How successful is secondary prevention for coronary artery disease [cad] in the real world?

To document the effects of secondary prevention on different risk factors in the real world situation. It was a cross sectional comparative study carried out at a referral cardiac clinic in Peshawar from January 2010 to December 2010. Study subjects presenting with at least 6 months follow up were included from different parts of Khyber Pukhtunkhawa. All patients with positive history or objective evidence of CAD were enrolled. Study subjects were divided in two groups based on the fact that either taking or had stopped medication for the duration of the study period. Study variables were levels of lipids, glucose, blood pressure [BP], smoking and obesity. A total of 843 patients were included in the study. Males were 70.4% [593]. Mean age was 58.74 +/- 10.6 years. Patients taking regular medicine were 69.03% while 30.97% had stopped their medicine for at least three months. Diabetics, hypertensive and positive family history for CAD were 33.4%, 50.25% and 24% respectively. When compared to patient who had stopped medicine, mean systolic BP [p= 0.014], diastolic BP [p= 0.05], mean Cholesterol [p=0.000], mean LDL [p=0.000], mean HDL [p=0.000] and HbA1c% [p=0.049], was well controlled in patients who were taking medicine regularly. Mean BMI [p=0.786], triglycerides and smoking [p=0.761] had no significant difference between the two groups. Blood pressure, serum cholesterol, LDL, HDL, as well as HbA1c% were reduced with little effect on serum TGs, BMI and smoking in those who were taking medicine regularly compared to those who had stopped

Effect of intervention on the control of risk factors in coronary artery disease patients

To assess the effect of optimal medical therapy on the control of risk factors in coronary artery disease [CAD] patients with or with-out intervention. It was a cross sectional comparative study carried out at Lady Reading Hospital, Peshawar January to December 2010. Subjects were divided into two groups based on percutaneous coronary intervention and optimal medical therapy. Study variables were smoking, physical activity, dyslipidemia, diabetes, hypertension and obesity. Informed written consent was taken from all the study participants. Data was recorded on a preformed Questionnaire and analyzed with SPSS version 16. P-value of 0.05 was taken as significant. A total of 315 patients were studied. Baseline characteristic were similar between groups. Smoking was decreased significantly in [PCI group] as compared to [OMT group] [p=0.027]. Physical activity goal >/= 150 min/ week were achieved more in [PCI group] compared to [OMT group][p=0.019]. Goals set for Serum cholesterol, HbA1c%, serum LDL, Systolic blood pressure and Diastolic blood pressure have significantly achieved in [PCI group] as compared to [OMT group] with p- valves of [0.018,0.027,0.023,0.033 and 0.017] respectively. While goals set for Triglycerides, serum HDL and BMI have no significant difference between the two groups with p-valves of [0.223, 0.089 and 0.164 respectively]. Patients who underwent intervention and remained on optimal medical therapy were more adherent to regular exercise and good compliance which lead to better risk factors control for coronary artery disease as compared to patients who remained on optimal medical therapy alone

Does anxiety and depression cause acute myocardial infarction?

To study the frequency of depression and anxiety in patients admitted with acute myocardial infarction [AMI]. Two hundred consecutive patients of AMI without complications presenting to the coronary care unit of Cardiology department of Lady Reading Hospital and 200 healthy controls among patient's attendants were interviewed with standard scales of HADS and HRS for the presence of depression from to date. Two hundred consecutive patients of AMI and 200 healthy controls among patient's relatives were assessed on HADS and HRS scale for the presence of depression. Sixty three percent of the patients were male in both groups. Mean age of patients was 59 +/- 11 years while that of controls was 52 +/- 10 years. Although significantly different between the two groups, age had no significant effect on the presence of depression in any group [p < 0.4]. A significant difference was noted in the number of events reported between patients of AMI and control group, 4.21 +/- versus 2.71+ respectively [p<0.001]. On Hospital Anxiety and Depression Scale [HADS] 77.5% of the acute MI patients had depression compared to 64% in the control group [p< 0.003]. When HADS was used to asses the level of anxiety and depression in the two groups, 83% of patients in the AMI group reported abnormal i.e. scores above 17 compared to 70% in the control group [p< 0.001]. Depression was more common in patients presenting with acute myocardial infarction as assessed by standard scales as compared to controls

Frequency of congenital heart diseases in patients under the age of twelve years at lady reading hospital Peshawar

To find out the frequency of various congenital heart diseases [CHI]] in patients less than 12 years of age at Lady Reading hospital, Peshawar. This retrospective study was conducted at Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. Patients referred for echocardiography were reviewed. Trans-thoracic two dimensional echocardiography and Doppler studies were done on all cases. The results were analyzed from the data retrieved from the computerized data base of Cardiology department from July 1998 to December 2005 covering almost seven years and six months. Records of patient aged twelve and below and labeled as congenital heart disease were analyzed on SPSS windows version 10. Out of 3072 patients with CHD, 83.7% were acyanotic heart diseases. Ventricular septal defect was present in 1248 patients [40.6%], atrial septal defects [ASD] were 493 [16%] comprising of ASD secundum in 397 [12.9%] and ASD primum in 96 [3.1%] patients. PDA was present in 394 patients [12.8%]. A total of 473 patients [15.4%] had the tetrology of Fallot and 236 patients [7.7%] had pulmonic stenosis. Complex congenital heart diseases were present in 198 [6.4%] patients and coarctation of aorta was found in 0.9%. Majority of the congenital cardiac anomalies in patients less than 12 years of age are acyanotic. VSD and ASD are the major acyanotic and TOF is the major cyanotic congenital heart disease