Background: South Asians (SA) from the Indian Subcontinent are known to have coronary artery disease (CAD) at a very young age and also to have a more diffuse disease when compared to indigenous patients in the Western world. Objective : The aim of the study was to compare clinical characteristics and outcome of South Asian patients to Qatari patients presenting with acute myocardial infarction (AMI) in Qatar. The majority of SA residing in Qatar are manual workers of lower socioeconomic status when compared to the Qatari population. Methods: We conducted a retrospective analysis of a prospectively collected data of all patients diagnosed with acute myocardial infarction (AMI) in the State of Qatar during ten years (1991 -2001). Patients were divided into two groups: Qataris (1598 patients) and South Asians (2606 patients). Diagnostic classification of definite AMI was made in accordance with criteria based on the International Classification of Disease ninth revision [ICD-9]. The obtained information was based on the following parameters: age at the time of admission, gender, cardiovascular risk factor profiles (smoking, hypercholesterolemia, diabetes, and pre-existing coronary heart disease), and ECG. Data analyses were performed using univariate and stepwise logistic regression analysis. Results: When compared to Qatari patients, SA patients were younger (47 yrs vs 61 yrs; p < 0.0001). SA were more likely to be smokers (50.5% vs 23.4%; p < 0.0001) and male (96.9 % vs 71.8% p < 0.0001). SA were less likely to have: diabetes mellitus (24.8% vs 54.0%; p < 0.0001); hypertension (19.9% vs 37.6%; p < 0.0001); previous MI (8.1% vs 15.8%; p < 0.0001); CABG (2.2% vs 3.9%; p = 0.002). The number of patients who received thrombolytic therapy was significantly higher among SA when compared to Qatari (54.6% vs 25.9%; p < 0.0001), and this was significantly associated with lower in-hospital mortality rate (6.7% vs 16.8%; p < 0.0001). Conclusion: SA patients who had AMI in Qatar had better outcome than Qataris. This may be explained by the patients' favorable baseline clinical characteristics such as younger age and less prevalence of diabetes and hypertension.

Objectives: To determine the opinions of the physicians posted in two tertiary care hospitals of Peshawar regarding future strategies to combat cardiovascular diseases (CVD). Methods: The study was a descriptive observational survey conducted in Khyber Teaching Hospital (KHT), Hyderabad Medical Complex (HMC) and Department of Community Medicine, Khyber Medical College, Pehawar. The study was conducted from June 20 to August 15, 2006. A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included. They were interviewed with a pre-designed questionnaire, prepared in accordance with the objectives of the study. Results: According to the clinicians' and general physicians' opinion, the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment (60%), national physical activity policy (70%), check on food quality (21.66%), research promotion in the field of CVD (36.66%), conducting workshops and seminars to educate people about CVD (30%) etc. Community approaches should be more specific towards promotion of healthy activities (71.66%), discouraging smoking (96.66%), and conducting local workshops to increase awareness (26.66%). Individual approaches to combat CVD include screening of blood pressure, glucose and lipid profile regularly (85%), cessation of smoking (96.66%), weight control with exercise (75%), compliance in medication (46.66%), and leadership and advocacy to increase awareness and decrease stigma (43.33%). Conclusion : While establishing a strategy to CVD, there is a need to offer multiple approaches on national, community and individual levels.

Background: To balance the cardiovascular benefits from low-dose aspirin against the gastrointestinal harm caused, studies have considered the coronary heart disease risk for each individual but not their gastrointestinal risk profile. We characterized the gastrointestinal risk profile of low-dose aspirin users in real clinical practice, and estimated the excess risk of upper gastrointestinal complications attributable to aspirin among patients with different gastrointestinal risk profiles. Methods: To characterize aspirin users in terms of major gastrointestinal risk factors (i.e., advanced age, male sex, prior ulcer history and use of non-steroidal anti-inflammatory drugs), we used The General Practice Research Database in the United Kingdom and the Base de Datos para la Investigacion Farmacoepidemiologica en Atencion Primaria in Spain. To estimate the baseline risk of upper gastrointestinal complications according to major gastrointestinal risk factors and the excess risk attributable to aspirin within levels of these factors, we used previously published meta-analyses on both absolute and relative risks of upper gastrointestinal complications. Results: Over 60% of aspirin users are above 60 years of age, 4 to 6% have a recent history of peptic ulcers and over 13% use other non-steroidal anti-inflammatory drugs. The estimated average excess risk of upper gastrointestinal complications attributable to aspirin is around 5 extra cases per 1,000 aspirin users per year. However, the excess risk varies in parallel to the underlying gastrointestinal risk and might be above 10 extra cases per 1,000 person-years in over 10% of aspirin users. Conclusion: In addition to the cardiovascular risk, the underlying gastrointestinal risk factors have to be considered when balancing harms and benefits of aspirin use for an individual patient. The gastrointestinal harms may offset the cardiovascular benefits in certain groups of patients where the gastrointestinal risk is high and the cardiovascular risk is low.