Relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients

Background: Hypertension stands as a widely recognized significant risk factor for cardiovascular disease. In clinical practice, it is advisable to measure blood pressure (BP) in both arms. The increasing attention on inter-arm blood pressure difference (IABPD) stems from its association with cardiovascular disease. This study aimed to assess the relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients. Methods: This cross-sectional study was conducted at the department of cardiology, Chittagong Medical College Hospital from July 2020 to June 2021. The study included 428 cases of previously or newly diagnosed hypertension, selected through convenient sampling. Data analysis was conducted using Microsoft Office tools and statistical package for the social sciences (SPSS) version 23.0. Results: In this study, 8.2% of patients exhibited noteworthy systolic IAD, and 2.3% demonstrated notable diastolic IAD. Median 10-year cardiovascular risk, assessed by Framingham and ASCVD calculators, was 21% and 11% respectively. A positive correlation was observed between sIAD and 10-year cardiovascular risk (p=0.003) and sIAD and 10-year ASCVD risk (p=0.041). Patients with significant sIAD had a higher incidence of ischemic heart disease compared to those without (p=0.041). Multiple regression analysis revealed a significant correlation between 10-year Framingham cardiovascular risk and sIAD (p=0.003). Conclusions: A significant difference in systolic blood pressure between arms is linked to a higher 10-year cardiovascular risk and the presence of cardiovascular disease in well-managed hypertensive patients. So, monitoring sIAD could be an additional factor in predicting future cardiovascular events in patients receiving hypertension treatment

Association between contrast-induced nephropathy and CHA2DS2-VASc score in patient with non-ST elevation myocardial infarction after percutaneous coronary intervention

Background: Contrast-induced nephropathy (CIN) is a recognized complication in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). CHA2DS2-VASc score, commonly employed in clinical settings, shares similar risk factors for CIN development. This cross-sectional observational study investigated the association between CHA2DS2-VASc score and CIN post-PCI in non-ST segment elevated myocardial infarction (NSTEMI) patients. Methods: Over one year (April 2019 to March 2020), 100 NSTEMI patients undergoing PCI at the national institute of cardiovascular diseases (NICVD), Dhaka, were included. Patients were categorized into two groups based on CHA2DS2-VASc scores (≥4, group I; <4, group II). CIN assessment utilized post-procedural serum creatinine within 48 hours, with statistical analysis performed using SPSS version 20.0. Results: Group I exhibited a significantly higher CHA2DS2-VASc score (4.15±1.35 vs. 2.25±0.92 in group II). Post-procedural serum creatinine was notably elevated in CHA2DS2-VASc score ≥4 (1.98±0.46 vs. 1.46±0.27, p<0.001). A CHA2DS2-VASc score cut-off ≥4 predicted CIN with 84.6% sensitivity, 55.2% specificity (AUC 0.83, CI: 0.743-0.90, p<0.001). Conclusions: This study establishes a significant association between CHA2DS2-VASc score and CIN in NSTEMI patients post-PCI, suggesting its potential utility in predicting CIN risk in this population.

Association between neutrophil to lymphocyte ratio with the severity of coronary artery diseases

Background: Coronary artery disease is a type of heart disease where the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. This study aimed to evaluate the association between neutrophil to lymphocyte ratio (NLR) with the severity of coronary artery diseases. Methods: This cross-sectional study was conducted in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram, Bangladesh during the period from 1 July 2020 to 31 June 2021. 160 patients undergoing elective coronary angiography with the symptoms of coronary artery disease were enrolled in this study. A purposive sampling technic was used. The association between NLR and Gensini score was assessed using Pearson’s or Spearman’s correlation analysis as appropriate. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 23.0 program as per necessity. Results: The mean (±SD) Gensini score of our participants was 42.75 (±29.50) and the mean (±SD) NLR (Neutrophil-lymphocyte ratio) was 2.38 (±1.11). In this study, the AUROC for NLR was found as 0.851 with a P-value of <0.001, indicating a statistically significant association of NLR with the severity of CAD. The scatter dot diagram showed the correlation between NLR and Gensini score. Both the variables were positively correlated and the degree of correlation was found statistically significant (r=0.44; p<0.001) by Pearson’s correlation test. The multivariate logistic regression analysis showed that a high level of NLR had an independent association with severe CAD (with OR being 3.308) along with dyslipidemia. Conclusion: High blood NLR is associated with the severity of CAD and it may be useful for predicting angiographically severe disease

Correlation of lipoprotein (a) level with severity of coronary lesion in coronary heart disease patients

Background: Cardiovascular diseases (CVDs) are the leading cause of death in developing nations, especially in low and middle-income countries (LMICs). Bangladesh has been undergoing an epidemiological transition from communicable to non-communicable diseases. This study aimed to investigate the association of risk factors with coronary heart disease (CHD) in patients from Bangladesh. Methods: This cross-sectional observational study was conducted in the department of cardiology, Chattogram Medical College and Hospital, Chattogram, Bangladesh from July 2018 to June 2019. A total of 100 patients were enrolled. Results: This cross-sectional study enrolled 100 CHD patients with a mean age of 53.21±10.29 years. The majority were obese (64, 64.0%), and hypertension was the most prevalent risk factor (77, 77.0%), followed by smoking (65, 65.0%) and dyslipidemia (58, 58.0%). Most patients had triple vessel disease (53, 53.0%), and significant CHD (81, 81.0%). Patients with severe CHD had higher levels of blood LDL-C, triglycerides, and Lp(a). Lp(a) levels, history of dyslipidemia, and LDL-C were independently associated with a Gensini score ≥20. These findings emphasize the independent association between Lp(a) and CHD severity, warranting greater attention to patients with elevated Lp(a) levels. Conclusions: This study suggested that Lp(a) is an independent risk factor for CHD in patients from Bangladesh. More attention should be paid to such patients with elevated Lp(a) level

Association of serum uric acid level with angiographic severity of coronary artery disease: a study in a tertiary care hospital, Chittagong, Bangladesh

Background: Coronary artery disease (CAD) is a major global health issue. Serum uric acid (SUA), a byproduct of purine metabolism, is linked to CAD development and progression. Elevated SUA levels are an independent risk factor for cardiovascular mortality and may indicate endothelial dysfunction. The aim of the study was to the observed associate serum uric acid level with the angiographic severity of CAD. Methods: This observational study was conducted at Chittagong medical college hospital in Bangladesh from October 2020 to September 2021. It included 130 patients and used unpaired t-tests to analyze the association between serum uric acid level and angiographic severity of CAD patients. Ethical clearance was obtained from the institutional review board of Chittagong medical college and hospital. Results: A study of 130 patients found a significant relationship between serum uric acid (SUA) levels and CAD (CAD), vessel involvement, and CAD severity (p=0.001). Patients with CAD had higher SUA levels (mean 5.26±1.32 mg/dL) compared to those without CAD (mean 4.22±1.03 mg/dL). A SUA level range of 3.94-6.58 mg/dL was associated with CAD presence. Gender also showed a highly significant association with SUA levels (p=0.001), while age, BMI, and smoking status did not show significant differences. Conclusions: A strong positive association has been found between serum uric acid level and the severity of CAD. The findings of this study approve the effectiveness of hyperuricemia as an emerging risk factor for CAD