Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been... more Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been increasingly recognized, particularly those affecting the cardiovascular system. Patients with COVID-19 infection can suffer from increased coagulopathy as well as myocardial injury. In this review, we discuss these complications with special focus on management challenges in patients with acute coronary disease based on the available evidence from published literature.
DOAJ (DOAJ: Directory of Open Access Journals), 2020
Pressured by the enormous human and economic costs of the COVID-19 pandemic, certain countries an... more Pressured by the enormous human and economic costs of the COVID-19 pandemic, certain countries and political figures have advocated the use of drugs and vaccines that did not go through the required regulatory stages of the development. Although the reason for bypassing these stages in a race to produce a treatment and vaccine for the COVID-19 patients could have been caused by good intentions to stop the human suffering from the pandemic, nonetheless, history has taught us that the results of this action could be catastrophic. In this article, we briefly review the lessons and tragedies in the evolution of human subject research regulations emphasizing the need for the proper evaluation of drugs and vaccines for COVID-19.
PCSK9 monoclonal antibodies are novel lipid-lowering therapy that have been extensively studied i... more PCSK9 monoclonal antibodies are novel lipid-lowering therapy that have been extensively studied in patients with hypercholesterolemia either as monotherapy or as an add-on to other LLTs. PCSK9 monoclonal antibodies have significantly reduced the low-density lipoprotein cholesterol (LDL-C) plasma level resulting in a better LDL-C goal attainment. The commercially available PCSK9 monoclonal antibodies, alirocumab and evolocumab, have demonstrated reductions in major adverse cardiovascular events such as myocardial infarction, stroke, unstable angina, and the need for coronary revascularization but not mortality. PCSK9 monoclonal antibodies have demonstrated a favorable safety profile. The most reported side effects are mild injection site with no causal relationship proven between the inhibition of PCSK9 and neurocognitive or glycemic adverse events. In this overview, the efficacy and safety of PCSK9 monoclonal antibodies in the treatment of primary and familial hypercholesterolemia will be discussed.
Background: Little is known about the epidemiology of atrial fibrillation (AF) among patients adm... more Background: Little is known about the epidemiology of atrial fibrillation (AF) among patients admitted with acute heart failure (HF) in the Middle East. Here, we describe the prevalence of AF and c...
Abstract Background Cardiogenic shock (CS) is an acute complex condition leading to morbidity and... more Abstract Background Cardiogenic shock (CS) is an acute complex condition leading to morbidity and mortality. Vasoactive medications, such as vasopressors and inotropes are considered the cornerstone of pharmacological treatment of CS to improve end-organ perfusion by increasing cardiac output (CO) and blood pressure (BP), thus preventing multiorgan failure. Objective A critical review was conducted to analyze the currently available randomized studies of vasoactive agents in CS to determine the indications of each agent and to critically appraise the methodological quality of the studies. Methods PubMed database search was conducted to identify randomized controlled trials (RCTs) on vasoactive therapy in CS. After study selection, the internal validity of the selected studies was critically appraised using the three-item Jadad scale. Results Nine studies randomized 2388 patients with a mean age ranged between 62 and 69 years, were identified. Seven of studies investigated CS in the setting of acute myocardial infarction (AMI). The studies evaluated the comparisons of norepinephrine (NE) vs. dopamine, epinephrine vs. NE, levosimendan vs. dobutamine, enoximone or placebo, and nitric oxide synthase inhibitors (NOSi) vs. placebo. The mean Jadad score of the nine studies was 3.33, with only three studies of a score of 5. Conclusions The evidence from the studies of vasoactive agents in CS carries uncertainties. The methodological quality between the studies is variable due to the inherent difficulties to conduct a study in CS. Vasopressors and inotropes continue to have a fundamental role given the lack of pharmacological alternatives.
OBJECTIVES: Although community acquired infections (CAI) are one of the most common causes for ho... more OBJECTIVES: Although community acquired infections (CAI) are one of the most common causes for hospitalization of patients with heart failure (HF), yet very few studies have systematically examined...
OBJECTIVES: It is well recognized that cardiac autonomic neuropathy associated with diabetes mell... more OBJECTIVES: It is well recognized that cardiac autonomic neuropathy associated with diabetes mellitus (DM) can cause silent myocardial ischemia, however there is limited research examining how the ...
OBJECTIVES: There is very scarce contemporary data about the prognostic impact of presentation wi... more OBJECTIVES: There is very scarce contemporary data about the prognostic impact of presentation with cardiac arrest in patients with acute coronary syndromes (ACS), particularly from the developing countries. Accordingly, we sought to assess the incidence, clinical features, immediate and long term mortality of patients with cardiac arrest at presentation using data from a large multicenter Middle-Eastern ACS registry. METHODS: For a period of 9 months in 2008 to 2009, consecutive patients with ACS were enrolled from 65 hospitals in 6 Middle East countries. Patients presenting with cardiac arrest in this cohort were selected and in-hospital outcomes, one-month and one-year mortality were examined. RESULTS: Among 7,930 ACS patients enrolled, there were 89 patients hospitalized alive after resuscitation from cardiac arrest with a rate of 1.1%. Compared with patients without cardiac arrest, patients presenting with cardiac arrest had a significantly higher rate of prior myocardial infarction (32.6% vs. 19.6%)...
Aim: To investigate the precipitating factors that contribute to hospitalization and mortality in... more Aim: To investigate the precipitating factors that contribute to hospitalization and mortality in postacute heart failure (AHF) hospitalization in the Middle-East region. Methods: We evaluated patient data from the Gulf AHF registry (Gulf CARE), a prospective multicenter study conducted on hospitalized AHF patients in 47 hospitals across seven Middle Eastern Gulf countries in 2012. We performed analysis by adjusting confounders to identify important precipitating factors contributing to rehospitalization and 90- to 120-day follow-up mortality. Results: The mean age of the cohort (n = 5005) was 59.3 ± 14.9 years. Acute coronary syndrome (ACS) (27.2%), nonadherence to diet (19.2%), and infection (14.6%) were the most common precipitating factors identified. After adjusting for confounders, patients with AHF precipitated by infection (hazard ratio [HR], 1.40; 95% confidence interval [CI] 1.10–1.78) and ACS (HR-1.23; 95% CI: 0.99-1.52) at admission showed a higher 90-day mortality. Similarly, AHF precipitated by infection (HR-1.13; 95% CI: 0.93–1.37), and nonadherence to diet and medication (HR-1.12; 95% CI: 0.94–1.34) during hospitalization showed a persistently higher risk of 12-month mortality compared with AHF patients without identified precipitants. Conclusion: Precipitating factors such as ACS, nonadherence to diet, and medication were frequently identified as factors that influenced frequent hospitalization and mortality. Hence, early detection, management, and monitoring of these prognostic factors in-hospital and postdischarge should be prioritized in optimizing the management of HF in the Gulf region.
Background: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cau... more Background: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries. Aim: The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE. Objective: The main objective was to report the 10-years risk for CHD in a sample of the UAE population. Methods: We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes). Results: 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by β-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors. The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages. Conclusion: The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.
Objectives: There is scarce data about gender differences in in-hospital cardiac arrest (IHCA) co... more Objectives: There is scarce data about gender differences in in-hospital cardiac arrest (IHCA) complicating acute coronary syndromes (ACS), particularly from the developing countries. In the curren...
Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been... more Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been increasingly recognized, particularly those affecting the cardiovascular system. Patients with COVID-19 infection can suffer from increased coagulopathy as well as myocardial injury. In this review, we discuss these complications with special focus on management challenges in patients with acute coronary disease based on the available evidence from published literature.
DOAJ (DOAJ: Directory of Open Access Journals), 2020
Pressured by the enormous human and economic costs of the COVID-19 pandemic, certain countries an... more Pressured by the enormous human and economic costs of the COVID-19 pandemic, certain countries and political figures have advocated the use of drugs and vaccines that did not go through the required regulatory stages of the development. Although the reason for bypassing these stages in a race to produce a treatment and vaccine for the COVID-19 patients could have been caused by good intentions to stop the human suffering from the pandemic, nonetheless, history has taught us that the results of this action could be catastrophic. In this article, we briefly review the lessons and tragedies in the evolution of human subject research regulations emphasizing the need for the proper evaluation of drugs and vaccines for COVID-19.
PCSK9 monoclonal antibodies are novel lipid-lowering therapy that have been extensively studied i... more PCSK9 monoclonal antibodies are novel lipid-lowering therapy that have been extensively studied in patients with hypercholesterolemia either as monotherapy or as an add-on to other LLTs. PCSK9 monoclonal antibodies have significantly reduced the low-density lipoprotein cholesterol (LDL-C) plasma level resulting in a better LDL-C goal attainment. The commercially available PCSK9 monoclonal antibodies, alirocumab and evolocumab, have demonstrated reductions in major adverse cardiovascular events such as myocardial infarction, stroke, unstable angina, and the need for coronary revascularization but not mortality. PCSK9 monoclonal antibodies have demonstrated a favorable safety profile. The most reported side effects are mild injection site with no causal relationship proven between the inhibition of PCSK9 and neurocognitive or glycemic adverse events. In this overview, the efficacy and safety of PCSK9 monoclonal antibodies in the treatment of primary and familial hypercholesterolemia will be discussed.
Background: Little is known about the epidemiology of atrial fibrillation (AF) among patients adm... more Background: Little is known about the epidemiology of atrial fibrillation (AF) among patients admitted with acute heart failure (HF) in the Middle East. Here, we describe the prevalence of AF and c...
Abstract Background Cardiogenic shock (CS) is an acute complex condition leading to morbidity and... more Abstract Background Cardiogenic shock (CS) is an acute complex condition leading to morbidity and mortality. Vasoactive medications, such as vasopressors and inotropes are considered the cornerstone of pharmacological treatment of CS to improve end-organ perfusion by increasing cardiac output (CO) and blood pressure (BP), thus preventing multiorgan failure. Objective A critical review was conducted to analyze the currently available randomized studies of vasoactive agents in CS to determine the indications of each agent and to critically appraise the methodological quality of the studies. Methods PubMed database search was conducted to identify randomized controlled trials (RCTs) on vasoactive therapy in CS. After study selection, the internal validity of the selected studies was critically appraised using the three-item Jadad scale. Results Nine studies randomized 2388 patients with a mean age ranged between 62 and 69 years, were identified. Seven of studies investigated CS in the setting of acute myocardial infarction (AMI). The studies evaluated the comparisons of norepinephrine (NE) vs. dopamine, epinephrine vs. NE, levosimendan vs. dobutamine, enoximone or placebo, and nitric oxide synthase inhibitors (NOSi) vs. placebo. The mean Jadad score of the nine studies was 3.33, with only three studies of a score of 5. Conclusions The evidence from the studies of vasoactive agents in CS carries uncertainties. The methodological quality between the studies is variable due to the inherent difficulties to conduct a study in CS. Vasopressors and inotropes continue to have a fundamental role given the lack of pharmacological alternatives.
OBJECTIVES: Although community acquired infections (CAI) are one of the most common causes for ho... more OBJECTIVES: Although community acquired infections (CAI) are one of the most common causes for hospitalization of patients with heart failure (HF), yet very few studies have systematically examined...
OBJECTIVES: It is well recognized that cardiac autonomic neuropathy associated with diabetes mell... more OBJECTIVES: It is well recognized that cardiac autonomic neuropathy associated with diabetes mellitus (DM) can cause silent myocardial ischemia, however there is limited research examining how the ...
OBJECTIVES: There is very scarce contemporary data about the prognostic impact of presentation wi... more OBJECTIVES: There is very scarce contemporary data about the prognostic impact of presentation with cardiac arrest in patients with acute coronary syndromes (ACS), particularly from the developing countries. Accordingly, we sought to assess the incidence, clinical features, immediate and long term mortality of patients with cardiac arrest at presentation using data from a large multicenter Middle-Eastern ACS registry. METHODS: For a period of 9 months in 2008 to 2009, consecutive patients with ACS were enrolled from 65 hospitals in 6 Middle East countries. Patients presenting with cardiac arrest in this cohort were selected and in-hospital outcomes, one-month and one-year mortality were examined. RESULTS: Among 7,930 ACS patients enrolled, there were 89 patients hospitalized alive after resuscitation from cardiac arrest with a rate of 1.1%. Compared with patients without cardiac arrest, patients presenting with cardiac arrest had a significantly higher rate of prior myocardial infarction (32.6% vs. 19.6%)...
Aim: To investigate the precipitating factors that contribute to hospitalization and mortality in... more Aim: To investigate the precipitating factors that contribute to hospitalization and mortality in postacute heart failure (AHF) hospitalization in the Middle-East region. Methods: We evaluated patient data from the Gulf AHF registry (Gulf CARE), a prospective multicenter study conducted on hospitalized AHF patients in 47 hospitals across seven Middle Eastern Gulf countries in 2012. We performed analysis by adjusting confounders to identify important precipitating factors contributing to rehospitalization and 90- to 120-day follow-up mortality. Results: The mean age of the cohort (n = 5005) was 59.3 ± 14.9 years. Acute coronary syndrome (ACS) (27.2%), nonadherence to diet (19.2%), and infection (14.6%) were the most common precipitating factors identified. After adjusting for confounders, patients with AHF precipitated by infection (hazard ratio [HR], 1.40; 95% confidence interval [CI] 1.10–1.78) and ACS (HR-1.23; 95% CI: 0.99-1.52) at admission showed a higher 90-day mortality. Similarly, AHF precipitated by infection (HR-1.13; 95% CI: 0.93–1.37), and nonadherence to diet and medication (HR-1.12; 95% CI: 0.94–1.34) during hospitalization showed a persistently higher risk of 12-month mortality compared with AHF patients without identified precipitants. Conclusion: Precipitating factors such as ACS, nonadherence to diet, and medication were frequently identified as factors that influenced frequent hospitalization and mortality. Hence, early detection, management, and monitoring of these prognostic factors in-hospital and postdischarge should be prioritized in optimizing the management of HF in the Gulf region.
Background: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cau... more Background: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries. Aim: The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE. Objective: The main objective was to report the 10-years risk for CHD in a sample of the UAE population. Methods: We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes). Results: 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by β-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors. The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages. Conclusion: The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.
Objectives: There is scarce data about gender differences in in-hospital cardiac arrest (IHCA) co... more Objectives: There is scarce data about gender differences in in-hospital cardiac arrest (IHCA) complicating acute coronary syndromes (ACS), particularly from the developing countries. In the curren...
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