In 2019, the Global Burden of Disease study revealed alarming statistics regarding cardiovascular disease (CVD) in Pakistan. The estimated age-standardized incidence and death rates were 918.18 and 357.88 per 100,000 respectively, surpassing global averages.1 Notably, Pakistan faces unique challenges with a high prevalence of Rheumatic heart disease and early onset coronary artery disease.1 The World Health Organization's 2021 factsheet underscores four pivotal modifiable behavioral risk factors for CVD and stroke: unhealthy diet, physical inactivity, tobacco use, and harmful alcohol consumption. These behaviors manifest in individuals as elevated blood pressure, glucose, lipids, and adverse body mass index, exacerbating cardiovascular risk.2 In Pakistan, the consumption of unhealthy foods and excessive calories significantly contributes to adverse cardiometabolic profiles, including obesity and dyslipidemia.2 Recent research, such as that by Daruish Mozaffain et al. in "Food is Medicine," advocates for food-based interventions tailored to individual health conditions, ranging from medically tailored meals to nutritional and culinary education.3 However, Pakistani patients with CVD face challenges due to the lack of localized guidelines, educational resources, and accessible nutritionists. Shah et al.'s review underscores the importance of providing clear and culturally relevant dietary guidance for the local population.4 Addressing these challenges requires the development of high-quality, culturally sensitive educational materials. These resources should be readily understandable, pictorial, and integrated into both inpatient and outpatient care. Local experts, including dietitians and researchers, can play a crucial role in creating tailored educational content. Figures 1 exemplify the efforts of these experts to provide practical guidance to the Pakistani population.4 In conclusion, there is an urgent need for comprehensive, easy-to-understand patient education resources catering to the unique nutritional needs of Pakistani individuals with cardiovascular disease. By addressing these gaps, we can empower patients to make informed dietary choices and improve cardiovascular outcomes. References Samad Z, Hanif B. Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future. Circulation. 2023;147(17):1261-3. Liaquat A, Javed Q. Current trends of cardiovascular risk determinants in Pakistan. Cureus. 2018;10(10):e3409. Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, et al. “Food Is Medicine” Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;83(8):843-64. Shah SU, Waseem T, Afridi T, Shah MI. Nutritional Needs for Cardiovascular Health in Pakistani Population. Pak Heart J. 2022;55(2):101-13. American Heart Association. Lifestyle Changes for Heart Failure. Accessed on March 30, 2024. Available at: https://www.heart.
{"title":"Food and Cardiovascular Disease: What to Eat and What Not to Eat","authors":"Tariq Ashraf, Saeedullah Shah, Riffat Sultana","doi":"10.47144/phj.v57i1.2759","DOIUrl":"https://doi.org/10.47144/phj.v57i1.2759","url":null,"abstract":"In 2019, the Global Burden of Disease study revealed alarming statistics regarding cardiovascular disease (CVD) in Pakistan. The estimated age-standardized incidence and death rates were 918.18 and 357.88 per 100,000 respectively, surpassing global averages.1 Notably, Pakistan faces unique challenges with a high prevalence of Rheumatic heart disease and early onset coronary artery disease.1 \u0000The World Health Organization's 2021 factsheet underscores four pivotal modifiable behavioral risk factors for CVD and stroke: unhealthy diet, physical inactivity, tobacco use, and harmful alcohol consumption. These behaviors manifest in individuals as elevated blood pressure, glucose, lipids, and adverse body mass index, exacerbating cardiovascular risk.2 In Pakistan, the consumption of unhealthy foods and excessive calories significantly contributes to adverse cardiometabolic profiles, including obesity and dyslipidemia.2 \u0000Recent research, such as that by Daruish Mozaffain et al. in \"Food is Medicine,\" advocates for food-based interventions tailored to individual health conditions, ranging from medically tailored meals to nutritional and culinary education.3 However, Pakistani patients with CVD face challenges due to the lack of localized guidelines, educational resources, and accessible nutritionists. Shah et al.'s review underscores the importance of providing clear and culturally relevant dietary guidance for the local population.4 \u0000Addressing these challenges requires the development of high-quality, culturally sensitive educational materials. These resources should be readily understandable, pictorial, and integrated into both inpatient and outpatient care. Local experts, including dietitians and researchers, can play a crucial role in creating tailored educational content. Figures 1 exemplify the efforts of these experts to provide practical guidance to the Pakistani population.4 \u0000In conclusion, there is an urgent need for comprehensive, easy-to-understand patient education resources catering to the unique nutritional needs of Pakistani individuals with cardiovascular disease. By addressing these gaps, we can empower patients to make informed dietary choices and improve cardiovascular outcomes. \u0000References \u0000 \u0000Samad Z, Hanif B. Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future. Circulation. 2023;147(17):1261-3. \u0000Liaquat A, Javed Q. Current trends of cardiovascular risk determinants in Pakistan. Cureus. 2018;10(10):e3409. \u0000Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, et al. “Food Is Medicine” Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;83(8):843-64. \u0000Shah SU, Waseem T, Afridi T, Shah MI. Nutritional Needs for Cardiovascular Health in Pakistani Population. Pak Heart J. 2022;55(2):101-13. \u0000American Heart Association. Lifestyle Changes for Heart Failure. Accessed on March 30, 2024. Available at: https://www.heart.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140362015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anoshi Anoshi, Shakir Zada, K. Khan, Sumera Rajpoot, Poonam Bai, Paras Nazir, Sorath Sorath, Pashmina Kumari
Objectives: The “early repolarization (ER)” pattern, previously regarded as benign, has recently shown associations with adverse outcomes, including all-cause, arrhythmic and cardiac mortality. This study aimed to assess the prevalence and factors linked to ER changes in the ECG among chest pain patients at a tertiary cardiac center. Methodology: We enrolled 271 patients aged 18-80 with chest pain complaints. Baseline 12-lead ECGs were used to assess the ER pattern. Multivariable binary logistic regression was conducted, and “odds ratios (OR)” with 95% “confidence intervals (CI)” were reported. Results: Of the 271 patients, 162 (59.8%) were male, with a mean age of 55.3 ± 10 years, and 40 (14.8%) were ≤45 years old. The ER pattern was present in 92 (33.9%) patients. The ER pattern was associated with low “body mass index (BMI)” (OR=0.85 [95% CI: 0.77 - 0.94; p=0.002]), shorter T-wave duration (OR=0.99 [95% CI: 0.98 - 1.00; p=0.008]), and lower heart rate (OR=0.94 [95% CI: 0.90 - 0.98; p=0.007]). Additionally, the odds of ER pattern were lower in patients with “ST-elevation myocardial infarction (STEMI)” (OR=0.23 [95% CI: 0.07 - 0.72; p=0.012]) and non-STEMI (OR=0.21 [95% CI: 0.07 - 0.63; p=0.006]) compared to non-cardiac chest pain. Conclusion: Early repolarization is a common ECG pattern in one-third of chest pain patients. Associated factors include low BMI, shorter T-wave duration, and lower heart rate, and it is less frequent in patients with STEMI and non-STEMI.
{"title":"Frequency and Factors Associated with Early Repolarization Changes in ECG in Patients Presenting With Chest Pain","authors":"Anoshi Anoshi, Shakir Zada, K. Khan, Sumera Rajpoot, Poonam Bai, Paras Nazir, Sorath Sorath, Pashmina Kumari","doi":"10.47144/phj.v56i4.2668","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2668","url":null,"abstract":"Objectives: The “early repolarization (ER)” pattern, previously regarded as benign, has recently shown associations with adverse outcomes, including all-cause, arrhythmic and cardiac mortality. This study aimed to assess the prevalence and factors linked to ER changes in the ECG among chest pain patients at a tertiary cardiac center. Methodology: We enrolled 271 patients aged 18-80 with chest pain complaints. Baseline 12-lead ECGs were used to assess the ER pattern. Multivariable binary logistic regression was conducted, and “odds ratios (OR)” with 95% “confidence intervals (CI)” were reported. Results: Of the 271 patients, 162 (59.8%) were male, with a mean age of 55.3 ± 10 years, and 40 (14.8%) were ≤45 years old. The ER pattern was present in 92 (33.9%) patients. The ER pattern was associated with low “body mass index (BMI)” (OR=0.85 [95% CI: 0.77 - 0.94; p=0.002]), shorter T-wave duration (OR=0.99 [95% CI: 0.98 - 1.00; p=0.008]), and lower heart rate (OR=0.94 [95% CI: 0.90 - 0.98; p=0.007]). Additionally, the odds of ER pattern were lower in patients with “ST-elevation myocardial infarction (STEMI)” (OR=0.23 [95% CI: 0.07 - 0.72; p=0.012]) and non-STEMI (OR=0.21 [95% CI: 0.07 - 0.63; p=0.006]) compared to non-cardiac chest pain. Conclusion: Early repolarization is a common ECG pattern in one-third of chest pain patients. Associated factors include low BMI, shorter T-wave duration, and lower heart rate, and it is less frequent in patients with STEMI and non-STEMI.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139136582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To determine the relationship of body mass index (BMI) with peripheral circulation in healthy adults. Methodology: This cross-sectional study was carried out at Jamshoro's Liaquat University of Medical and Health Sciences' Physiology Department. The study lasted one year (January to December 2018). One hundred and eighty healthy persons under the age of forty were chosen, including males and females. After calculating the BMI, to determine the peripheral circulation, arterial blood pressure and heart rate (pulse rate) were recorded. Data was analyzed using IBM SPSS version 23.0. Results: A total of one hundred eighty (180) people took part in the study, 94 (52.2%) of whom were men and 86 (47.8%) of whom were women. Participants in the study had an average age of 21.83 5.88 years. The average person weighed 66.12 kg and was 2.85 m tall. Their average body mass index was 25.10±6.55. The pulse rate (beats/minute) in underweight, normal, overweight, and obese were 73.85±6.17, 73.56±6.04, 76.66±6.72, and 78.85±6.85, respectively (p<0.01). The mean arterial pressures in underweight, normal weight, overweight, and obese were 87.08±6.70, 85.72±8.15, 91.20±6.57 and 94.59±8.14mmHg respectively (p<0.01) Mean pulse pressure in BMI groups mentioned above were also statistically significant (p<0.01), i.e., 36.32±6.43, 39.12±8.12, 40.33±6.78 and 43.49±6.67mmHg respectively. Similarly, systolic BP (mmHg) in underweight, normal weight, overweight, and obese were 111.32±9.31, 113.17±10.41, 120.86±9.23 and 127.23±10.77 respectively (p<0.01). Conclusion: Peripheral vascular resistance varies in accordance with body mass index, but no variation is noted on the basis of gender. In the present study, mean systolic and diastolic BP were significantly different on the basis of difference in BMI.
{"title":"Association of Body Mass Index with Peripheral Vascular Resistance","authors":"Urooj Bhatti, Ramesh Kumar, Kavita Bai, K. Laghari, Bheem Soothar, Zoheb Rafique Memon","doi":"10.47144/phj.v56i4.2636","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2636","url":null,"abstract":"Objectives: To determine the relationship of body mass index (BMI) with peripheral circulation in healthy adults. Methodology: This cross-sectional study was carried out at Jamshoro's Liaquat University of Medical and Health Sciences' Physiology Department. The study lasted one year (January to December 2018). One hundred and eighty healthy persons under the age of forty were chosen, including males and females. After calculating the BMI, to determine the peripheral circulation, arterial blood pressure and heart rate (pulse rate) were recorded. Data was analyzed using IBM SPSS version 23.0. Results: A total of one hundred eighty (180) people took part in the study, 94 (52.2%) of whom were men and 86 (47.8%) of whom were women. Participants in the study had an average age of 21.83 5.88 years. The average person weighed 66.12 kg and was 2.85 m tall. Their average body mass index was 25.10±6.55. The pulse rate (beats/minute) in underweight, normal, overweight, and obese were 73.85±6.17, 73.56±6.04, 76.66±6.72, and 78.85±6.85, respectively (p<0.01). The mean arterial pressures in underweight, normal weight, overweight, and obese were 87.08±6.70, 85.72±8.15, 91.20±6.57 and 94.59±8.14mmHg respectively (p<0.01) Mean pulse pressure in BMI groups mentioned above were also statistically significant (p<0.01), i.e., 36.32±6.43, 39.12±8.12, 40.33±6.78 and 43.49±6.67mmHg respectively. Similarly, systolic BP (mmHg) in underweight, normal weight, overweight, and obese were 111.32±9.31, 113.17±10.41, 120.86±9.23 and 127.23±10.77 respectively (p<0.01). Conclusion: Peripheral vascular resistance varies in accordance with body mass index, but no variation is noted on the basis of gender. In the present study, mean systolic and diastolic BP were significantly different on the basis of difference in BMI.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139133815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tariq Ashraf, Rafat Sultana, Asif Nadeem, M. Lashari
For over two millennia, physicians have been aware of the morbidity and mortality linked to overweight and obesity. Various definitions of obesity, as outlined by the World Health Organization (WHO) and the Centers for Disease Control & Prevention (CDC), utilize the Body Mass Index (BMI) to characterize these conditions. Screening for high-risk patients is crucial for guiding lifestyle changes, treatment decisions, and risk reduction strategies.1,2 The assessment involves clinical and laboratory studies to categorize the type and severity of obesity, forming the foundation for effective management. Globally, the prevalence of obesity in 2015 exhibited a rising trend in females compared to males. Between 1980 and 2015, the prevalence surged from 11.1% to 38.3% for males aged 25 to 29 in low to middle-income countries.3 Pakistan ranks tenth among 188 countries, with half of its population classified as overweight or obese. Alarming projections from the World Obese Federation estimate that 5.4 million Pakistani school-aged children will grapple with obesity by 2030, emphasizing the dual challenges of overnutrition and poor nutrition.4,5 World Health Organization data indicates that 58.1% of Pakistanis are overweight, with 43.9% classified as obese. Asian cutoffs, though not globally recognized, suggest that 72.3% of Pakistanis are overweight, with obesity affecting 58.1% of the population. Research by Danielle H. Bodicoat et al. suggests an obesity threshold of 25 kg/m2 for South Asian individuals, coupled with a very high Waist Circumference (WC).6 A WC ≥ 31 inches (80cm) in Asian females and ≥ 35 inches (90cm) in Asian males is considered abnormal. The primary rationale for managing obesity is to mitigate morbidity, including conditions like diabetes, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, and cancer, ultimately reducing mortality. The initial step in managing obesity involves screening to determine the degree of overweight using BMI and waist circumference measurements. However, studies reveal that only 6% of individuals receive ongoing care for weight management, such as prescriptions for obesity medication or referrals to dieticians.7,8 BMI classifications, primarily based on cardiovascular disease (CVD) risk, may underestimate risks for conditions like diabetes in the Asian population. Beyond BMI, measuring waist circumference is essential for identifying adults at increased risk for morbidity and mortality, especially in the BMI range of 25 to 35 kg/m2.9 In addition to physical examinations, measurements of fasting glucose (or glycated hemoglobin [A1C]), thyroid-stimulating hormone (TSH), liver enzymes, and fasting lipids should be conducted.10 Investigating the causes of obesity involves ruling out a sedentary lifestyle, increased caloric intake, and secondary factors. Medical history should include inquiries about medications that cause weight gain and smoking cessation. Weight loss interventions are recommended for
两千多年来，医生们一直意识到超重和肥胖与发病率和死亡率有关。世界卫生组织（WHO）和美国疾病控制与预防中心（CDC）对肥胖做出了各种定义，并利用体重指数（BMI）来描述这些症状。对高危患者进行筛查对于指导改变生活方式、治疗决策和降低风险策略至关重要。1,2 评估包括临床和实验室研究，以对肥胖的类型和严重程度进行分类，为有效管理奠定基础。在全球范围内，2015 年女性肥胖症患病率较男性呈上升趋势。在 1980 年至 2015 年期间，中低收入国家 25 至 29 岁男性的肥胖率从 11.1%飙升至 38.3%。3 巴基斯坦在 188 个国家中排名第十，其一半人口被归类为超重或肥胖。世界肥胖者联合会（World Obese Federation）的预测令人震惊，估计到 2030 年，540 万巴基斯坦学龄儿童将面临肥胖问题，强调了营养过剩和营养不良的双重挑战。亚洲的分界线（虽然不是全球公认的）表明，72.3% 的巴基斯坦人超重，58.1% 的人口肥胖。Danielle H. Bodicoat 等人的研究表明，南亚人的肥胖临界值为 25 kg/m2，同时腰围（WC）很高。6 亚洲女性腰围≥ 31 英寸（80 厘米）和亚洲男性腰围≥ 35 英寸（90 厘米）被认为是不正常的。控制肥胖的主要理由是降低发病率，包括糖尿病、高血压、血脂异常、心脏病、中风、睡眠呼吸暂停和癌症等疾病，最终降低死亡率。管理肥胖症的第一步是进行筛查，通过测量体重指数和腰围来确定超重程度。然而，研究显示，只有 6% 的人接受了持续的体重管理护理，如肥胖症药物处方或转介给营养师。7,8 主要基于心血管疾病（CVD）风险的体重指数分类可能低估了亚洲人患糖尿病等疾病的风险。除 BMI 外，测量腰围对于识别发病和死亡风险增加的成年人也很重要，尤其是 BMI 在 25 至 35 kg/m2 之间的人群。9 除体检外，还应测量空腹血糖（或糖化血红蛋白 [A1C]）、促甲状腺激素 (TSH)、肝酶和空腹血脂。病史应包括询问导致体重增加的药物和戒烟情况。建议对体重指数（BMI）超过 25 kg/m2 的人群进行减肥干预，以预防、治疗或逆转与肥胖相关的并发症。总之，管理巴基斯坦人的肥胖症需要医生进行临床和实验室评估的综合方法。这包括评估身高、体重、体重指数、腰围、血压、血清甘油三酯、血清高密度脂蛋白、胆固醇、空腹血糖/HbA1C、睡眠呼吸暂停病史、用药史、体力活动和病因。此外，医生应了解饮食目标和促进减肥的药物，如果对其他干预措施无效，应考虑进行减肥手术。参考文献 世界卫生组织。肥胖症。访问日期：2023 年 12 月 12 日。网址： https://www.who.int/health-topics/obesity#tab=tab_1 成人超重和肥胖的定义。美国疾病控制和预防中心。2021 年 6 月 7 日更新。访问日期：2023 年 5 月 24 日。cdc.gov/obesity/adult/defining.html GBD 2015 肥胖合作者。195 个国家 25 年间超重和肥胖对健康的影响。N Engl J Med.2017 Jul 6;377(1):13-27.Curry SJ、Krist AH、Owens DK、Barry MJ、Caughey AB、Davidson KW 等：《预防成人肥胖相关发病率和死亡率的行为减肥干预》：美国预防服务工作组建议声明。JAMA.2018;320(11):1163-71.全球儿童肥胖地图集》。世界肥胖联合会。2023 年 12 月 12 日访问。Available at: https://www.worldobesity.org/membersarea/global-atlas-on-childhood-obesity Bodicoat DH, Gray LJ, Henson J, Webb D, Guru A, Misra A, et al. Body mass index and waist circumference cut-points in multi-ethnic populations from the UK and India: the ADDITION-Leicester, Jaipur heart watch and New Delhi crosssectional studies. PloS One.PloS One.2014;9(3):e90813.Perreault L, Suresh K, Rodriguez C, Dickinson LM, Willems E, Smith PC, et al.
{"title":"Obesity from Clinical Evaluation to Management Local Perspective","authors":"Tariq Ashraf, Rafat Sultana, Asif Nadeem, M. Lashari","doi":"10.47144/phj.v56i4.2704","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2704","url":null,"abstract":"For over two millennia, physicians have been aware of the morbidity and mortality linked to overweight and obesity. Various definitions of obesity, as outlined by the World Health Organization (WHO) and the Centers for Disease Control & Prevention (CDC), utilize the Body Mass Index (BMI) to characterize these conditions. Screening for high-risk patients is crucial for guiding lifestyle changes, treatment decisions, and risk reduction strategies.1,2 The assessment involves clinical and laboratory studies to categorize the type and severity of obesity, forming the foundation for effective management. Globally, the prevalence of obesity in 2015 exhibited a rising trend in females compared to males. Between 1980 and 2015, the prevalence surged from 11.1% to 38.3% for males aged 25 to 29 in low to middle-income countries.3 Pakistan ranks tenth among 188 countries, with half of its population classified as overweight or obese. Alarming projections from the World Obese Federation estimate that 5.4 million Pakistani school-aged children will grapple with obesity by 2030, emphasizing the dual challenges of overnutrition and poor nutrition.4,5 World Health Organization data indicates that 58.1% of Pakistanis are overweight, with 43.9% classified as obese. Asian cutoffs, though not globally recognized, suggest that 72.3% of Pakistanis are overweight, with obesity affecting 58.1% of the population. Research by Danielle H. Bodicoat et al. suggests an obesity threshold of 25 kg/m2 for South Asian individuals, coupled with a very high Waist Circumference (WC).6 A WC ≥ 31 inches (80cm) in Asian females and ≥ 35 inches (90cm) in Asian males is considered abnormal. The primary rationale for managing obesity is to mitigate morbidity, including conditions like diabetes, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, and cancer, ultimately reducing mortality. The initial step in managing obesity involves screening to determine the degree of overweight using BMI and waist circumference measurements. However, studies reveal that only 6% of individuals receive ongoing care for weight management, such as prescriptions for obesity medication or referrals to dieticians.7,8 BMI classifications, primarily based on cardiovascular disease (CVD) risk, may underestimate risks for conditions like diabetes in the Asian population. Beyond BMI, measuring waist circumference is essential for identifying adults at increased risk for morbidity and mortality, especially in the BMI range of 25 to 35 kg/m2.9 In addition to physical examinations, measurements of fasting glucose (or glycated hemoglobin [A1C]), thyroid-stimulating hormone (TSH), liver enzymes, and fasting lipids should be conducted.10 Investigating the causes of obesity involves ruling out a sedentary lifestyle, increased caloric intake, and secondary factors. Medical history should include inquiries about medications that cause weight gain and smoking cessation. Weight loss interventions are recommended for","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139134775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rizwan Zafar, Mohammad Asad Ali Saleem, A. Niazi, Arsalan Ahmad, Aamir Naseer, Danish Hassan Khan
Objectives: Syncope is a non-traumatic and self-limiting transient loss of consciousness (TLOC) caused by momentary cerebral hypo-perfusion. It can be classified into orthostatic, cardiac, and vasovagal etiologies, distinguished using the up-tilt table test (HUTT). Our objective was to determine the characteristics of patients undergoing HUTT for TLOC. Methodology: We conducted a single-center retrospective chart review of patients aged > 16 years who underwent HUTT from January 2010 to March 2020 at the cardiology and neurology departments of Shifa International Hospital, Islamabad, Pakistan. Charts were reviewed for basic demographic data and indications and outcomes of HUTT. Results: Our study included 496 patients with 72.2% males and a mean age of 51.1 ± 19.08 years. Vasovagal syncope was the most common etiology (79.8%, 158), followed by orthostatic syncope (11.6%, 23), autonomic syncope (6.1%, 12) and postural orthostatic tachycardia syndrome (2.5%, 5). Vasovagal syncope was divided into three subtypes, with the most common being mixed type (82.3%, 130), followed by pure vasodepressor (14.6%, 23) and cardio-inhibitory (3.2%, 5). The two most common prodromal symptoms were loss of consciousness (45.8%, 227) with or without preceding dizziness, followed by dizziness alone (34.5%, 171). Both symptoms had a statistical significance when compared to the diagnostic yield of HUTT testing (p<0.05). No significant correlation (p>0.05) was found between presenting symptoms, age, gender, and HUTT outcomes. Conclusion: The most common etiology of syncope is vasovagal, predominantly the mixed type. LOC and dizziness were significantly associated with the HUTT yield.
{"title":"A Retrospective Chart Review of the Head-Up Tilt Table Test at a Tertiary Care University Hospital","authors":"Rizwan Zafar, Mohammad Asad Ali Saleem, A. Niazi, Arsalan Ahmad, Aamir Naseer, Danish Hassan Khan","doi":"10.47144/phj.v56i4.2606","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2606","url":null,"abstract":"Objectives: Syncope is a non-traumatic and self-limiting transient loss of consciousness (TLOC) caused by momentary cerebral hypo-perfusion. It can be classified into orthostatic, cardiac, and vasovagal etiologies, distinguished using the up-tilt table test (HUTT). Our objective was to determine the characteristics of patients undergoing HUTT for TLOC. Methodology: We conducted a single-center retrospective chart review of patients aged > 16 years who underwent HUTT from January 2010 to March 2020 at the cardiology and neurology departments of Shifa International Hospital, Islamabad, Pakistan. Charts were reviewed for basic demographic data and indications and outcomes of HUTT. Results: Our study included 496 patients with 72.2% males and a mean age of 51.1 ± 19.08 years. Vasovagal syncope was the most common etiology (79.8%, 158), followed by orthostatic syncope (11.6%, 23), autonomic syncope (6.1%, 12) and postural orthostatic tachycardia syndrome (2.5%, 5). Vasovagal syncope was divided into three subtypes, with the most common being mixed type (82.3%, 130), followed by pure vasodepressor (14.6%, 23) and cardio-inhibitory (3.2%, 5). The two most common prodromal symptoms were loss of consciousness (45.8%, 227) with or without preceding dizziness, followed by dizziness alone (34.5%, 171). Both symptoms had a statistical significance when compared to the diagnostic yield of HUTT testing (p<0.05). No significant correlation (p>0.05) was found between presenting symptoms, age, gender, and HUTT outcomes. Conclusion: The most common etiology of syncope is vasovagal, predominantly the mixed type. LOC and dizziness were significantly associated with the HUTT yield.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139131045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Left ventricular pseudoaneurysm (LVPA) is a rare and life-threatening condition characterized by “an outpouching resulting from a rupture in the ventricular free wall.” We present a case with a history of myocardial infarction and left ventricular (LV) apical thrombus who presented with worsening dyspnea. Echocardiography revealed LVPA with bidirectional flow, confirmed by cardiac CT. He underwent successful surgical repair of LVPA and coronary artery bypass grafting. LVPA is associated with significant morbidity and mortality, so early diagnosis is crucial. This case report highlights the successful management of LVPA, underscoring the importance of prompt diagnosis and multidisciplinary care.
{"title":"Left Ventricular Apical Pseudoaneurysm: A Case Report Incidental Diagnosis and Management","authors":"Shakeela Naz, Mariam Naz, Parveen Akhter, Sabha Bhatti","doi":"10.47144/phj.v56i4.2649","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2649","url":null,"abstract":"Left ventricular pseudoaneurysm (LVPA) is a rare and life-threatening condition characterized by “an outpouching resulting from a rupture in the ventricular free wall.” We present a case with a history of myocardial infarction and left ventricular (LV) apical thrombus who presented with worsening dyspnea. Echocardiography revealed LVPA with bidirectional flow, confirmed by cardiac CT. He underwent successful surgical repair of LVPA and coronary artery bypass grafting. LVPA is associated with significant morbidity and mortality, so early diagnosis is crucial. This case report highlights the successful management of LVPA, underscoring the importance of prompt diagnosis and multidisciplinary care.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139136303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Faheem Shaikh, Abdul Sattar Shaikh, Muhammad Mutasim Billah Tufail, Hussain Bux, Veena Kumari
Objectives: The hospital industry has changed its dimension from diagnosis to complete total patient satisfaction. This study aims to identify the critical variables that can enhance overall patient satisfaction in the hospital industry. The study identified three critical factors for any hospital to provide quality service. Methodology: The study adopted the lean Six Sigma process improvement methodology to identify the critical service factors in hospitals. Lean Six Sigma is a flexible problem-solving tool that comprehensively solves any problem. DMAIC process improvement methodology is used to define, measure, analyze, improve, and control the overall experience in the hospital. CTQ (critical to quality) was defined and represented by Kano methodology. After filtration through cause and effect analysis, three core dimensions and 25 sub-dimensions of critical quality were identified. The impacts of these 25 sub-dimensions were evaluated and prioritized using the Kano Model of patient satisfaction. This identifies the most critical service requirement. This study is an initiative for service quality improvement in the hospital industry. In the future, this technique can be modified and adopted by different public and private hospitals to enhance the practical implementation. Results: Findings indicate that healthcare organizations demonstrate enhanced system-wide capabilities, optimizing resource utilization. Understanding patient needs propels satisfaction and delight. Three overarching factors, with 25 sub-factors, significantly impact patient satisfaction, predominantly yielding positive effects across the categories. Conclusion: This research concludes that providing quality service is critical in the hospital industry. Quality service is pivotal in the evolving hospital industry, transitioning from a focus on diagnosis to holistic patient satisfaction. This study aims to identify critical variables essential for enhancing overall patient satisfaction, pinpointing key factors crucial for delivering quality service in any hospital.
{"title":"Improving Quality Health Care Services by Implementing DMAIC Approach in Paediatric Cardiology Department of Public Hospital of Sindh, Pakistan: A Case Study","authors":"Faheem Shaikh, Abdul Sattar Shaikh, Muhammad Mutasim Billah Tufail, Hussain Bux, Veena Kumari","doi":"10.47144/phj.v56i4.2504","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2504","url":null,"abstract":"Objectives: The hospital industry has changed its dimension from diagnosis to complete total patient satisfaction. This study aims to identify the critical variables that can enhance overall patient satisfaction in the hospital industry. The study identified three critical factors for any hospital to provide quality service. Methodology: The study adopted the lean Six Sigma process improvement methodology to identify the critical service factors in hospitals. Lean Six Sigma is a flexible problem-solving tool that comprehensively solves any problem. DMAIC process improvement methodology is used to define, measure, analyze, improve, and control the overall experience in the hospital. CTQ (critical to quality) was defined and represented by Kano methodology. After filtration through cause and effect analysis, three core dimensions and 25 sub-dimensions of critical quality were identified. The impacts of these 25 sub-dimensions were evaluated and prioritized using the Kano Model of patient satisfaction. This identifies the most critical service requirement. This study is an initiative for service quality improvement in the hospital industry. In the future, this technique can be modified and adopted by different public and private hospitals to enhance the practical implementation. Results: Findings indicate that healthcare organizations demonstrate enhanced system-wide capabilities, optimizing resource utilization. Understanding patient needs propels satisfaction and delight. Three overarching factors, with 25 sub-factors, significantly impact patient satisfaction, predominantly yielding positive effects across the categories. Conclusion: This research concludes that providing quality service is critical in the hospital industry. Quality service is pivotal in the evolving hospital industry, transitioning from a focus on diagnosis to holistic patient satisfaction. This study aims to identify critical variables essential for enhancing overall patient satisfaction, pinpointing key factors crucial for delivering quality service in any hospital.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139133609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiovascular diseases (CVDs) are the fastest-growing cause of death around the world, and atherosclerosis plays a major role in the etiology of CVDs. The most recent figures show that the total number of CVD patients worldwide surged from 271 million in 1990 to 523 million in 2019. Furthermore, globally, the number of fatalities caused by coronary artery disease (CAD) went up from 1.2 million in 1990 to 18.6 million in 2019.1 The morbidity and mortality rates for patients with heart failure (HF) are still too high, despite being given the therapy according to the recommended guidelines.2 HF strains the public health system, so better treatment options are required. According to different studies, in HF, the manifestation of ventricular and vascular remodeling, as well as the progression of the illness, may be influenced by elevated oxidative stress.3,4 The most prevalent form of inflammatory arthritis in the world, gout, correlates with CVDs and is a standalone predictor of all-cause death.5,6 An important therapeutic target and potential contributor to oxidative stress is the enzyme xanthine oxidase (XO). Oxidative stress is a state in which there is excessive production of reactive oxygen species (ROS). The key generators of ROS are oxidant-producing enzymes, which are increased in various disease conditions.7 Superoxide and uric acid (UA) are produced due to increased XO activity during purine metabolism. In addition to being the primary cause of gout, elevated xanthine oxidase is also to blame for several clinical illnesses linked to hyperuricemia, such as cardiovascular disorders, diabetes, chronic wounds, and Alzheimer's disease. Numerous studies have shown a direct connection between high urate levels and CVDs. The generation of urate crystals is a complicated process. Since the same enzyme that makes urate also causes the creation of ROS. According to some research, the urate molecule can scavenge in vitro free radicals and acute urate infusions help at-risk population restore their endothelial function.8,9 More and more evidence suggests that XO activity plays a significant role in target organ damage and tissue destruction rather than UA itself. The formation of UA requires the xanthine oxidoreductase (XOR) enzyme, and XOR is composed of XO and xanthine dehydrogenase (XDH). By posttranslational modification, XDH is transformed into XO, which catalyzes the final two steps of the processes that change hypoxanthine into xanthine and xanthine into UA. During this process, superoxide and hydrogen peroxide are produced. As a result, ROS can be produced when XO is activated, which might cause tissue damage. Nitric oxide (NO) and circulating XO can directly interact when the latter binds to vascular cells, causing NO levels to drop and peroxynitrite levels to rise. On the other hand, uric acid transporters (UATs) have been identified to mediate the effects of serum UA on vascular endothelial cells or smooth muscle cells, as URAT1 is only expr
15 别嘌醇是一种强效 XO 抑制剂，有可能逆转多种高频病理生理过程，包括钙敏感性受损、无氧代谢加速、机械能解偶联和能量耗竭。16,17临床上常用的黄嘌呤氧化酶抑制剂包括别嘌醇、非布司他和托吡罗司他，它们都有致命的副作用，给医疗系统带来了严重的困境，并引发了全球寻找新型、强效和更安全的黄嘌呤氧化酶抑制剂的紧急行动。草药因其有效性、经济性、可及性和安全性而在全球范围内得到广泛应用。由于秋水仙碱具有特殊的抗炎特性，而且近年来人们认识到慢性炎症在多种人类疾病中的作用，因此秋水仙碱的用途已从治疗痛风扩展到心血管疾病。心包炎现已被视为常规治疗的一部分，其对冠状动脉疾病、心包切开术后综合征和经皮冠状动脉介入治疗的影响已成为众多临床研究的主题。几项有效的临床试验拓展了我们对减少炎症治疗心血管疾病的理解，并为我们提供了炎症如何影响心血管疾病的新视角19。中草药是一种可行的选择，因为它们方便、安全、高效；然而，要确定它们是否可用于治疗痛风和高尿酸血症患者的心血管疾病，还需要进一步的研究：作者声明无利益冲突。参考文献 Zhang F-S，He Q-Z，Qin CH，Little PJ，Weng J-P，Xu S-W。秋水仙碱在心血管医学中的治疗潜力：药理学综述。中国医药学报》。2022;43(9):2173-90.Chen J, Normand S-LT, Wang Y, Krumholz HM.1998-2008年医疗保险受益人心衰住院率和死亡率的国家和地区趋势。美国医学会杂志》。2011;306(15):1669-78.Tsutsui H, Kinugawa S, Matsushima S. Oxidative stress and heart failure.Am J Physiol Heart Circ Physiol.Ashiq K，Ashiq S，Shehzadi N. 《高尿酸血症及其与高血压的关系：风险因素与管理》。Pak Heart J. 2022;55(2):200-1.Abhijit D, Bhaskar G, Jitendra ND.印度西孟加拉邦普鲁利亚地区部落防治皮肤病和伤口愈合的传统植物疗法》（J Med Plants Res. 2012;6(33):4825-483）。痛风综合综述：痛风的流行趋势、病理生理学、临床表现、诊断和治疗。J Pak Med Assoc. 2021;71(4):1234-8.Bergamini C, Cicoira M, Rossi A, Vassanelli C.氧化应激和高尿酸血症：慢性心力衰竭的病理生理学、临床相关性和治疗意义。Eur J Heart Fail.2009;11(5):444-52.George J, Struthers AD.尿酸盐和黄嘌呤氧化酶抑制剂在心血管疾病中的作用》。Cardiovascular Drug Rev. 2008; 26(1):59-64.Singh A, Singh K, Sharma A, Kaur K, Chadha R, Bedi PMS.黄嘌呤氧化酶抑制剂的过去、现在和未来：黄嘌呤氧化酶抑制剂的过去、现在和未来：设计策略、结构和药理学见解、专利和临床试验。RSC Med Chem.2023;14(11):2155-91.Sekizuka H. 尿酸、黄嘌呤氧化酶和血管损伤：黄嘌呤氧化还原酶抑制剂预防心血管疾病的潜力。高血压研究》，2022；45（5）：772-4。Karantalis V, Schulman IH, Hare JM.亚硝基氧化还原失衡影响心脏结构和功能。美国心脏病学院基金会，华盛顿特区；2013 年。第 933-5 页。Kittleson MM、St John ME、Bead V、Champion HC、Kasper EK、Russell SD 等。尿酸水平升高可预测心力衰竭患者的血流动力学损害，与 B 型钠尿肽水平无关。心脏。2007;93(3):365-7.Ky B、French B、Levy WC、Sweitzer NK、Fang JC、Wu AH 等：《慢性心力衰竭风险预测的多种生物标志物》。循环：心力衰竭。2012;5(2):183-90.Levy WC、Mozaffarian D、Linker DT、Sutradhar SC、Anker SD、Cropp AB 等：《西雅图心衰模型：心衰患者生存预测》。循环。2006;113(11):1424-33.Mouradjian MT、Plazak ME、Gale SE、Noel ZR、Watson K、Devabhakthuni S. 《心血管疾病和心力衰竭患者痛风的药物治疗》。Am J Cardiovasc Drugs.2020;20(5):431-45.Cappola TP, Kass DA, Nelson GS, Berger RD, Rosas GO, Kobeissi ZA, et al. Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy.循环。2001;104(20):2407-11.
{"title":"The Effects of Xanthine Oxidase Inhibitors on the Management of Cardiovascular Diseases","authors":"K. Ashiq, Sana Ashiq, Khaled Alsubari","doi":"10.47144/phj.v56i4.2633","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2633","url":null,"abstract":"Cardiovascular diseases (CVDs) are the fastest-growing cause of death around the world, and atherosclerosis plays a major role in the etiology of CVDs. The most recent figures show that the total number of CVD patients worldwide surged from 271 million in 1990 to 523 million in 2019. Furthermore, globally, the number of fatalities caused by coronary artery disease (CAD) went up from 1.2 million in 1990 to 18.6 million in 2019.1 The morbidity and mortality rates for patients with heart failure (HF) are still too high, despite being given the therapy according to the recommended guidelines.2 HF strains the public health system, so better treatment options are required. According to different studies, in HF, the manifestation of ventricular and vascular remodeling, as well as the progression of the illness, may be influenced by elevated oxidative stress.3,4 The most prevalent form of inflammatory arthritis in the world, gout, correlates with CVDs and is a standalone predictor of all-cause death.5,6 An important therapeutic target and potential contributor to oxidative stress is the enzyme xanthine oxidase (XO). Oxidative stress is a state in which there is excessive production of reactive oxygen species (ROS). The key generators of ROS are oxidant-producing enzymes, which are increased in various disease conditions.7 Superoxide and uric acid (UA) are produced due to increased XO activity during purine metabolism. In addition to being the primary cause of gout, elevated xanthine oxidase is also to blame for several clinical illnesses linked to hyperuricemia, such as cardiovascular disorders, diabetes, chronic wounds, and Alzheimer's disease. Numerous studies have shown a direct connection between high urate levels and CVDs. The generation of urate crystals is a complicated process. Since the same enzyme that makes urate also causes the creation of ROS. According to some research, the urate molecule can scavenge in vitro free radicals and acute urate infusions help at-risk population restore their endothelial function.8,9 More and more evidence suggests that XO activity plays a significant role in target organ damage and tissue destruction rather than UA itself. The formation of UA requires the xanthine oxidoreductase (XOR) enzyme, and XOR is composed of XO and xanthine dehydrogenase (XDH). By posttranslational modification, XDH is transformed into XO, which catalyzes the final two steps of the processes that change hypoxanthine into xanthine and xanthine into UA. During this process, superoxide and hydrogen peroxide are produced. As a result, ROS can be produced when XO is activated, which might cause tissue damage. Nitric oxide (NO) and circulating XO can directly interact when the latter binds to vascular cells, causing NO levels to drop and peroxynitrite levels to rise. On the other hand, uric acid transporters (UATs) have been identified to mediate the effects of serum UA on vascular endothelial cells or smooth muscle cells, as URAT1 is only expr","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139135716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Syed Haseeb, Raza Naqvi, H. N. Tun, F. A. Cader, Jolanda Sabatino, Madiha Fatima
In the recent era of medicine, Novel Oral Anticoagulants (Apixaban, Dabigatran, Edoxaban, and Rivaroxaban) have become the preferred drugs for long-term anticoagulation therapy in the majority of cardiovascular conditions, along with non-cardiac co-morbid conditions with few necessary exceptions. This preference is based on their easy availability, therapeutic efficacy, all-cost effectiveness, safety profile, and more convenient usage for both patients and clinicians. Novel Oral Anticoagulants (NOACs) have different pharmacokinetics and pharmacodynamics than oral vitamin K antagonists. This article highlights the basic pharmacology, common complications, available antidotes, and the utility of NOACs in different common cardiovascular diseases requiring long-term oral anticoagulation, including stroke prevention in valvular and non-valvular atrial fibrillation, coronary artery disease, myocardial infarction, left ventricular thrombus and cerebrovascular attacks. NOACs are still underutilized in cardiovascular practice because the concomitant co-morbid conditions hinder a clinician from prescribing these drugs confidently. This manuscript will provide a brief critical overview to help clinicians prescribe NOACs more conveniently.
在当今医学时代，新型口服抗凝药（阿哌沙班、达比加群、埃多沙班和利伐沙班）已成为大多数心血管疾病和非心血管并发症长期抗凝治疗的首选药物，但也有少数必要的例外情况。之所以如此，是因为这些药物易于获得、疗效显著、成本低廉、安全可靠，而且患者和临床医生都能更方便地使用。新型口服抗凝药（NOAC）的药代动力学和药效学与口服维生素 K 拮抗剂不同。本文重点介绍了 NOACs 的基本药理、常见并发症、可用解毒剂以及在需要长期口服抗凝药的不同常见心血管疾病中的应用，包括预防瓣膜性和非瓣膜性房颤、冠心病、心肌梗死、左心室血栓和脑血管病发作中的卒中。在心血管领域，NOACs 的使用率仍然很低，因为伴随的并发症阻碍了临床医生自信地开具这些药物的处方。本手稿将提供简要的重要概述，以帮助临床医生更方便地开具 NOAC。
{"title":"Novel Oral Anticoagulants in Cardiovascular Practice","authors":"Syed Haseeb, Raza Naqvi, H. N. Tun, F. A. Cader, Jolanda Sabatino, Madiha Fatima","doi":"10.47144/phj.v56i4.2618","DOIUrl":"https://doi.org/10.47144/phj.v56i4.2618","url":null,"abstract":"In the recent era of medicine, Novel Oral Anticoagulants (Apixaban, Dabigatran, Edoxaban, and Rivaroxaban) have become the preferred drugs for long-term anticoagulation therapy in the majority of cardiovascular conditions, along with non-cardiac co-morbid conditions with few necessary exceptions. This preference is based on their easy availability, therapeutic efficacy, all-cost effectiveness, safety profile, and more convenient usage for both patients and clinicians. Novel Oral Anticoagulants (NOACs) have different pharmacokinetics and pharmacodynamics than oral vitamin K antagonists. This article highlights the basic pharmacology, common complications, available antidotes, and the utility of NOACs in different common cardiovascular diseases requiring long-term oral anticoagulation, including stroke prevention in valvular and non-valvular atrial fibrillation, coronary artery disease, myocardial infarction, left ventricular thrombus and cerebrovascular attacks. NOACs are still underutilized in cardiovascular practice because the concomitant co-morbid conditions hinder a clinician from prescribing these drugs confidently. This manuscript will provide a brief critical overview to help clinicians prescribe NOACs more conveniently.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139135136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Tiksnadi, Kurnia Wahyudi, Rien Afrianti, Yulia Sofiatin, F. Y. Fihaya, Maulana Ibrahim, N. F. Tarsidin, Lisda Amalia, Rully MA Roesli, Rizki Akbar
Objectives: Residential areas are considered part of the sociocultural aspect for determining health but are rarely studied in a cardiovascular disease-community study in developing countries. Jatinangor, considered a university area, has unique characteristics surrounded by urban and rural villages. We aim to investigate the association of residential areas in Jatinangor with cardiovascular morbidity and mortality. Methodology: A cross-sectional study from July to November 2018 was done in appointed rural and urban areas in Jatinangor district, West Java, Indonesia. Cardiovascular disease is defined using a self-reported questionnaire. Cardiovascular death was identified through a verbal autopsy performed by a general practitioner as an interviewer. The morbidity data were obtained from September to October 2018, while the mortality data were obtained from July to November 2018. Poisson regression was done to determine the association of residential areas to cardiovascular disease morbidity. Results: Data were obtained from 1469 respondents; 58.7% were from rural areas. The prevalence of cardiovascular disease morbidity is higher in urban than rural areas (5.6% vs. 2.5%, p=0.004). There were 42 cases of death reported during the study period, with 33 deaths considered caused by cardiovascular disease. The urban-rural differences in cardiovascular mortality showed no significant differences (p=0.388). The unadjusted model of the association of the urban-rural residential area with cardiovascular disease morbidity was (PR 2.253 (95% CI 1.262, 4.024)) while the adjusted model was (PR 2.264 (95% CI 1.257, 4.078, p = 0.007)). Conclusion: Urban area is associated with two times higher cardiovascular disease morbidity but not with mortality than those who live in rural areas.
目的：居住区被认为是决定健康的社会文化的一部分，但在发展中国家的心血管疾病社区研究中却很少对居住区进行研究。被视为大学区的 Jatinangor 具有独特的特点，周围环绕着城市和农村村庄。我们的目的是调查 Jatinangor 居民区与心血管疾病发病率和死亡率的关系。研究方法2018年7月至11月，我们在印度尼西亚西爪哇省Jatinangor区的指定农村和城市地区进行了一项横断面研究。心血管疾病通过自我报告问卷进行定义。心血管疾病死亡是通过全科医生作为访谈者进行的口头尸检确定的。2018年9月至10月获得了发病率数据，2018年7月至11月获得了死亡率数据。采用泊松回归法确定居住区与心血管疾病发病率的关联。结果：数据来自 1469 名受访者；58.7% 的受访者来自农村地区。城市地区的心血管疾病发病率高于农村地区（5.6% 对 2.5%，P=0.004）。研究期间共报告 42 例死亡病例，其中 33 例被认为是心血管疾病导致的死亡。心血管疾病死亡率的城乡差异无显著性差异（P=0.388）。城乡居住区与心血管疾病发病率的未调整模型为（PR 2.253 (95% CI 1.262, 4.024)），而调整模型为（PR 2.264 (95% CI 1.257, 4.078, p = 0.007)）。结论城市居民的心血管疾病发病率比农村居民高两倍，但死亡率却不高。
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