Prognostic value of C-reactive protein in acute coronary syndrome

It is well recognized that inflammation plays a key role in acute coronary syndromes [ACS]. Researchers have turned to biochemical markers of inflammation as possible noninvasive predictors of high risk. High-sensitivity measurement of C-reactive protein [hs-CRP] is one of the most extensively studied biochemical markers. Recent studies had suggested a significant association between its level and the risk of future cardiovascular events in patients with ACS. In this study, serial measurements of hs-CRP were performed in patients with ACS admitted in Sohag university hospital to find out its prognostic value and evaluate its possible use for risk stratification. This study included 150 patients who were admitted to coronary care unit in Sohag University hospital with the diagnosis of ACS [unstable angina-Acute Myocardial infarction]. Clinical and laboratory assessment as well as hs-CRP measurements were performed on admission and at monthly interval for 6 months. Angiographic analyses were performed for 68 patients. Development of major adverse cardiac events [MACE] or cardiac deaths during the follow-up period were recorded. The study included 50 patients with unstable angina, 100 patients with myocardial infarction. In the 1st group; MACE occurred in 10 patients [20%] and mortality in 3 [6%] patients. In the 2nd group; MACE occurred in 16 patients [16%] and mortality in 8 patients [8%]. The median level of hs-CRP was high in all groups on admission [3.5 [1.5-6.9]]. A significantly higher on-admission levels of hs-CRP were observed in patient with MACE during the follow-up period as compared to those with no MACE with a P value=0.021 in both groups. The estimated hazard ratio was increased more than 2 folds in patients with higher hs-CRP in both groups. MACE were significantly associated with the disease extent and extent score [p=0.4 and 0.5 respectively] in both groups, but the later 2 factors were not associated with increase in hazard ratio [1.1 and 1.00 respectively]. Mortality was associated with significantly higher median levels of hs-CRP in both groups. Monthly measurements of hs-CRP shows significantly higher median levels in patients with MACE at the 1st and 2nd month in patients with UA [p=0.034 and 0.049 respectively] and at the 1st month only[p=0.026] in patients with MI. Measurement of hs-CRP in patients with ACS is a simple, reproducible and adds to the predictive value of traditional risk factors. Its measurement is recommended in routine clinical practice for risk stratification in acute coronary syndromes

Hypertension; ecological factors, control and complication in Urban Sohag, Upper Egypt

Because of the associated morbidity, mortality and the cost to societies, hypertension is an important public health challenge being the most common worldwide disease-affecting human. To study the clinical characteristics, therapeutic regimens, compliance with treatment, risk factors and target organ damage of hypertensive patients among people > 35 years old. A cross sectional study; conducted in Sohag city; it involved 520 patients; males [45.7%] and females [54.3%]. Their ages were 35 to 85 years. Hypertension presented more between non-smokers [72.55%], females [54.3%], educated patients [50.99%] and patients with low SES [54.9%]. ECG of hypertensive patients showed that ischemia presented in [51.63%] of patients, while their laboratory investigations showed that hyperglycemia presented in [28.7%], anemia in [18.3%], high serum creatinine level presented in [8.49%] and proteinuria in [10.45%] of patient. Adequate BP control was found to be achieved in [49.67%]; older patients had lower adequacy of BP control in spite of the extensive use of multiple-drug therapy and of appropriate drug choice. This is probably due to high prevalence of a difficult to control form of hypertension and poor compliance with the multiple-drug regimen. Most hypertensive patients had more than one coexistent CV risk factor. Aging, being a female [54.3%], diabetes, family history of hypertension [28.7%], smoking [27.45%], family history of coronary heart disease [25.4%], and obesity [10%] were of the contributing risk factors .About 72% had target organ damage. Heart involvement was the most frequent finding [63.39%]; coronary heart disease was the most common heart damage [51.63%]. ACE-inhibitors were prescribed in [58.16%]; mostly capotril and zestril. Beta-blockers were used in [34.64%] of the patients, Ateno is the drug mostly used in this group. Monotherapy was prescribed for [41.17%] only of the patients. Fortunately [75.81%] of patients showed regular use of their drug regimens. It was observed that [49.67%] only of patients had their condition under control, the number of drugs was inversely related to BP control. Hypertensive patients in Sohag city had a profile of high CV risks, target organs damage and poor blood pressure control particularly in the elderly. Great efforts towards improving the compliance of both service providers with guidelines and patients with treatment must be done. A multidisciplinary approach for routine clinical check up, follow-up, training, prescribing simple once-daily regimens and encourage life style modifications; all to optimize patient outcomes and prevent disease