الفهرس 
The clinical presentation of ischemic heart disease
Emerging risk factorsOnly 14 pages are availabe for public view
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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 )