Determinants of in-hospital cardiac catheterization in acute coronary syndrome patients in Kuwait

Clinical trials and practice guidelines have established the efficacy of early invasive strategy for high risk acute coronary syndrome [ACS] patients. This analysis was undertaken to detect the predictors of in-hospital cardiac catheterization [prior to hospital discharge] in patients with ACS in Kuwait and to assess if this use of early catheterization was according to published guidelines. We analyzed data from a prospective registry of 2054 consecutive patients admitted to all 7 general hospitals in Kuwait with the diagnosis of ACS over a period of 6 months in 2004. Citizens were more likely to receive in-hospital catheterization than expatriates [52.1% vs 38.6%; odds ratio 1.7; 95% confidence interval [CI], 1.4 to 2.2; p<0.001]. Patients with recurrent ischemia were more likely to undergo in-hospital catheterization than patients without recurrent ischemia [55.9% vs 12.2%; odds ratio 11.2; 95% CI, 8.6 to 14.5; p<0.001]. two coronary artery disease risk factors [hyperlipidemia and positive history] were associated with high rate of in-hospital cardiac catheterization [respectively, odds ratio 1.3; 95% CI, 1.2 to 2; p<0.001 and odds ratio 1.5; 95% CI, 1.3 to 2.3; p<0.001]. Although high risk patients benefit the most from an early invasive strategy after ACS, this strategy was persrvered for those with recurrent ischemia and citizens. Other risk factors were not determinants of in-hospital cardiac catheterization. Thus, there is substantial opportunity to improve the use of this effective therapy in high risk patients

Familial mineralocorticoid induced hypertension in the Sultanate of Oman

In Oman, many hypertensive patients with a family history of the disease respond to treatment with spironolactone, a mineralocorticoid receptor [MC-R] blocking agent thus suggesting a high prevalence of mineralocorticoid [MC] induced disease. The aim of this study was to document the prevalence of MC induced disease in patients with a positive family history of hypertension [HTN]. Serum calcium, potassium, creatinine, aldosterone and renin levels were measured under standard conditions in all patients together with an abdominal ultrasound scan and an adrenal computed tomography [CT] scan in four patients. In this small study, we show that 18 of the 27 patients [66%] had undetectable [suppressed] renin levels with usually normal aldosterone values [14 patients] and respond to treatment with spironoactone. We suggest that MC induced hypertension is likely to be common in the Middle East. In evolutionary terms, this makes sense as the ability to conserve salt in hot climates might be expected to confer a definite survival advantage

Serum leptin and its relationship with metabolic variables in Arabs with type 2 diabetes mellitus

Most studies on serum leptin in type 2 diabetes mellitus have focused on white populations. We studied serum leptin concentrations and parameters related to glycemic control and the association between leptin levels and anthropometric and metabolic factors in Arab patients with type 2 diabettes and in Arab control subjects. Ninety-two patients [65 females and 27 males] with type 2 diabetes and 69 matched normal control subjects [48 females and 21 males] were included. Anthropometric measures [including body mass index [BMI] and waist:hip ratio] were assessed in all subjects. After an overnight fast, blood was collected for serum leptin assay. Other metabolic parameters including glucose, insulin, C-peptide, intact proinsulin, insulin resistance index [HOMA-IR], insulin-like growth factor 1 [IGF-1], lipids and hemoglobin A1c [HbA[1C][C]] were determined. Fasting serum leptin levels, IGF-1 and high-density lipoprotein [HDL] cholesterol were similar in pattients with type 2 diabetes and control subjects. When obese subjects [BMI >/= 30 kg/m[2]] were analyzed separately, serum levels of leptin were significantly lower in patients compared to controls. In contrast, patients had higher fasting glucose, insulin, C-peptide, intact proinsulin, insulin resistance, total cholesterol, triglycerides, HbA[1C], and a larger waist circumference and waist-to-hip ratio than controls. Serum leptin correlated positively with BMI, negatively with waist-to-hip ratio, and demonstrated no relationship to other parameters. Patients with type 2 diabetes in an Arab ethnic population showed evidence of an unfavorable metabolic profile despite having leptin levels similar to controls. Obesity influences serum leptin levels more significantly in type 2 diabetes, in which leptin levels tends to be low