Association between coronary artery disease and hepatitis C virus seropositivity

Background: Coronary artery disease [CAD] is one of the leading causes of death worldwide. Predisposing factors include some infectious aetiologies that have a systemic effect like hepatitis C virus.

Aims: The aim of this study was to explore the association between hepatitis C viral infection and coronary artery disease.

Methods: This case–control study was designed to include 100 patients attending the Cardiology Department in Tanta University Hospital, Gharbia Governorate, Egypt, for diagnostic angiography. A consecutive sample of 50 patients with abnormal angiographic findings was matched with another 50 consecutive patients with normal angiographic findings regarding age, sex, and major risk factors for coronary artery disease [diabetes mellitus, hypertension and smoking]. Patients were investigated for hepatitis C virus [HCV] infection.

Results: We found that 46% of abnormal angiography were HCV-positive compared to 28% of patients with normal angiography; this difference was not statistically significant. On studying the number of vessels affected among patients with abnormal angiography it was noted that one vessel affection was found mainly among HCV-negative patients [59.3% compared to 17.4% among HCV-negative and -positive patients]. Multi-vessel affection was found mainly among HCV-positive patient [47.8% compared to 22.2% among HCV-positive and -negative respectively].

Conclusions: The possible association between HCV positivity and extension of coronary artery disease may refer to the role of HCV in coronary artery disease pathology. Further studies on a large scale to investigate this association are recommended.

Stenting in acute coronary syndromes

The aim of this study was to assess Early and long-term outcome of intracoronary stent implantation for the treatment of acute coronary syndromes. Stenting has historically been contraindicated in thrombus containing lesion because of the risk of subacute thrombosis. With advance in stent implantation technique, and the recognition of the importance of adequate platelet inhibition, the incidence of subacute thrombosis has progressively fallen despite stenting in increasingly complex subset, inducing acute coronary syndromes and thrombus lader lesions. 50 patients with acute coronary syndromes who underwent coronary stenting where included in the study. According to medical history, resting 12 leads ECG, and serum cardiac enzymes, they were divided into 3 groups; the Q-wave Ml group, the non Q-Wave MI group, and the unstable angina group. All patients were treated with Aspirin, Ticlopidine and Heparin regimen. Through out the study period, 60 stents were successfully implanted in 50 patients [100%] success rate], with TIMI grade 3 restored in the whole study population. During hospitalization and at I month follow-up, there was no death, Q-wave MI or emergency CABG in the 3 groups. There was no major vascular complication but minor bleeding occurred in 16%. Late clinical follow up at a mean follow-up period of 6.3 +/- 1.02 months post coronary stenting showed that there was no death but there was 6% rate of Q-MI, 8% of elective bypass surgery and 8% repeated PCI for stented segments and 6%for non stented segment follow-up angiogram at a mean follow-up time of 6.1 +/- 0.5 stent restenosis rate was 19%. Stent implantation in acute coronary syndromes is associated with excellent early clinical outcome and good long-term results

role of sildenafil citrate in treatment of erectile dysfunction in- Egyptian men with stable ischemic heart disease

Erectile dysfunction [ED] is a common condition in men with cardiovascular disease [CVD]. Risk factors for ED include many of the same risk factors for CVD. Sildenafil is-an oral phosphodiesterase inhibitor that enhances erectile function through the same general pathway used by nature. Two hundred Egyptian patients with IHD and ED were included in the study. They had a clinical diagnosis of ED of at least 12 months duration. All were in a stable relation with their female partner. In addition to symptoms, one positive objective test for myocardial ischemia was mandatory as an inclusion criterion. Exclusion criteria included, patients with unstable angina pectoris, recent myocardial infarction [< 6 weeks]. Patients were also excluded if they had penile anatomical defects or if they were dependent on nitrate therapy, In some patients, if their clinical state allowed, nitrate therapy was stopped 24 hours before sildenafil administration. Patients were also excluded if they had any significant concomitant medical condition that would impair participation in the study. Patients were classified into 2 groups; group A included 100 patients who received sildenafil citrate [viagra, D- fizer Inc]. The other 100 patients represent group B and they received matching placebo. The dosage of sildenafil citrate was started as 50 mg, which could be adjusted to 100 mg or 25 mg. based on efficacy and tolerability. Efficacy was assessed using end-of-treatment responses to Question 3 [ability to achieve an erection] and Question 4 [ability to maintain an erection] of the 15-question International Index of Erectile function [IIEF] that includes scores for the 5 domains of male sexual function assessed by the IIEF [i.e. erectile function orgasmic function sexual desire intercourse satisfaction, and overall satisfaction] and responses to a global efficacy question ["Did the treatment improve your erections?"]. The responses to the 2 IIEF questions, which assessed treatment out comes, were graded on a scale of I [almost never or never] to 5 [almost always or always], with a score of 0 indicating no attempt at sexual intercourse. As regards efficacy, the mean score for question 3 [achieving an erection] and question. 4 [maintaining an erection] of the IIEF for patients with ED and IHD were significantly higher for group A [sildenafil group] than for group B [placebo group] [P < 0.0001]. The mean score for the orgasmic function domain, the sexual desire domain, the intercourse satisfaction domain and, the overall satisfaction domain were significantly higher for the sildenafil group [all P < 0.05]. At the end of treatment improved erection were reported in 61% of patients with IHD in sildenafil group. and by 3% of patients in placebo group [P < 0.0001]. There were no significant difference between both groups as regards major side effects as unstable angina,myocardial infarction and sudden death.. The most common minor complications, which included headache. flushing, and dyspepsia, were significantly higher in sildenafil group. Because there is small but definite risk of having a cardiac event with sexual activity, physicians should discuss with their cardiac patients the risk of sexual activity before prescribing any treatment for ED. Physicians should evaluate their patients cardiac status when considering the safety of administration of' any ED treatment that may have systemic vasodilatory properties and can potentially lower blood pressure the results of this study showed that oral sildenafil is effective and well tolerated in treatment of erectile dysfunction in Egyptian patients with stable coronary artery disease who are not on nitrate therapy