Coronary heart disease risk-factor profile in a lower middles class urban community in Pakistan.

We determined the risk-factor profile and prevalence of coronary heart disease in Metroville, a lower middle class urban community in Karachi, and compared them to the Pakistan health survey PNHS 1990-94, and the US health and nutrition survey 1988-94 NHANES111. Subjects < 18 years and pregnant women were excluded as were people with extreme ranges BMI [corrected] heart rate, height and waist. The prevalence of hypertension was 23% in men and women, hypercholesterolaemia was 17% in men and 22% in women (P < 0.001). Hyperglycaemia was present in 5% of men and women and obesity in 33% of men and 47% of women (P < 0.001). Compared to PNHS, the prevalences of obesity, hypertension, hypercholesterolaemia and WHR were higher in our population. Mean values of BMI [corrected] cholesterol, WHR were higher in the US population while mean values were lower for diastolic blood pressure and blood glucose.

Coronary heart disease risk-factor profile in a lower middles class urban community in Pakistan

We determined the risk-factor profile and prevalence of coronary heart disease in Metroville, a lower middle class urban community in Karachi, and compared them to the Pakistan health survey PNHS 1990-94, and the US health and nutrition survey 1988-94 NHANES111. Subjects < 18 years and pregnant women were excluded as were people with extreme ranges BMI [corrected] heart rate, height and waist. The prevalence of hypertension was 23% in men and women, hypercholesterolaemia was 17% in men and 22% in women [P < 0.001]. Hyperglycaemia was present in 5% of men and women and obesity in 33% of men and 47% of women [P < 0.001]. Compared to PNHS, the prevalences of obesity, hypertension, hypercholesterolaemia and WHR were higher in our population. Mean values of BMI [corrected] cholesterol, WHR were higher in the US population while mean values were lower for diastolic blood pressure and blood glucose

Evaluation and comparison of coronary heart disease risk factor profiles of children in a country with developing economy.

OBJECTIVE: To define the risk factors (RF) profile and prevalence rates of high risk factors in an urban Pakistani community and compare it to the RF profile and prevalence rates of Pakistan National Health Survey. METHODS: The present study included RF relevant data of 400 house hold children selected by open invitation as a part of Metroville Health Study (MHS), a risk factor modification study which was a cooperation between National Heart Lung Blood institute (NHLBI) USA and National Institute of Cardiovascular Diseases Pakistan. The base line data of 389 girls and 417 boys age 5-17 was included. PMRC data of 5067 and NHANES III survey data of 10,252 US children was used for comparison with MHS. RF analyzed were height weight, SBP, DBP, BMI and serum cholesterol. Comparisons between MHS and PMRC and US were made by using two tailed student t test and of high RF were defined as those exceeding US standards and expressed as percentages. RESULTS: The RF factor profile of urban Metroville children was worse than the national average of PMRC children. Except for diastolic blood pressure in both boys and girls and SBP in PMRC boys, all other RF were less than US children. Prevalence rates were higher in urban Metroville community, i.e., MHS compared to the PMRC which represents national average data. CONCLUSION: RF profile of Pakistani children has been presented and effect of urbanization demonstrated by comparing the PMRC and MHS RF profile. Hypertension in Pakistani children has emerged as a single most important RF requiring urgent prevention.

Coronary artery diameter in a cohort of adult Pakistani population.

OBJECTIVE: To study the diameter of coronary arteries in a cohort of adult Pakistani population and to compare these with the diameters of Caucasians mentioned in the literature. METHODS: A study of 220 adult patients referred to National Institute of Cardiovascular Disease (NICVD) for diagnostic coronary angiography between May 2000 to December 2000. RESULTS: The mean diameter of Right Coronary Artery (RCA) was found to be 3.08 + 0.78 mm with a 95% CI of 2.9 - 3.2, and of Left Main Coronary Artery (LMCA), 4.28 +/- 0.82 with a 95% CI of 4.2 - 4.4. While the mean diameter of Left Anterior Descending Artery (LAD) was 3.22 +/- 0.74 with a 95% CI of 3.1 - 3.33, and that of the Circumflex Artery (CX) 3.02 + 0.75 with a 95% CI 2.9 - 3.1. The total coronary area (TCA), diameter of three vessels was 9.32 + 1.68 with a 95% CI of 9.1 - 9.5, while the sum of 4 vessels diameter was 13.6 + 2.26 with a 95% CI of 13.3 - 13.9. CONCLUSION: The diameters of coronary arteries of Pakistani population are not significantly different from that of Caucasians and the cause of increased mortality in the people of South Asians origin seems to be other than the diameter of coronary arteries.

Risk factors for non-fatal myocardial infarction in young South Asian adults.

OBJECTIVE: To determine the risk factors for premature myocardial infarction among young South Asians. DESIGN AND SETTING: Case-control study in a hospital admitting unselected patients with non-fatal acute myocardial infarction. METHODS AND SUBJECTS: Risk factor assessment was done in 193 subjects aged 15-45 years with a first acute myocardial infarct, and in 193 age, sex, and neighbourhood matched population based controls. RESULTS: The mean (SD) age of the subjects was 39 (4.9) years and 326 (84.5%) were male. Current smoking (odds ratio (OR) 3.82, 95% confidence interval (CI) 1.47 to 9.94), use of ghee (hydrogenated vegetable oil) in cooking (OR 3.91, 95% CI 1.52 to 10.03), raised fasting blood glucose (OR 3.32, 95% CI 1.21 to 8.62), raised serum cholesterol (OR 1.67, 95% CI 1.14 to 2.45 for each 1.0 mmol/l increase), low income (OR 5.05, 95% CI 1.71 to 14.96), paternal history of cardiovascular disease (OR 4.84, 95% CI 1.42 to 16.53), and parental consanguinity (OR 3.80, 95% CI 1.13 to 1.75) were all independent risk factors for acute myocardial infarction in young adults. Formal education versus no education had an independently protective effect on acute myocardial infarction (OR 0.04, 95% CI 0.01 to 0.35). CONCLUSIONS: Tobacco use, ghee intake, raised fasting glucose, high cholesterol, paternal history of cardiovascular disease, low income, and low level of education are associated with premature acute myocardial infarction in South Asians. The association of parental consanguinity with acute myocardial infarction is reported for the first time and deserves further study.

Efficacy of CVD risk factor modification in a lower-middle class community in Pakistan: the Metroville Health Study.

The Metroville Health Study aimed to reduce consumption of total cooking fats by 33%, salt by 25% and replace ghee with vegetable oil in a lower middle class urban community in Pakistan. Households (n=403) were randomly assigned to Intervention and Control groups. A baseline screening collected data on CVD risk factors, knowledge and attitudes and household consumption of cooking fats and salt. Intervention households received information about CVD and regular visits by social workers who measured cooking fats and salt and counselled cooks on the goals of intervention. Two years later, 291 households were re-screened. Intervention households reduced consumption of fats and salt compared to differences were total fat, 48% (p<0.0001); ghee, 37% (p=0.005); vegetable oil, 33% (p=0.0001); and salt, 41% (p=0.011). Household visits by trained social workers were effective in achieving reductions in consumption of cooking fat and salt in a lower class urban community.

Experience of direct coronary stenting at National Institute of Cardiovascular Diseases.

OBJECTIVE: To assess the efficacy, safety and advantage of direct coronary stenting versus traditional angioplasty and stenting. METHODS: From May 2000 to June 2001, 486 patients underwent PTCA procedure. One hundred fifteen (24%) were considered candidates for direct stenting. Out of 150 coronary lesions, 119 (79%) had direct coronary stenting. In 5% patients stent could not be passed across the lesion. These stents were withdrawn without stent damage and after predilatation the same were successfully deployed. RESULTS: Primary success rate was 95%. Angiographically assessed success was achieved in all patients with immediate TIMI 111 flow in 97%. The vessels directly stented were LAD 53%, RCA 27% and LCX 18%. Two saphenous vein grafts were also directly stented. The coronary lesions stented were type A 36%, B1 54% and B2 10%. In borderline lesions IVUS was used for quantification of stenosis. There was no in-hospital death, MI or emergency CABG. Compared to traditional stenting there was 46% reduction in procedure time, 62% reduction in radiation exposure time and 35% decrease in use of contrast media. There was also significant (18%) cost benefit in direct stenting. CONCLUSION: This study supports the view that direct coronary stenting is feasible and a safe procedure in our population with additional benefits of cost reduction by 18%. We recommend direct stenting in appropriately selected patients.

Recommendations for the prevention of coronary artery disease in Asians: a scientific statement of the International College of Nutrition.

There has been a rapid increase in coronary artery disease (CAD) in most Asian countries in association with rapid economic development; however, there is no consensus of opinion on diet and lifestyle guidelines and desirable levels of risk factors for prevention of CAD in these countries. The proportion of deaths due to cardiovascular diseases in Asians may be about 15% but there are wide variations. In view of the lower fat intake of the low-risk rural populations of India, the People's Republic of China, Indonesia, Korea, Thailand and Japan compared with that of urban subjects, the limit for total energy from fat intake in an average should be 21% (7% each from saturated, polyunsaturated and mono-unsaturated fatty acids). The n-6: n-3 fatty acids ration should be < 5.0. The carbohydrates intake should be > 65% and mainly from complex carbohydrates (> 55%). A body mass index of 21 kg/m2 may be safe but the range may be 18.5-23.0 kg/m2 and someone with a body mass index > 23 kg/m2 should be considered overweight. A waist: waist:hip ratio > 0.88 for men and > 0.85 for women should be considered to define central obesity. The desirable limit for serum total cholesterol may be 170 mg/dl, the borderline high level may be 170-199 mg/dl and the high level 200 mg/dl or above. The corresponding values for low-density lipoprotein cholesterol may be 90, 90-109 and 110 mg/dl or above. Fasting serum triglycerides may be < 150 mg/dl and high-density lipoprotein cholesterol > 35 mg/dl, which are close to the levels in low-risk rural populations. Fasting blood glucose > 140 mg/dl and postprandial blood glucose > 200 mg/dl may be considered conditions for diabetes, and 140-200 mg/dl, glucose intolerance. An intake of 400 g/day fruit, vegetables and legumes, mustard or soybean oil (25 g/day) instead of hydrogenated fat, coconut oil or butter in conjunction with moderate physical activity (1255 kJ/day), cessation of tobacco consumption and moderation of alcohol intake may be an effective package of remedies for prevention of CAD in Asians.

Successful percutaneous removal of cardiac foreign body afer 13 months in situ.

We have reported the uncomplicated percutaneous removal of an embolized polyethylene catheter that had remained in the right ventricle for 13 months. This case suggests that transvenous catheterization technics should be attempted before resorting to more invasive measures in retrieving embolized catheters from the heart, regardless of time in situ.

Isolated acquired pulmonary valve regurgitation. Report of long-term follow-up.

A patient is reported with isolated pulmonary valvular regurgitation acquired probably as a result of endocarditis at age 22 years. The patents remained essentially asymptomatic with physical findings compatible with haemodynamically significant pulmonary regurgitation until death at age 85 years. A necropsy confirmed the presence of isolated severe pulmonary valvular destruction. This long-term follow-up lends further support to the concept that significant volume overload of the right ventricle from pulmonary regurgitation is well tolerated and usually does not require surgical intervention.

Acute acquired toxoplasmosis.

A case of acute acquired toxoplasmosis presenting as a fever of unknown origin is described in a 62-year-old man. The diagnosis was prompted by the presence of Toxoplasma gondii in lymph nodes obtained at abdominal laparotomy. The unusual features of the case include the patient's age, the presence of cysts in the lymph node, and itc clinical presentation as a prolonged remittent fever.