Apolipoprotein E, CI and B gene polymorphisms in a sample of patients with coronary heart disease in the Kuwaiti population

The objective of this study was to investigate the possible association of clinical variables and apolipoprotein [APOE, APOCI and APOB] polymorphisms with the development of myocardial infraction [MI] and coronary heart disease [CHD] in Kuwaitis. APOE, APOCI and APOB genotypes were determined by polymerase chain reaction followed by restriction fragment length polymorphism in 143 Kuwaiti CHD patients with [n = 88] and without [n = 55] MI and in 122 controls matched for gender and age. Statistical and genetic analyses of the genotype, allele and haplotype frequencies, as well as regression analyses of genetic and clinical variables were done. There was a statistically significant association between CHD and medical history of diabetes mellitus [p < 0.001], hypertension [p < 0.01], high cholesterol [p < 0.05] and family history of CHD [p < 0.001]. A highly significant association [p < 0.001] was found, with an adjusted odds ratio of 9.32, for family history and the development of MI. No significant differences were found for allele or genotype frequencies between CHD patients and controls. The strong effect of family history suggests a major genetic component for the development of CHD in Kuwaitis, but this association does not appear to be related to the APO genes studied here. The results in this study encourages future research into these and other polymorphisms and their potential association with MI and CHD in the Kuwaiti population

Accuracy of 64-multidetector-row computed tomography in the diagnosis of coronary artery disease

The aim of this prospective study was to assess the accuracy of 64-multidetector-row computed tomography coronary angiography [CTA] in the diagnosis of coronary artery disease [CAD Ninety-two patients suspected of having CAD underwent CTA using a 64-slice CT scanner before a scheduled, conventional coronary angiogram [CCA]. Blinded assessment of CTA to detect CAD was performed. The accuracy of CTA in detecting significant stenoses [>/= 50%] was compared to CCA. Data analysis was performed on 73 patients because the scans were nondiagnostic in 5 patients and 14 refused to undergo coronary angiography The CTAs of 21 of these 73 patients were considered as normal; 19 were confirmed on CCA. For the remaining 52 diagnosed as abnormal, 51 were confirmed on CCA. For patient-based analysis, CTA had a sensitivity of 95%, a specificity of 96%, a positive predictive value of 98% and a negative predictive value of 90%. For the whole vessel, the sensitivity of CTA was 60-100%, for all vessels and the specificity was 82-100%. Pooled sensitivity was 92% and pooled specificity was 98%. For the segments, the sensitivity of CTA was 64% or above for all vessels except for the distal left anterior descending artery [40%], mid circumflex artery [50%] and posterior descending artery [60%]; the pooled sensitivity was 79%. The specificity for the segments was 82-100% for all vessels and pooled specificity was 94%. The sensitivity and specificity for patient-based analysis and for the main coronary vessels were high whereas for the segments, the sensitivity was moderately good, but the specificity was high, confirming that a negative CTA is useful to rule out significant CAD. A coordinated classification system between radiologists and cardiologists is required to eliminate errors in segment classification

Impact of fasting in Ramadan in patients with cardiac disease

To investigate whether Ramadan fasting has any effect on patients with heart disease. We prospectively studied 465 outpatients with heart disease who were fasting during the month of Ramadan from October 24 to November 24, 2003. These studied subjects were from various medical centers in the Gulf region; State of Qatar, Kuwait, United Arab Emirates, and Bahrain. We performed detailed clinical assessments one month before Ramadan, during Ramadan and one month after Ramadan and analyzed predictors of outcome. Overall, the mean age was 55.9 +/- 11.3 years [age range 32-72]. Of the 465 patients treated, 363 [78.1%] were males and 102 [21.9%] females. Among them, 119 [25.6%] patients had congestive heart failure, 288 [62%] patients with angina, 22 [4.7%] patients with atrial fibrillation and 11 [2.4%] patients with prosthetic metallic valves. Three hundred and seventy [79%] had prior myocardial infarction [MI], 195 [17.2%] had prior coronary artery bypass surgery [CABG], and 177 [38%] had prior percutaneous coronary interventions [PCI]. At the time of follow-up, we found that 91.2% could fast and only 6.7% felt worse while fasting in Ramadan. Of the studied subjects, 82.8% were compliant with cardiac medications and 68.8% were compliant with dietary instructions. We hospitalized 19 patients during Ramadan for cardiac reasons [unstable angina, worsening heart failure, MI, uncontrolled hypertension, subtherapeutic anticoagulation or arrhythmias]. The effects of fasting during Ramadan on stable patients with cardiac disease are minimal. Most patients with stable cardiac disease can fast