Are routine checkups necessary?: The Shinawatra's employee study.

The authors performed a survey in 3,615 Shinawatra employees aged 18-60 years to determine the abnormalities found with routine checkup. The annual checkup included: history taking. anthropometric measurement, physical examination, complete blood count, urine analysis, chest roentgenography, blood chemistry (fasting blood glucose, BUN, creatinine, uric acid, AST/ALT, cholesterol, triglyceride and HDL-cholesterol). The prevalence of abnormalities with management change detected by complete blood count, urine analysis was low and we did not recommend the routine use of complete blood count and urine analysis. The prevalence of hypertension was more common in males and the prevalence increased sharply after the age of 25 years in males and 40 years in females. The prevalence of abnormalities of BUN, creatinine (both males and females) and uric acid (in females) was very low. There was high prevalence of high AST/ALT which suggested hepatitis in our population, and the prevalence was more common in males beginning at a young age. Diabetes mellitus was more common in males especially after the age of 45 years. Chest roentgenography abnormalities were found in 9.4 per cent and the prevalence of abnormalities increased with age and was common after the age of 44 years. Most of the abnormalities found by chest roentgenography were pulmonary infiltration and cardiomegaly. The authors' findings did not recommend the routine use of complete blood count, urine analysis, fasting BUN and creatinine. We recommend routine blood pressure measurement in males aged 25 years or more and in females aged 40 years or more. We suggest routine blood cholesterol measurement in both sexes, blood triglyceride measurement in males aged 25 years or more and fasting blood sugar tests in males aged more than 44 years, chest roentgenography in males and females after the age of 45 years.

Impaired fasting glucose, diabetes mellitus and coronary risk factors.

The authors conducted a prevalence survey of impaired fasting glucose and diabetes mellitus in 3,615 Shinawatra employees, and we also determined various risk factors of coronary artery disease such as blood pressure level, body mass index and serum lipids. The prevalence of impaired fasting glucose and diabetes mellitus were 1.7 per cent and 0.8 per cent respectively. The prevalences were more common in males and increased with increasing age. Coronary risk factors were higher in impaired fasting glucose (IFG) and diabetes mellitus (DM) when compared with normal glucose levels. There were also significant differences between impaired fasting glucose and diabetes mellitus, except for pulse pressure, serum cholesterol level, LDL-cholesterol level and HDL-cholesterol level.

The prevalence of left ventricular hypertrophy and associated factors in a Thai population.

Electrocardiographic left ventricular hypertrophy (LVH) has been a bad prognostic factor for cardiovascular morbidity and mortality. However the prevalence and prognostic value of LVH are varied among nationalities and populations. Several factors have been shown to associate with LVH. Some factors are treatable such as hypertension. We prospectively studied the prevalence of LVH and associated factors in selected group of Thai population. The study population was 1,606 Shinawatra employees who were 30 year old or more. The prevalence of LVH was 13 per cent (210) among study population. Hypertension, lower body weight and male sex were significantly associated factors. In the subjects with LVH, the prevalence of hypertension was 25.6 per cent, male ratio was 5:1 and mean body weight was 57.7 kg, compare to 9.8 per cent prevalence of hypertension, 2:1 female ratio and mean body weight was 62.3 kg in the group without LVH.

Obesity and risk factors of coronary heart disease in healthy Thais: a cross-sectional study.

Association between obesity and conventional risk factors for coronary artery disease is well established. Obesity is currently considered an independent risk for coronary artery disease. The relationship between body mass index (BMI) and fasting plasma lipids and glucose and blood pressures in non-obese subjects is not established. The authors studied relationships between BMI and lipids, and glucose, and blood pressure levels in healthy a population. The authors measured the weights and heights of 3,615 employees of a company during a routine yearly health examination. There were 1,250 males aged 31.3 +/- 6.6 and 2,365 females aged 29.3 +/- 4.9 years old. The average BMI for males and females were 23.5 +/- 3.6 and 20.1 +/- 3.0 respectively. The levels of total cholesterol (Chol), LDL-cholesterol, and triglyceride (TG), fasting plasma glucose (FPG) had a positive relationship with BMI (r = 0.22, 0.26, 0.41, 0.20; p < 0.001). HLD-cholesterol had a negative correlation with BMI (r = -0.36, p < 0.001). Both systolic (SBP) and diastolic (DBP) blood pressures had a positive correlation with BMI. The association persisted after all values were adjusted by age and sex. BMI has a significant positive relationship with the conventional risk factors for coronary artery disease and a negative relationship with HDL-cholesterol.

Percutaneous transluminal coronary angioplasty in the young patients--Siriraj Hospital's experience.

The aim of this study was to follow-up immediate and long term results of patients aged less than 40 years with CAD treated by PTCA. Primary end points were to record major coronary events, incidence and timing of restenosis and requirement of repeated revascularization after initial PTCA. Data was collected retrospectively from records of patients aged less than 40 years who underwent PTCA from Jan 1996 to June 1998 in Her Majesty Cardiac Center, Siriraj Hospital. Patients were followed up and data was collected regarding recurrent angina, major coronary events and results of repeated coronary angiography and revascularization if available. Out of 830 procedures performed for 325 patients, 30 patients (9%) were less than 40 years of age and comprised of 26 males (87%) and 4 females (13%). Eighteen patients (60%) had more than one risk factor. The most important risk factor was smoking (60%) followed by dyslipidaemia (47%) and family history of coronary artery disease (20%). DM was strikingly uncommon. 14 patients had single vessel disease and 16 patients had multiple vessel disease. Initial stenosis was 87.5 +/- 9.8 and residual stenosis was 17.8 +/- 10.8. PTCA failed for 5 lesions, overall success rate was 89 per cent. Stent was used for 12 lesions in 10 patients. There was no major complication during the procedure. Minor complications included non occlusive dissection in four cases and groin haematoma in three cases. The follow up ranged from 7-36 months with the median of 23 months. During follow up, there was no major cardiac event such as death, acute MI, congestive heart failure or cerebero-vascular accident. Eleven patients (37%) had sustained improvement without recurrent angina. Recurrent angina occurred in 19 patients (63%) after initial PTCA and second/third recurrent angina occurred in 5 patients. On repeated coronary angiography angiographic restenosis was seen in 10 patients (33%) after initial PTCA. Overall repeated revascularization was done twenty times for sixteen patients which included 4 CABGs and 16 PTCA. Twenty one patients (70%) showed sustained improvement after repeated PTCA and medications. Follow up results of PTCA in young patients showed sustained improvement but achieved at high rate of repeated revascularization.

A 5-year prospective study of conventional risk factors of coronary artery disease in Shinawatra employees: a preliminary prevalence survey of 3,615 employees.

We conducted a prevalence survey of conventional risk factors of coronary artery disease in 3,615 Shinawatra employees and we planned to prospectively follow up this population to determine the impact of the risk factors in the development of coronary disease. The prevalence of hypertension, diabetes mellitus, hyperlipidemia, obesity, physical inactivity and smoking were 7.4 per cent, 1.4 per cent, 21.1 per cent, 13.9 per cent, 76.3 per cent and 16.3 per cent respectively. The awareness of hypertension, diabetes mellitus and hyperlipidemia were 42.2 per cent, 78 per cent and 32.9 per cent respectively. The prevalence of the risk factors was more common in males and increased with increasing age. Dependent variables which were associated with hypertension included: excessive weight; male sex; increasing age; hypercholesterolemia and diabetes mellitus. Variables which were associated with diabetes mellitus were hypertriglyceridemia, hypertension, male sex, increasing age and excessive weight.. Variables which were associated with hypercholesterolemia were hypertriglyceridemia, high HDL-cholesterol, increasing age, excessive weight and hematocrit level while overweight, hypercholesterolemia, low HDL-cholesterol, smoking, hematocrit level, low income and increasing age were associated with hypertriglyceridemia. Excessive weight was associated with hypertriglyceridemia, low HDL-Cholesterol, presence of hypertension, hypercholesterolemia, diabetes mellitus, increasing age and low education.

Acute and follow-up results of laser angioplasty: single center experience.

Excimer laser angioplasty was used to treat total occluded coronary arteries and instent restenosis lesions with high success rate. To assess immediate and long-term results of patients treated with excimer laser, we analyzed demographic information and the immediate results of 44 patients who underwent ELCA. The patients were followed up and assessed for clinical restenosis. The initial success rate of ELCA was 86.4 per cent which is comparable to plain balloon angioplasty performed during the same period. Clinical restenosis was 29 per cent. In conclusion, ELCA for patients with coronary artery disease can be performed with initial high success rate and reasonable long-term restenosis.

Prevalence of new coronary risk factors in Thai population.

Many new cardiovascular biomarkers of atherosclerosis have recently been emerging. However, there is a paucity of these data in the Thai population. This study aims to determine the prevalence of these biomarkers of atherosclerosis and the relationship between these new risk factors and other conventional risk factors for atherosclerosis in the healthy Thai population. As a yearly check-up program, we surveyed 3,615 normal healthy populations for their conventional risk factors and some new cardiovascular biomarkers for atherosclerosis. The authors found hyperhomocysteinemia and high level of Lp(a) in 27 per cent and 32 per cent of the cases respectively. Prevalence of recent and past chlamydial infection was found in 30 per cent and 51 per cent respectively.

Regular exercise and cardiovascular risk factors.

Physical inactivity has been counted as a risk factor for coronary artery disease. Regular exercise has also been reported to reduce risk of cardiovascular disease and its risk factors. We surveyed 3615 subjects for their conventional risk factors of coronary disease and for the frequency of their exercise. We found that subjects who had regular exercise were more likely to have lower triglyceride and resting heart rate. HDL cholesterol was higher in the group of subjects who had regular exercise. There was no difference in fasting plasma glucose, total cholesterol or blood pressure levels between those who had and those who did not have regular exercise.

Ticlopidine in the prevention of thrombus formation after percutaneous transluminal coronary angioplasty (PTCA).

We studied the additive effect of ticlopidine to aspirin compared with aspirin in the prevention of thrombus formation after PTCA in two groups of 21 patients who underwent PTCA at Her Majesty's Cardiac Centre, Siriraj Hospital from January to April 1993. Patients in both groups were comparable in baseline patient data and characteristics of angiographic lesions. There was no difference in angiographic outcome including the presence of intracoronary thrombus between the two groups. We concluded that ticlopidine had no additive effect to aspirin in the prevention of thrombus formation after PTCA.

Immediate angioplasty results of total coronary artery occlusion in Thai population.

Attempted angioplasty of totally occluded vessels may be done. However, a lower success rate is expected compared to those with subtotal occlusion. The complication rate is comparable to that of partial occlusion in experienced hands.

Experience of the first 60 cases of intracoronary stent placement.

In conclusion, elective stent placement, compared to angioplasty, has a higher clinical success rate. However, in our early experience major complications did occur.

Effectiveness of percutaneous transluminal coronary angioplasty for patients with unstable angina.

We have reported a series of patients with unstable angina successfully treated with PTCA. It can be performed safely with a high success rate in a selected population.

Radiofrequency ablation of cardiac arrhythmia: the first fifty cases experience in Siriraj Hospital.

In our series of 50 consecutive patients with a wide variety of cardiac arrhythmia, a combined approach to electrophysiological diagnosis and definitive treatment with catheter ablation was associated with a high degree of efficacy, low procedural complication and low rate of arrhythmia recurrence. The radiofrequency catheter ablation should be considered as the acceptable or preferable first line treatment in patients with supraventricular tachycardia and idiopathic ventricular tachycardia.

Radiofrequency catheter ablation in monomorphic ventricular tachycardia.

Twenty patients with symptomatic monomorphic ventricular tachycardia (VT) underwent radiofrequency (RF) energy catheter ablation. Four patients (20%) had underlying heart disease (1 prolapse mitral valve, 1 dilated cardiomyopathy and 2 myocarditis). Five patients (25%) had left sided VT and right sided VT in the remainder (75%). Radiofrequency catheter ablation was initially successful in all patients without major complication. Recurrence occurred in three patients (15%). In conclusion, RF ablation is an effective treatment for symptomatic monomorphic right and left sided VT especially in patients who do not want long term antiarrhythmic agents.

Resolution of dilated cardiomyopathy after radio-frequency catheter ablation of atrial tachycardia.

The dilated cardiomyopathies are characterized by an increase in left ventricular internal dimensions without an appropriate increase in ventricular wall thickness. Sustained tachyarrhythmia, either supraventricular or ventricular, may be associated with this condition and may improve after termination of the tachycardia. We report a case of secondary dilated cardiomyopathy caused by incessant atrial tachycardia who underwent successful radiofrequency catheter ablation and left ventricle returned to normal size and function in six months post ablation.