poorly controlled HTN (presence of left ventricular hypertrophy on transthoracic echo), history of vascular disease not on an antiplatelet agent, poorly controlled DM (A1c>10), current smoking. Groups were compared based on age, sex and 90 day functional outcomes, with favorable outcome defined as mRS ≤ 2. Results: Our sample included 396 patients who underwent EVT (mean age 65, 50% female). 42% of patients with Afib were not on anticoagulation, 31% of patients with HLD were untreated, 39% of patients with HTN were poorly controlled, 27% of patients with a history of vascular disease were not on an antiplatelet, 14% of patients with DM were poorly controlled, and 46% of all patients were smokers. In total, 78% of patients had at least 1 poorly controlled risk factor and 37% had at least 2. There was no difference in rates of preventable stroke between males and females (48% vs 52%, p=0.30) and between age groups above and below 70 (40% vs 60%, p=0.68). 64% of patients with well controlled risk factors had a favorable outcome compared to 51% with at least one poorly controlled risk factor (p=0.03). Conclusions: Our data suggests that despite guidelines on management of vascular risk factors, a large number of these are poorly controlled prior to admission for large vessel stroke, leading to a potentially preventable procedure. Not only could improved primary prevention save the wide array of resources utilized in EVT, but it could also influence long term outcomes in this cohort of patients.


2019 ◽  
Vol 131 (3) ◽  
pp. 941-948
Author(s):  
Eric S. Nussbaum ◽  
Kevin Kallmes ◽  
Jodi Lowary ◽  
Leslie A. Nussbaum

OBJECTIVEUndiagnosed hepatitis C virus (HCV) and HIV in patients present risks of transmission of bloodborne infections to surgeons intraoperatively. Presurgical screening has been suggested as a protocol to protect surgical staff from these pathogens. The authors sought to determine the incidence of HCV and HIV infection in elective craniotomy patients and analyze the cost-effectiveness of universal and risk factor–specific screening for protection of the surgical staff.METHODSAll patients undergoing elective craniotomy between July 2009 and July 2016 at the National Brain Aneurysm Center who did not refuse screening were included in this study. The authors utilized rapid HCV and HIV tests to screen patients prior to elective surgery, and for each patient who tested positive using the rapid HCV or HIV test, qualitative nucleic acid testing was used to confirm active viral load, and risk factor information was collected. Patients scheduled for nonurgent surgery who were found to be HCV positive were referred to a hepatologist for preoperative treatment. The authors compared risk factors between patients who tested positive on rapid tests, patients with active viral loads, and a random sample of patients who tested negative. The authors also tracked the clinical and material costs of HCV and HIV rapid test screening per patient for cost-effectiveness analysis and calculated the cost per positive result of screening all patients and of screening based on all patient risk factors that differed significantly between patients with and those without positive HCV test results.RESULTSThe study population of patients scheduled for elective craniotomy included 1461 patients, of whom 22 (1.5%) refused the screening. Of the 1439 patients screened, 15 (1.0%) tested positive for HCV using rapid HCV screening; 9 (60%) of these patients had active viral loads. No patient (0%) tested positive for HIV. Seven (77.8%) of the 9 patients with active viral loads underwent treatment with a hepatologist and were referred back for surgery 3–6 months after sustained virologic response to treatment, but the remaining 2 patients (22.2%) required urgent surgery. Of the 9 patients with active viral loads, 1 patient (11%) had a history of both intravenous drug abuse and tattoos. Two of the 9 patients (22%) had tattoos, and 3 (33%) were born within the age-screening bracket (born 1945–1965) recommended by the Centers for Disease Control and Prevention. Rates of smoking differed significantly (p < 0.001) between patients who had active viral loads of HCV and patients who were HCV negative, and rates of smoking (p < 0.001) and IV drug abuse (p < 0.01) differed significantly between patients who were HCV rapid-test positive and those who were HCV negative. Total screening costs (95% CI) per positive result were $3,877.33 ($2,348.05–$11,119.28) for all patients undergoing HCV rapid screening, $226.29 ($93.54–$312.68) for patients with a history of smoking, and $72.00 ($29.15–$619.39) for patients with a history of IV drug abuse.CONCLUSIONSThe rate of undiagnosed HCV infection in this patient population was commensurate with national levels. While the cost of universal screening was considerable, screening patients based on a history of smoking or IV drug abuse would likely reduce costs per positive result greatly and potentially provide cost-effective identification and treatment of HCV patients and surgical staff protection. HIV screening found no infected patients and was not cost-effective.


Author(s):  
Ritu Attri ◽  
Harsimran Kaur ◽  
Raminderpal Singh Sibia ◽  
Mandip Singh Bhatia

Introduction: CAD is the most common cause of mortality in India. It is a common multifarious public health crisis today and a leading cause of morbidity and mortality in both developing and developed countries. Hence, understanding the predominant risk factors among the Indian population is important. Materials and Methods: This was a hospital based age and sex matched case control study, carried out at Government Medical College and Rajindra Hospital Patiala. A total of 100 patients of Acute coronary syndrome were studied. Patients and controls were enquired about  the presence of cardiometabolic risk factors and the significance of association of these risk factors with the occurrence of Acute coronary syndrome was given by p value of  <0.05. Results: Majority of the cases were in the age group 61-70 years (32%) with male to female ratio  of 1.25:1. Significant association was found between ACS and risk factors like smoking, positive family history of IHD, hypertension, diabetes, dyslipidemia, waist hip ratio and body mass index. Overall, most common outcome of ACS in the present study was NSTEMI (45%) followed by STEMI (35%) followed by Unstable angina (20%). Conclusion: Significant association was found between smoking and occurrence of STEMI and significant association was found between Hypertension and occurrence of NSTEMI.


Author(s):  
Denny Khusen

Objective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/μl, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsia


2018 ◽  
Vol 25 (1) ◽  
pp. 6 ◽  
Author(s):  
Amelia Rahmah Kartika ◽  
Muhammad Ilham Aldika Akbar ◽  
Pirlina Umiastuti

Objectives: to determine which of the risk factors above associated with the occurrence of severe preeclampsia at dr. Soetomo Hospital, Surabaya during 2015.Materials and Methods: The type and design of the study were analytic and retrospective. This study was held in the dr. Soetomo Hospital from April until November 2016. The instrument of the study was the medical records then being coded and analysed. The samples were 134 pregnant women, consisting of 67 pregnant women with severe preeclampsia as cases and 67 pregnant women as controls.Results: Maternal obesity (OR= 5,786; 95% CI: 2,300–14,555), history of hypertension (OR= 6,693; 95% CI: 1,848–24,237) and secondary elderly primi (OR= 6,384; 95% CI: 1,357–30,031) are associated with the development of severe preeclampsia.Conclusion: In conclusion, the significant risk factors of severe preeclampsia in dr. Soetomo Hospital Surabaya during 2015 are obesity, history of hypertension and secondary elderly primi variables.


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