Arya Atherosclerosis
Volume:19 Issue: 2, Feb 2023

Acute Myocardial Infarction (AMI) is the leading cause of global mortality. Moreover, Left Ventricular Ejection Fraction (LVEF) is the most important predictor of post-AMI mortality. Thus, the present study aimed to investigate the relationship between smoking cessation and LVEF following one year from the STEMI.

CASE REPORT: 

The present study was a part of the Kermanshah STEMI Registry and included 825 smokers admitted to Imam Ali Hospital, Kermanshah, Iran, with AMI during a 2-year study period. Data collection was performed using the standardized case report form by the European Observational Registry Program (EORP). Moreover, multiple logistic regression was used to compare LVEF between the patients who had quit smoking post-AMI and those who were still smokers after one year. Also, one-to-one Propensity Score Matching (PSM) was used to reduce the assessment error and selection bias, increase the result accuracy, and minimize the effects of confounders on the LVEF-smoking relationship.

Following one year after AMI, 219 (26.55%) patients had quit smoking, while 606 (73.45%) still smoked. Using the PSM, a total of 168 ex-smokers were matched to 168 current smokers. Moreover, it was shown that LVEF was higher in current smokers compared to ex-smokers. However, the difference was not significant. Also, multiple logistic regression showed that the Odds Ratio (OR) of LVEF reduction was insignificantly higher in ex-smokers (OR=1.13; 95% CI: 0.98-1.29) compared to current smokers. Multivariate regression analysis found similar results even after the application of PSM (OR 1.02; 95% CI: 0.82-1.22).

Given the low rate of smoking cessation after MI, physicians are recommended to ask about the smoking status of MI patients at each office visit or re-admission and strongly recommend quitting smoking.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Acute coronary syndrome is a manifestation of CVD. In Indonesia, limited studies have been conducted on genetics as a potential risk factor for acute coronary syndrome (ACS). Consequently, this study aimed to examine the effect of the methylenetetrahydrofolate reductase (MTHFR) A1298C gene polymorphism on the incidence of ACS. The study employed a case-control design. Outpatients from the cardiology and internal medicine clinics at the University of Airlangga (UNAIR) Hospital in Surabaya, Indonesia, constituted the study population. The case group comprised 60 patients with a history of ACS, while the control group consisted of 30 patients without a history of cardiovascular complaints. MTHFR A12980C gene polymorphism examination was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR RFLP) method at the Tropical Disease Center UNAIR Laboratory. Among the ACS group, 29 (48.1%), 13 (21.7%), and 18 (30%) of the individuals had AA, AC, and CC genotype patterns, respectively. In the control group, 16 individuals had AA (53.3%), 6 AC (20%), and 8 CC (26.7%). The C allele variant was identified in 41% of the ACS group and 37% of the control group. The odds ratio (OR) for the incidence of ACS was 1.195 (95% confidence interval [CI]; 0.381-3.752), 1.241 (95% CI; 0.481-3.486), and 1.222 (95% CI; 0.381-3.752). Chi-square analysis revealed no association between MTHFR A1298C gene polymorphism and the incidence of ACS (p > 0.05). MTHFR A1298C gene polymorphism did not significantly affect ACS incidence.

Obesity is strongly associated with increased cardiovascular diseases (CVD) and cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. However, numerous studies have suggested the existence of an “obesity paradox” in which overweight and mildly obese patients often exhibit a better outcome than their leaner counterparts. Therefore, this study aimed to characterize the association between BMI and in-hospital and one-year outcomes. This hospital-based research was conducted as a part of the Kermanshah STEMI Registry. Following the application of inclusion criteria, a total of 2,397 STEMI patients were evaluated. The data were collected using a standardized case report developed by the European Observational Registry Program (EORP). Body mass index (BMI) (kg/m2) was classified into underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), class I/mild obese (30–34.9), and class II/extreme obese (≥35) categories. The independent predictors of the in-hospital and one-year outcomes were assessed using multivariable logistic regression models.  Out of the 2397 patients, 43 (1.79%) were underweight, 934 (38.97%) were normal, 1038 (43.30%) were overweight, 322 (13.43%) were class I obese, and 60 (2.50%) were class II obese. The results of the crude analysis showed that class I obesity was protective against CV death (OR 0.50; 95% CI 0.30-0.84), MACE3 (MI, stroke, and death) (OR 0.47; 95% CI 0.29-0.76), and MACE5 (MACE3 plus unstable angina and heart failure) (OR 0.59; 95% CI 0.44-0.79).  Multivariate adjustment eliminated the protective effect of class I obesity against death and MACE events. Therefore, it is possible that this protective effect does not exist and instead reflects the impact of confounding variables such as age.

Coronary Artery Diseases (CAD) are the leading cause of Myocardial Infarction (MI). However, their underlying etiology can be found in the interplay between environmental and genetic factors. On the other hand, it has been shown that Extracellular Matrix (ECM) proteins, such as Thrombospondins (TSP), play a crucial regulatory role in vascular pathologies, including atherogenesis. TSPs are extracellular proteins responsible for intercellular and cell-ECM interactions and are involved in regulating functional responses. Recently, a missense mutation in the TSP-4 gene has been reported to potentially increase the risk of CADs. The present study aimed to investigate the role of rs1866389 Guanosine to Cytosine (G/C) Single Nucleotide Polymorphism (SNP) of the TSP-4 gene on the prevalence of premature MI in southern Iran. The present case-control study included 100 patients with premature MI and 100 healthy individuals. The DNA extracted from the blood samples of the participants underwent Polymerase Chain Reaction (PCR) for the sequence of the TSP-4 gene. Afterward, the frequency of C (mutated) and G (normal) alleles of the TSP-4 gene was evaluated in the case and control groups.  According to our findings, there was no significant intergroup difference in gender, age, and smoking status. However, the case group was significantly higher in the prevalence of Diabetes mellitus (DM), Hyperlipidemia (HLP), and Hypertension (HTN) compared to the control group. Moreover, 22%, 49%, and 29% of the case group had CC, GC, and GG genotypes in the TSP-4 gene, respectively, while the prevalence of CC, GC, and GG genotypes were 10%, 44%, and 46% in the control group. Also, the prevalence of allele C was significantly higher in the case group (47%) compared to the control group (33%, P=0.043), showing its significant association with the increased risk of premature MI (OR = 1.80; 95% CI = 1.01-3.19).  The rs1866389 G/C SNP of the TSP-4 gene significantly increased the risk of premature MI in the population of southern Iran. Thus, such mutated gene can be used as a target for gene therapy or a marker for early detection of individuals at high risk for CADs.

Myocardial infarction (MI) is a life-threatening condition affecting an individual's physical and social circumstances. Life expectancy and self-efficacy are required to determine the risk of cardiac complications associated with this disease. This study examined the effect of family-centered intervention via short message service (SMS) on patients with acute MI's life expectancy and self-efficacy in medication regimens. This study was a randomized, single-blind clinical trial. In 2018, 80 patients hospitalized with acute MI at educational centers affiliated with Shahrekord University were randomly assigned to the control and experimental groups. Routine intervention was performed in the control group. The experimental group was sent four educational text messages weekly for three months. Both groups' life expectancy and belief in their ability to adhere to their prescribed medication regimen were evaluated before and after the intervention. The data were analyzed using descriptive statistics, independent t, paired t, and chi-square tests via SPSS software.  The results showed that the mean difference score of total life expectancy change was significantly different between the experimental (12.23± 10.48) and the control group (0.06±7.16) (p < 0.001). The mean difference score of self-efficacy in the experimental group (21.94±12.76) was significantly higher than that in the control group (4.66±9.49) (P<0.001).  In patients with acute MI, using a text message intervention improved life expectancy and self-efficacy regarding medication regimens. Therefore, this intervention can be used as a low-cost and readily accessible tool to improve these patients' self-efficacy and life expectancy.

The Isfahan Twin Cohort (ITC) aims to provide a comprehensive understanding of the interplay between genetics and environment in the development of Non-Communicable Diseases (NCDs). As a type of specialized epidemiological investigation, twin studies are designed to quantify the contribution of genetics to a particular phenotype when confronted with environmental factors. In this context, the present study aims to present a detailed overview of the ITC methodology. The ITC is a prospective longitudinal study started in 2020. Data collection, including the demographics, socioeconomic status, health-related habits, medical history, and zygosity of the participants, was performed using validated questionnaires. Moreover, anthropometric measurements and blood pressure assessments were performed by a trained nurse. Also, fasting blood and morning urine samples were collected during a morning visit, and biochemical investigations were conducted at the central laboratory of the Isfahan Cardiovascular Research Institute. The participants underwent follow-up telephone interviews biannually, in which brief questionnaires were filled out on the changes in the lifestyle factors of the participants, such as diet, physical activity, psychological factors, and smoking habits. The second and final follow-up visit will include complete assessments, including blood and biological sample collections, similar to the baseline assessment.  The ITR has registered a total of 112 (n=224) monozygotic and 291 (n=582) dizygotic twin pairs during two years. The age range of the participants is 1 month to 56 years. Until November 2020 / 2021, the registered twins were categorized by age and included 48 pairs (n=96) in the infant group (monozygotic: 7 pairs, dizygotic: 41 pairs); 283 pairs (n=566) in the early childhood, late childhood, and adolescent groups (monozygotic: 74 pairs, dizygotic: 209 pairs); and 72 pairs (n=144) in the adult group (monozygotic: 31 pairs, dizygotic: 41 pairs).  The cohort is being prospectively followed with plans to investigate the clinical utility of the newly developed biomarkers and gene-environmental interactions in the future.

Stroke is one of the primary causes of morbidity and mortality worldwide, including a large proportionof cryptogenic strokes. Long-term electrocardiographic monitoring is beneficial in prospective studies fordetecting atrial fibrillation in patients with cryptogenic stroke. This review aimed to evaluate the advancedechocardiographic parameters and their roles in assessing left atrial (LA) function in the incidence ofcryptogenic and ischemic strokes. Main resources, including PubMed, Scopus, and ISI Web of Sciencedatabases, were evaluated for articles published in English from 2010 until May 2021. LA echocardiographicparameters such as LA strain and strain rate, isovolumetric relaxation time (IVRT), the mean left atrialvolume index (LAVI), LA reservoir volume, systole strain rate (SSR) of left atrial appendage, and lack ofLA function response to maximal exercise as measured by the LA ejection fraction during rest and exercisecould be considered for assessing the risk of cryptogenic strokes and ischemic strokes. The results indicatedthat increased LA volumes and reduced LA strain rate were correlated with cryptogenic stroke. Advancedparameters of LA function, measured by speckle tracking echocardiography, such as strain and strainrate values in different parts of the cardiac cycle, in addition to standard measures of LA function suchas LA ejection fraction and LAVI, will define an excellent understanding regarding LA myopathy and riskassessment of cryptogenic stroke, independent of considering conventional cardiovascular risk factors.

Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths in theUnited States. In addition, myocardial infarction (MI) due to CO poisoning in a young, healthy adult is rare.On the other hand, smokeless tobacco, processed in various forms, is a controversial coronary heart disease(CHD) risk factor.

CASE REPORT: 

In this study, we describe a 29-year-old man who presented with acute chest pain followinga night of smoking tobacco and using smokeless tobacco in the presence of carbon monoxide poisoning.ST-segment elevation was observed on an electrocardiogram, and echocardiography revealed akinesia. Inaddition, cardiac markers were elevated. In this particular instance, thrombolytic therapy demonstratedsuccessful outcomes.

We believe the case and discussion could shed light on the emergency departmentmanagement of such individuals. We advise clinicians to consider the possibility of coronary heart diseasein carbon monoxide poisoning patients and to obtain a baseline electrocardiogram and cardiac markers.