Prevalence of lipid abnormalities and cholesterol target value attainment in patients with coronary heart disease in Saudi Arabia

Introduction: Hyperlipidemia is highly prevalent among patients surviving an acute coronary syndrome (ACS) and those with stable coronary heart disease (CHD). Evidence-based guidelines advocate specific target LDL-C levels depending on patient risk; however, it is unclear to what extent these targets have been met in ACS and CHD patients in Saudi Arabia. Methodology: A multicenter observational study, data were collected from treated patients with stable CHD or those presenting with an ACS at any of the four participating sites in Saudi Arabia. Patients were enrolled from December 2013 to October 2014. Individuals were included if they were over 18 years of age and had a full lipid profile available, recorded either prior to the baseline physician visit (stable CHD patients) or within 24 h of admission to hospital (ACS patients). Results: A total of 737 patients were included in the study, 597 with stable CHD and 140 with ACS. Approximately 78% of the patients were male, and comorbidities and cardiovascular risk factors were highly prevalent. Few patients in either group had an LDL-C level of <70 mg/dl, which is advocated for very high-risk patients (24.3% and 11.4%, respectively). The median distances to this value were 19.0 mg/dl and 25.0 mg/dl for the CHD and ACS patients, respectively. Only low doses of statins were being utilized for both groups. For the ACS patients, LLT was intensified after hospital admission; however, the mean statin dosage remained low 4 months after the ACS event. Conclusion: Achievement of recommended LDL-C levels was poor for both patients with stable CHD and those admitted to hospital as a result of an ACS. Statin intensity was low, indicating huge scope for improving the treatment of these very high risk patients

Celiac crisis in an adult on immunosuppressive therapy

‘Celiac crisis’ is a rare presentation of celiac disease with manifestations that include severe diarrhea, and severe metabolic and electrolyte abnormalities. It is most frequently seen in children younger than two years of age and has been rarely described in adults. A case of a 50-year-old woman who presented with diarrhea, severe dehydration, hypokalemia and metabolic acidosis is described. Based on positive serology and small bowel biopsy, she was diagnosed with celiac disease. She also had histological evidence of lymphocytic colitis. Microscopic colitis has not previously been described in association with celiac crisis, but it may have contributed to the presentation of celiac crisis in the current case. The patient was on corticosteroids and azathioprine for autoimmune hepatitis at the time of her presentation. The current case demonstrates that modest immunosuppression does not prevent a celiac crisis, although previous reports have shown that patients may respond rapidly to high-dose corticosteroids

A Tailored, Bundle Care Intervention Strategy to Reduce Cardiac Mortality During the Hajj: A Population-Based, Before and After Study.

Hajj is the largest human gathering with over 2 million people. We evaluated the effect of bundle care intervention on mortality. A population-based, before and after study compared the effect of an intervention on mortality. The intervention included recruitment of cardiac team, introducing 24/7 catheterization service, cardiac coordination, standardized cardiac care pathways, and establishment of an effective transportation system. Cardiac mortality accounted for about 52% of all in-hospital deaths before intervention in 2009. This decreased significantly to 43.3%, 32.5%, and 19.7% in 2009, 2010, and 2011, respectively. In-hospital mortality of acute coronary syndromes was 4.7%, 4.6%, and 3.0%, in the years 2009, 2010, and 2011, respectively. Mortality due to other causes remained largely unaffected. There was no significant change in the national mortality due to cardiac causes over the same period provided a reassurance that the observed improvement in in-hospital acute coronary syndrome mortality was not due to overall improvement in health care. The numbers of cardiac catheterization procedures increased 3-fold and cardiac surgical procedures increased 5-fold between 2009 and 2011. In this study, we found that an evidence-based intensive bundle care intervention substantially reduced the cardiac mortality among the pilgrims assembling for Hajj in Makkah

Prevalence of lipid abnormalities and cholesterol target value attainment in patients with stable coronary heart disease or an acute coronary syndrome in Saudi Arabia

Objectives: To provide an overview of the extent of hyperlipidemia in very high-risk patients, and how lipid-lowering therapy (LLT) is used in a real-world setting. Methods: In this multicenter observational study, data were collected from LLT-treated patients with stable CHD or an ACS in Saudi Arabia between 2013 and 2014. Individuals were included if they were greater than 18 years and had a full lipid profile available, recorded either prior to the baseline physician visit (CHD patients) or within 24-hours of admission to hospital (ACS patients). Results: A total of 737 patients were included in the study, 597 with stable CHD and 140 with ACS. Few patients in either group had an LDL-C level of greater than 70 mg/dl, which is advocated for very high-risk patients (24.3% and 11.4%, respectively). The median distances to this value were 19.0 mg/dl (CHD) and 25.0 mg/dl (ACS). Low doses of statins were being utilized (31 and 24 mg/day for CHD and ACS, respectively), with only minimal intensification for the ACS patients after hospital admission (41 mg/day at follow-up). Conclusions: Achievement of recommended LDL-C levels was poor for patients with stable CHD or an ACS. Statin intensity was low, indicating huge scope for intensifying the treatment of these very high-risk patients