Background:Fasting during the month of Ramadan is a religious obligation that is practiced by millions of people around the world yet there is no clear scientific consensus on its effects on cardiovascular disease. This study was performed to inform physicians as well as patients of evidence based recommendations on this subject.Aim:The study was undertaken to assess: (1) any alteration in the incidence of acute cardiac illness during Ramadan fasting; (2) whether fasting during the month of Ramadan alters the clinical status of patients with stable cardiac disease; and (3) the impact of Ramadan fasting on cardiovascular risk factors in normal subjects, in patients with stable cardiac disease, metabolic syndrome, dyslipidemia, type 2 diabetes and systemic hypertension.Study design:Systematic review of the literature.Method:A Medline search of the English literature published between January 1980 and September 2012.Results:The incidence of acute cardiac illness during Ramadan fasting was similar to non-fasting days, although the timing of symptom onset may be different, with significant increase in events during the period of 'breaking fast' when compared to non-fasting days. The majority of patients with stable cardiac illness can undergo Ramadan fasting without any clinical deterioration. Body mass index, lipid profile, and blood pressure showed significant improvement in normal healthy subjects, patients with stable cardiac illness, metabolic syndrome, dyslipidemia and hypertension during Ramadan fasting. The lipid profile of diabetic patients deteriorated significantly during Ramadan fasting.Conclusions:Ramadan fasting is not associated with any change in incidence of acute cardiac illness and the majority of cardiac patients can fast without any difficulty. Improvement in lipid profile, especially 30% to 40% increment in high-density lipoprotein, as reported in some studies, appear promising. Diabetic patients should be carefully monitored during Ramadan fasting.
Background: Resting electrocardiogram (ECG) is a valuable non-invasive diagnostic tool used in clinical medicine to assess the electrical activity of the heart while the patient is resting. Abnormalities in ECG may be associated with clinical biomarkers and can predict early stages of diseases. In this study, we evaluated the association between ECG traits, clinical biomarkers, and diseases and developed risk scores to predict the risk of developing coronary artery disease (CAD) in the Qatar Biobank. Methods: This study used 12-lead ECG data from 13,827 participants. The ECG traits used for association analysis were RR, PR, QRS, QTc, PW, and JT. Association analysis using regression models was conducted between ECG variables and serum electrolytes, sugars, lipids, blood pressure (BP), blood and inflammatory biomarkers, and diseases (e.g., type 2 diabetes, CAD, and stroke). ECG-based and clinical risk scores were developed, and their performance was assessed to predict CAD. Classical regression and machine-learning models were used for risk score development. Results: Significant associations were observed with ECG traits. RR showed the largest number of associations: e.g., positive associations with bicarbonate, chloride, HDL-C, and monocytes, and negative associations with glucose, insulin, neutrophil, calcium, and risk of T2D. QRS was positively associated with phosphorus, bicarbonate, and risk of CAD. Elevated QTc was observed in CAD patients, whereas decreased QTc was correlated with decreased levels of calcium and potassium. Risk scores developed using regression models were outperformed by machine-learning models. The area under the receiver operating curve reached 0.84 using a machine-learning model that contains ECG traits, sugars, lipids, serum electrolytes, and cardiovascular disease risk factors. The odds ratio for the top decile of CAD risk score compared to the remaining deciles was 13.99. Conclusions: ECG abnormalities were associated with serum electrolytes, sugars, lipids, and blood and inflammatory biomarkers. These abnormalities were also observed in T2D and CAD patients. Risk scores showed great predictive performance in predicting CAD.
Background: Family consent and organ donors rates are colinear to each other. The low consent rate can be influenced by socioeconomic and behavioral factors in the population. This study aimed to assess the influence of sociodemographic and behavioral factors on family consent for organ donation in the household population.Subjects dan Method: This is a secondary data analysis of the cross-sectional research design of 1044 household participants conducted in Qatar on organ donation between October and November 2016. A two-stage systematic random sampling was applied to collect data. The dependent variable was family consent. The independent variables were demographic and behavioral factors such as knowledge, attitude, intention, and beliefs about organ donation. Data were collected using household survey Questionnaire and analyzed using Student t-tests (unpaired), chi-square tests, and multivariate logistic regression analysis. C-statistics were applied to see discriminate accuracy of the developed regression model for family consent.Results: Knowledge (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380), behavioral belief (aOR= 1.11; 95%CI= 0.77 to 1.61; p= 0.580), heard organ donation (aOR= 1.12; 95%CI= 0.71 to 1.76; p= 0.630), registered for organ donation (aOR= 1.11; 95%CI= 0.50 to 2.46; p= 0.800), donated any organ/ blood/tissue (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380) can increased with family consent for organ donation registration. But, it’s not significantly statistic. Attitude (aOR= 1.73; 95%CI= 1.28 to 2.34; p= 0.001), control belief (aOR= 0.74; 95%CI= 0.55 to 0.99; p= 0.050), and Intention (aOR= 7.50; 95%CI= 4.04 to 13.92; p= 0.001) can increased with family consent for organ donation registration and the results were statistically significant.Conclusion: Attitude, control belief, and intention can increase family consent for organ donation registration. Keywords: Family consent, intention, attitude, knowledge, organ donation. Correspondence:Rajvir Singh. Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar, Post Box: 3050; email: rajvir.aiims@gmail.com. Mobile: 97455897044.
Clinical trials of several platelet glycoprotein (GP) IIb/IIIa receptor inhibitors have demonstrated an unequivocal benefit of this potent antithrombotic therapy in high-risk patients with acute coronary syndromes (ACS) as well as in those undergoing percutaneous coronary intervention. In all of these major trials, however, GP IIb/IIIa inhibitors were used in combination with unfractionated (UF) heparin. Low molecular weight heparins (LMWH) have several advantages over UF heparin therapy, making them attractive alternatives for use in combination with GP IIb/IIIa inhibitors. In the INTegrelin and Enoxaparin Randomized assessment of Acute Coronary syndrome Treatment (INTERACT) study, combination therapy using the GP IIb/IIIa inhibitor eptifibatide (Integrilin®) and the LMWH enoxaparin (Lovenox®) in patients with high-risk non-ST-segment elevation ACS, resulted in improved outcomes compared to the currently recommended therapy of UF heparin, with better safety results. It is anticipated that the LMWHs may soon replace the traditional UF heparin for combination therapy with GP IIb/IIIa inhibitors in the medical stabilisation of patients with ACS. Results of other ongoing studies of LMWH combinations with other GP IIb/IIIa inhibitors and in the setting of percutaneous coronary intervention are awaited.
Atrial fibrillation (AF) with coexistent chronic kidney disease (CKD) is poorly described in the literature. We compared the presenting symptoms, clinical characteristics, treatment, and outcome of patients hospitalized with AF with and without CKD in a large clinical registry. Data of patients hospitalized with AF between 1991 and 2012 in Qatar were analyzed. Of 5201 patients hospitalized for AF, 264 (5.1%) had CKD. Patients with AF and CKD were older with higher prevalence of other comorbidities and left ventricular dysfunction and were more likely to present with shortness of breath and chest pain compared with patients with AF alone who were more likely to present with palpitation. The crude in-hospital mortality was 3 times higher in patients with dual disease. On multivariable adjustments, CKD was an independent predictor of mortality (odds ratio: 2.84; 95% confidence interval: 1.33-6.08, P = .001). Further studies are warranted to try to reduce the increased mortality observed in this high-risk population.
The Heart Protection Study is the largest trial of statin therapy conducted to date. It provides important new information on the use of statins in women, the elderly, diabetics and people with low baseline cholesterol pretreatment and those with prior occlusive non-coronary vascular disease. In this report, the paper is discussed with the significance of the results outlined in view of existing evidence from previously published trials. In addition, ongoing trials and future directions are explored.
Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East. For a period of 9 months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries. The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5 years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P = 0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type –STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%). There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.
There is strong evidence from controlled clinical trials that in the setting of acute myocardial infarction complicated by heart failure or isolated left ventricular dysfunction, angiotensin-converting enzyme inhibitors started late during hospitalisation and continued in the long term, significantly reduced mortality and improved the prognosis. On the other hand, administration of angiotensin-converting enzyme inhibitors during the first 24 h in unselected patients with acute myocardial infarction provided only a slight benefit in terms of mortality. Angiotensin-II receptor blockers have and are being examined in the setting of acute myocardial infarction with left ventricular dysfunction and can provide an alternative for patients who cannot tolerate angiotensin-converting enzyme inhibitors. In this article, an evidence-based review of these major trials and suggestions for clinical application are presented.
A prospective registry was made of all patients hospitalized with atrial fibrillation (AF) in the State of Qatar from 1991 to 2010. Clinical characteristics, management, and outcomes were compared according to ethnicity (Middle Eastern Arab vs South Asian). During this 20-year period, 2857 Arabs and 548 Asians were hospitalized for AF. Arabs were 9 years older and more likely to have hypertension, diabetes mellitus (DM), chronic renal impairment, and dyslipidemia than the Asians. Valvular heart disease and acute coronary syndromes were more common among Asians, while congestive heart failure was more common in Arabs. The overall inhospital mortality was lower in Asians than that of Arabs, while stroke rates were comparable. There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period, but there was no change in mortality trends. Our findings underscore the need to study AF according to ethnicity.
