prognostic implications of timi risk scores in jordanian patients with acute coronary syndrome results from the glucometabolic abnormalities in acute coronary syndrome in Jordan [GLORY] study

Western studies have shown that TIMI [Thrombolysis In Myocardial Infarction] risk scores predict adverse events in patients with non ST-elevation acute coronary syndrome [NSTEACS] and ST-elevation myocardial infarction [STEMI]. Whether this also applies to Jordanian patients is largely unknown. We prospectively followed up 656 patients with ACS for total mortality, combined events of death, nonfatal MI or urgent coronary revascularization up to one year after admission. Of the whole group, 472 patients [72%] had NSTEACS, and 184 patients [28%] had STEMI. Among NSTEACS patients, 31.0% had a low risk score [total points 0 - 2 of 7], 43.5% had an intermediate risk score [total points 3 - 4], and 25.5% had a high risk score [total points 5 - 7]. In-hospital mortality was not different in the respective risk score groups [1.4%, 0.5%, and 3.4%, p = 0.123]. At 1 year, mortality was significantly higher in the high risk score group [12.8%] compared with the intermediate [4%] and low [1.4%] risk groups [p = 0.001]. Among STEMI patients, 58.6% had a low risk score [total points 0 - 3 of 13 - 14], 31.0% had a low intermediate risk score [total points 4 - 6], 8.0% had a high intermediate score [total points 7 - 9], and 2.4% had a high risk score [total points > 10]. In-hospital mortality rate was significantly higher in the two intermediate risk score groups [7.4%, 14.3%, respectively] and the high risk score group [50%] compared with the low risk score group [1.0%, p = 0.001]. The high risk and the two intermediate risk groups also had higher one-year mortality [75%, 28.6% and 16.7%, respectively] than the low risk group [3.9%, p = 0.001]. Similarly, composite events occurred at a significantly higher rate in patients with high risk scores than intermediate or low risk scores among NSTEACS and STEMI patients. TIMIRisk Scores and Prognosis in Jordan. Ayman J. Hammoudeh et al. In Jordanian ACS patients, high TIMI risk scores were associated with a high risk of cardiovascular events. Such patients are candidates for early aggressive therapeutic strategies

clinical and prognostic implications of natriuretic peptides in cardiovascular disease

several serum biomarkers with important diagnostic, therapeutic and/or prognostic implications in cardiovascular diseases [CVD] are being increasingly used in research as well as clinical arena nowadays. the list of these markers is expanding, and includes C -reactive protein, cardiac Eroponins, homocysteine, lipoprotein [a], lipoprotein-associated phospholipase A2 [Lp-PLA2], serum amyloid A [SAA], ischemia-modified albumin [IMA], soluble CD40, and natriuretic peptides. Most of these markers are related to atherosclerotic vascular disease, ischemic heart disease, and acute coronary syndromes, but the natriuretic peptides, especially brain-type natriuretic peptide [BNP], are used as biomarkers of left ventricular dysfunction and have assumed an important role in the diagnosis and treatment of heart failure. BNP is synthesized in the cardiac myocyte and its blood concentration increase in relation to increase in ventricular wall tension. Blood levels of BNP and its biologically inactive precursor, N-terminal pro BNP, can be measured by a commercially available rapid whole blood test. The physiology and clinical implications of BNP will be reviewed

Lipid profile in Jordanians with and without coronary artery disease: a study of 2000 consecutive individuals at Islamic hospital

dyslipidemias, including high serum cholesterol [C], high low -density lipoprotein cholesterol [LDL-C] and triglycerides [TG], and low levels of high-density lipoprotein cholesterol [HDL-C], are well-recognized coronary artery disease [CAD] risk factors. We sought to study the frequency of dyslipidemia among individuals with or without CAD in Jordan, as well as among those with or without certain risk factors such as diabetes and or smoking. we measured fasting serum lipids [in mg/dl] for 2000 consecutive individuals [mean age 52 years, range 17-88] and studied these levels according to several variables including gender [71% men], diabetes [30%], hypertension [40%], current smoking [24%], and cad [40%] including 26% with acute coronary syndrome [ACS] at Islamic Hospital between June 1999 to June 2000. mean C, TG, LDL-C, and HDL-C for the whole group were 209, 175, 135, and 40 respectively. Optimal C [<200] was present in 43%, and borderline high C [201-239] in 34%. normal TG [<150] was present in 44% and low HDL-C [<35] in 39% of the group. compared with men, women had higher mean C and HDL-C [212 vs 207, p=0.03, and 43 vs 39, p=0.001, respectively], but lower LDL-C and TG [131 vs 136, p-0.025, and 161 vs 181, p=0.001 respectively]. patients with CAD had lower C [207 vs 211, p=0.041], TG [171 vs 179, p=0.057], and HDL-C [39 vs 41, p=0.01]. among those with ACS, 80% had LDL-C>100, and 95% received statins during admission. smokers had significantly lower HDL-C [37 vs 41, p=0.0004] and higher TG [183 vs 173, p=0.046] compared with non-smokers. Compared with non-diabetics, diabetics had similar mean C [211 vs 209, p=NS] and LDL-C [134 vs 135, p=NS]. however, diabetics had lower mean HDL-C [39 vs 40, p-0.036] and higher TG [188 vs 170, p=0.0001] compared with non-diabetics. Conclusion patients with CAD were found to have higher C, TG, and HDL-C. LDL-C, however, was similar in the two groups. Diabetics and smokers had higher Tg and lower HDL-C compared with non- diabetics and non-smokers

survey of Jordanian physicians' management of dyslipidemia in patients with cardiovascular disease and diabetes

screening and treatment dyslipidemia are a pivotal component in managing patients with coronary artery disease. To study the attitude of jordanian physicians toward their approach in evaluating dyslipidemia, a group of physicians were asked to answer a questionnaire. of the 311 responders; 49% were residents and general practitioners, and 51% were internists or subspecialists. The participants worked either in a private clinic [27%] or in a hospital [73%]. Of the responders, only 10% would start screening adults for dyslipidemia at the age of 20 [NCEP recommendation]. Optimal cholesterol and triglyceride serum levels were considered to be <200 and <150 mg/dl respectively by 75% and 36% of the physicians. Low HDL-C was defined as any level <40 mg/dl by 48% only. Eighty percent and 72% agreed that the target LDL-C in cad and diabetic patients should be 100 mg/dl. Reduction of cardiac mortality and morbidity by lipid lowering was thought to be a correct statement by 96%.statins were thought to have rare side effects that are not of concern to the majority of the patients by 86%, while 80% noted that the most important factor that may limit prescription of statins was the high price of statins. Measuring serum lipoproteins during admission for acute coronary syndrome [ACS] was a common practice by 78% but 58% discharge >50% of their ACS patients on statins. more efforts are needed to facilitate guidelines application and integration into daily practice