HDL-cholesterol concentration and its association with coronary artery calcification: a systematic review and meta-analysis

BACKGROUND

Coronary artery calcification (CAC) is a potential risk marker of coronary atherosclerosis that has high specificity and sensitivity. However, the association between high-density lipoprotein cholesterol (HDL-C) concentration and CAC incidence and progression is controversial.

METHODS

PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies up to March 2023 and assessed the methodological quality using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratios (OR) and 95% confidence interval considering heterogeneity across studies.

RESULTS

Of the 2,411 records, 25 cross-sectional (n = 71,190) and 13 cohort (n = 25,442) studies were included in the systematic review. Ten cross-sectional and eight cohort studies were not eligible and were omitted from the meta-analysis. A total of 15 eligible cross-sectional studies (n = 33,913) were included in the meta-analysis and pooled results revealed no significant association between HDL-C and CAC > 0, CAC > 10, or CAC > 100 [pooled OR: 0.99 (0.97, 1.01)]. Meta-analysis of the 5 eligible prospective cohort studies (n = 10,721) revealed no significant protective effect of high HDL-C against CAC > 0 [pooled OR: 1.02 (0.93, 1.13)].

CONCLUSIONS

According to this analysis of observational studies, high HDL-C levels were not found to predict protection against CAC. These results suggest HDL quality rather than HDL quantity is important for certain aspects of atherogenesis and CAC.

REGISTRATION NUMBER

CRD42021292077.

A randomized, double-blind, placebo-controlled, clinical trial to evaluate the benefits of Nigella sativa seeds oil in reducing cardiovascular risks in hypertensive patients

The efficacy, safety, and utility of Nigella sativa seeds oil as a complementary treatment for hypertension, glucose control, and lipid metabolism were evaluated. Hypertensive patients in the intervention (n = 26) and placebo (n = 29) groups received 2.5 ml of N. sativa seeds oil and sunflower oil twice daily for 8 weeks, respectively. The levels of systolic and diastolic blood pressure (SBP, DBP), blood lipid profile, and fasting blood sugar (FBS), at different stages of the treatment period (0, 3, 6, 8 weeks), and malondialdehyde (MDA) and glutathione reductase (GR), at the baseline and end of the study, were assessed. SBP level in the intervention group was significantly reduced, compared with the baseline values (p < .001) and the placebo group (p < .05). A significant decline was observed in the levels of DBP, total cholesterols, and low density lipoprotein (LDL) (p < .000), MDA, and FBS (p < .001); also, a significant increase was observed in the levels of high density lipoprotein (HDL) and GR (p < .001). The use of N. sativa seeds oil as an adjunct to common medications exhibited additional antihypertensive effects as well as beneficial effects on glucose control and lipid metabolism in hypertensive patients with no renal, hepatic, and patient-reported adverse events.

Late presentation of iatrogenic dissection of right coronary cusp: A case report

Iatrogenic dissection of coronary arteries while performing catheter engagement, in general is not uncommon. However, we encountered a relatively rare case of iatrogenic right coronary cusp dissection.Here we report an iatrogenic coronary artery dissection after diagnostic angiography in a 54-year-oldwoman presented with exertional dyspnea and chest discomfort. In our case delayed progression of sub-intimal hematoma and subsequent compression of RCA ostium an SA node branch was the cause of SA node dysfunction and subsequent junctional rhythm and atrial fibrillation.

To conclude it should be said that in catastrophic cases of iatrogenic coronary ostia dissection and ensuing aortic cusp involvement, stenting of entry point at coronary ostia is a logical decision with good result.

A meta-meta-analysis: Evaluation of meta-analyses published in the effectiveness of cardiovascular comorbidities on the severity of COVID-19

On January 2020, WHO confirmed the epidemic outbreak of SARS-CoV-2 as a Health Emergency of International Concern. The aim of this meta-meta-analysis is quantifying meta-analytic findings on the association of cardiovascular disease (CVD) comorbidities and COVID-19 severity. Findings suggest that chances of getting severe COVID-19 disease in patients with CVD is greater than those without CVD. Also, prevalence of CVD in patents with COVID-19 is 0.08 (95% CI = 0.07–0.08). The OR as 3.44 indicates that the odds of getting severe COVID-19 is more than 3 times higher in those with CVD. Also, prevalence of hypertension in patient with COVID-19 is 0.27 (95%CI = 0.27–0.28) and the OR as 2.68 indicates that the odds of getting severe COVID-19 in cases with high blood pressure is more than 2.5 times higher than those without hypertension. It is rational to suppose that persons with coronary artery disease are prone to severe viral infection thereby, guideline-directed diagnosis and medical therapy is vital in CVD patients.

Extinction of herbivorous dinosaurs linked to Early Jurassic global warming event

Sauropods, the giant long-necked dinosaurs, became the dominant group of large herbivores in terrestrial ecosystems after multiple related lineages became extinct towards the end of the Early Jurassic (190-174 Ma). The causes and precise timing of this key faunal change, as well as the origin of eusauropods (true sauropods), have remained ambiguous mainly due to the scarce dinosaurian fossil record of this time. The terrestrial sedimentary successions of the Cañadón Asfalto Basin in central Patagonia (Argentina) document this critical interval of dinosaur evolution. Here, we report a new dinosaur with a nearly complete skull that is the oldest eusauropod known to date and provide high-precision U-Pb geochronology that constrains in time the rise of eusauropods in Patagonia. We show that eusauropod dominance was established after a massive magmatic event impacting southern Gondwana (180-184 Ma) and coincided with severe perturbations to the climate and a drastic decrease in the floral diversity characterized by the rise of conifers with small scaly leaves. Floral and faunal records from other regions suggest these were global changes that impacted the terrestrial ecosystems during the Toarcian warming event and formed part of a second-order mass extinction event.

Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients

BACKGROUND:

Many patients who are candidates for a pacemaker are also at the same time risk factors for coronary artery disease such as high blood pressure, hypertension, diabetes, and hyperlipidemia, and therefore the probability of having coronary artery disease is significant. Effective diagnostic measures can be taken to prove the factors affecting the incidence of CAD in patients undergoing pacemakers at high-risk, including angiography. Therefore, it can prevent complications during and after pacemaker implantation, which leads to an increase in the quality of treatment in patients requiring pacemaker implantation.

AIM:

Therefore, the purpose of this study was to determine the predictive factors of significant coronary artery disease in patients with pacemaker implantation to identify patients in need of coronary angiography at the time of pacemaker implantation.

METHODS:

This retrospective study was carried out to examine the patients’ files that were placed at the heart of Imam Reza Hospital during the period between March 2017 and September 2017. Demographic data, risk factors, echocardiography findings, and angiography, were collected and then recorded using a checklist. Statistical analysis was performed using SPSS software version 22 and Chi-square, and Mann-Whitney tests were used for determining significates variables.

RESULTS:

A group of 102 patients who had undergone a permanent cardiac pacemaker insertion due to an atrioventricular (AV) Block were included in the study, and also coronary anatomy was determined coronary angiography. Based on the results, 13.7% of patients with cardiac pacemaker had obstructive coronary artery disease (stenosis > 70%). Factors affecting coronary artery stenosis on angiography include gender, chest pain, history of myocardial infarction, angioplasty, diabetes, smoking, history of aspirin intake, calcium blocker and Plavix, high hematocrit, ST elevation and ST depression in the ECG, and severe mitral regurgitation.

CONCLUSION:

It seems that in most patients requiring permanent pacemaker insertion because of the atrioventricular (AV) Block, angiography does not change the patient’s fate, and so can be ignored. However, in patients who have several risk factors from the listed above, coronary angiography is recommended during admission.

Changes of QT Dispersion in Patients Suffering from Aluminium Phosphide Poisoning (Rice Pill)

BACKGROUND:

Aluminium phosphide (ALP) or rice pill is a substance used in developing countries due to its low cost as pesticides. The availability of this substance has been lead to an increased rate of the use of this toxic inorganic compound for suicide. Complications are considered to be dose-related toxicity and hospitalisation time, varying from hemodynamic disorder, hypoglycemia, hyperglycemia, shock, cardiotoxicity, pulmonary and renal failures. The consumption of this substance is one of the major causes of mortality due to heart arrhythmia. QT dispersion represents a regional difference in ventricular repolarisation and electrical instability of the heart.

AIM:

The purpose of this study was to investigate the effect of ALP poisoning on QT dispersion.

METHODS:

In this study, 70 patients with ALP poisoning were enrolled, and 10 patients were excluded due to the exclusion criteria. QT dispersion rate was calculated in 60 patients using the standard electrocardiography at the time of referral. The above data were compared with the control group, which included 40 subjects with normal coronary angiography, and without cardiovascular risk factors.

RESULTS:

The findings presented herein indicated a significant correlation between QT dispersion and control group (P < 0.0.5). There was a significant relationship between the severity of acidosis and the patient’s tablets –taking a number (P < 0.05). However, there was no relationship between QT dispersion with the severity of acidosis and mortality in patients.

CONCLUSION:

Because there is no CAD risk factor in the population, it can be concluded that increase in QT dispersion in these individuals can be due to ALP poisoning; nevertheless, this is not considered to be a factor in increasing the morbidity of these patients.

Effect of hibiscus sabdariffa on blood pressure in patients with stage 1 hypertension

Using different drug regimens has been proved to have effective effects on lowering blood pressure, but the adverse effects of long-term usage such medications is evident. According to recent trend in suing herbal and traditional medicines, researchers have been focused on evaluating the effect of different herbals on managing hypertension. The aim of the present study is the evaluation of the antihypertensive effect one of these herbs, sour tea (Hibiscus sabdariffa), on stage one hypertension. Patients with stage one hypertension who were diagnosed by a cardiologist has been included in the present clinical trial after giving informed consent. The patients were divided into two groups. The control and case group received the same lifestyle and dietary advices for controlling blood pressure. The case group received two standard cup of sour tea every morning for 1 month. The blood pressure of both groups was documented at baseline and at the end of the study and the results were analyzed using SPSS software. A total of 46 patients participated in this study and there was no significant difference in terms of age and body mass index between groups. There was a significant reduction in systolic blood pressure in both groups, but the mean reduction in systolic and diastolic blood pressure was significantly higher in the case group (P = 0.004 and P < 0.001, respectively). Using H. sabdariffa as sour tea two times a day can be effective in managing blood pressure in stage one hypertension along with lifestyle and dietary modification.

Clinical outcomes and complications of treatment with supraflex stent in patients with coronary artery disease: One-year follow-up

Cardiovascular disease is one of the most important causes of morbidity and mortality in the world. Treatment in most patients is percutanseous coronary intervention. One of new generation drug-eluting stent (DES) is Sirolimus Eluting Stent. The current study was aimed to investigate the clinical outcomes and complications of treatment with supraflex stent during one year follow up in patients with coronary artery disease. This cross-sectional study was performed on patients with myocardial ischemia who were candidate for coronary angioplasty between 2017-2018 in Imam Reza Hospital, Mashhad, Iran.. Patients were followed for four primary end points including Target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI) and cardiac death (CD) for one year. Descriptive data were analyzed by Freidman at a significance level of 0.05. A total of 287 patients were enrolled in the study. There was no TLR, MI, ST and CD records in the one month follow up. Six months follow up demonstrated three TLR patients and three MI patients, but no ST and death were reported. After one year follow up, three cases of CD and four ST cases were found in patients treated with supraflex stent. Based on the Freidman test, the highest rate of TLR was revealed in a six-month follow-up when comparing with one-month and twelve-month follow-up (p = 0.05). No significant relationship was found between the other cases. The most common complications associated with supraflex stent were TLR and MI in six-month follow-up. The most likely occurrence of CD and ST were found in one year follow up.

Salivary Alpha-amylase Activity Level in ST-segment Elevation Myocardial Infarction Patients

Background and Objective: Sudden death is the main cause of mortality and disability in patients with coronary artery disease or myocardial infarction. The aim of this study was to evaluate the activity level of salivary alpha-amylase to predict malignant ventricular arrhythmias in ST-segment elevation myocardial infarction (STEMI) patients. Materials and Methods: In this analytical cross-sectional study, 42 patients with STEMI who referred to Imam Reza Hospital participated. First, salivary amylase was taken from all STEMI patients and then these patients were divided into two groups of patients with malignant ventricular arrhythmia or without malignant ventricular arrhythmia during 72 hours. Results: A total of 42 patients were included in the study out of which 30 (71.4%) were females and 12 (28.6%) males. The average salivary amylase in patients was 118/41 ± 96/87. There was no significant difference in the frequency of diabetes, blood pressure, blood lipids, ischemic heart disease, and involvement severity in both groups with arrhythmia and lack of arrhythmias (P> 0.05). Also there was no significant difference in systolic and diastolic blood pressure, respiratory rate, heart rate, oxygen saturation, blood glucose, temperature and severity of infarction (P> 0.05). However, the two groups were different in terms of salivary amylase levels. Salivary amylase levels were significantly higher in arrhythmic group than in the non-arrhythmic group (P< 0.001). Conclusions: Our result shows that there is a difference in the concentrations of salivary Alpha-amylase activity level in with and without ventricular arrhythmias groups.

Pentoxifylline and prevention of contrast-induced nephropathy: Is it efficient in patients with myocardial infarction undergoing coronary angioplasty?

BACKGROUND

Contrast-induced nephropathy (CIN) is a major concern following procedures with applying iodinated contrast media. The basis prevention of CIN is hydration and to avoid hypovolemia. We aimed to evaluate the efficacy of pentoxifylline (PTX) for the prevention of CIN in patients with myocardial infarction (MI) undergoing coronary angioplasty.

METHODS

This prospective, single-blind, randomized clinical trial study was performed on 175 (127 men) of MI patients undergoing routine treatment. Patients were assigned randomly to the control (n = 84) and study groups (n = 91). In our study group, patients received 400 mg/3 times a day from 24 hours before to 24 hours after coronary angiography. In addition, before the procedure and after 48 hours from the procedure, serum creatinine was measured.

RESULTS

CIN occurred in 14 patients (8.0%); 8 controls (9.5%) and 6 patients (6.6%) in the PTX group )P = 0.475) showing PTX to have no significant effect on CIN [P = 0.750, odds ratio = 0.82 (confidence interval = 0.24-2.8)] though a significantly different volume of contrast was used between the groups (231.29 ± 105.10 mm3 and 190.88 ± 75.82 mm3; P = 0.005, respectively).

CONCLUSION

There was no significantly different occurrence of CIN on patients with MI, undergoing coronary angioplasty, but its relatively lower rate in PTX group would recommend the prophylactic oral use of PTX for CIN prevention.

A case of mitral valve tophus in a patient with severe gout tophaceous arthritis

A few cases of cardiac valve tophi have been reported in literature. In this case report, the echocardiographic characteristics of the hyperechoic mass in the posterior leaflet mitral valve, intact mitral valve ring, and the occurrence of severe tophaceous gout arthritis suggested the diagnosis of a gout tophus on the mitral valve.