الفهرس | Only 14 pages are availabe for public view |
Abstract CHD is the most common cause of mortality worldwide. At least 25% of coronary patients have sudden death or non-fatal MI without prior symptoms. Currently, more attention is given to unclassical risk factors in order to fill the gap for those individuals with coronary events inspite of the absence of conventional risk factors. Global risk assessment is a mandatory need to search for those vulnerable people who could potentially benefit from intensive primary prevention efforts. The aim of this study was to assess some unclassical risk factors of ACS; H.pylori seropositivity, metabolic syndrome and hsCRP. The study was conducted in Alexandria Students’ University hospital on 124 subjects, 62 ACS patients and 62 controls. The study participants were subjected to detailed history taking, full clinical evaluation, routine laboratory investigations and blood serology. The age, sex and the family history of CHD of the study population were documented as non-modifiable risk factors. Also, the clinical history of hypertension, diabetes, smoking and dyslipidemia were inquired about as conventional risk factors. The cardiovascular risk potential of H.pylori seropositivity and its pathogenic strains were investigated. Furthermore, the association between metabolic syndrome, hsCRP and ACS was tested. Thereafter, all variables that were considered potential predictors of ACS were analyzed using simple logistic regression and only those found to be significantly associated with ACS were entered into multilogistic regression analysis to identify the independent predictors of ACS. The results of this study showed that: 1- There was no significant difference between ACS cases and controls as regards sociodemographic and lifestyle characteristics. 2- HsCRP is an independent risk factor of ACS where hsCRP Q 3 mg/l increased the risk of acquiring ACS by 8.18 times (CI=1.67-39.67).In addition, this hsCRP level had the highest diagnostic utility for ACS with an AUC of 0.722 (P=0.00) at a cut-off value of 2.35 mg/l. 3- Only MS diagnosed by NCEP criteria was significantly associated with the occurrence of ACS (OR= 2.21, CI= 1.7 – 4.54). IDF criteria of MS failed to diagnose 10.5% of subjects diagnosed by NCEP. While, 7.3 % were missed by NCEP. 4- MS had no relation with hsCRP levels. 5- Hypertriglyceridemia >150 mg/dl and hyperglycemia >100 mg/dl were the only significantly associated metabolic syndrome components with ACS (OR=2.44,CI=1.17- 5.13) and (OR=2.12,CI=1.02-4.42) respectively.After multivariate analysis, these 2 components were independent risk factors of ACS rather than MS itself. 6- Neither H.pylori seropositivity nor anti-CagA seropositivity was increased in patients with ACS but H.pylori seropositivity was significant in young age. 7- Hypertension, diabetes and increased LDL-C were all considered as potential risk factors for ACS where their association was lost after adjusting for other confounding factors. 8- ACS patients were classified into 3 subgroups, the UA was the largest (41.9%) whereas NSTEMI and STEMI were (27.4%, 30.6% respectively). In comparison to UA group, the NSTEMI had significantly higher mean values of TC while the STEMI had significantly higher levels of TG (P=0.018,P=0.024 respectively ) |