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Loutati R, Bruoha S, Taha L, Karmi M, Perel N, Maller T, Amsalem I, Hitter R, Levi N, Zacks N, Shrem M, Amro M, Shuvy M, Glikson M, Asher E. The Effect of War on STEMI Incidence: Insights from Intensive Cardiovascular Care Unit Admissions. J Clin Med 2024; 13:1356. [PMID: 38592151 PMCID: PMC10931653 DOI: 10.3390/jcm13051356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The impact of armed conflicts on public health is undeniable, with psychological stress emerging as a significant risk factor for cardiovascular disease (CVD). Nevertheless, contemporary data regarding the influence of war on CVD, and especially on acute coronary syndrome (ACS), are scarce. Hence, the aim of the current study was to assess the repercussions of war on the admission and prognosis of patients admitted to a tertiary care center intensive cardiovascular care unit (ICCU). (2) Methods: All patients admitted to the ICCU during the first three months of the Israel-Hamas war (2023) were included and compared with all patients admitted during the same period in 2022. The primary outcome was in-hospital mortality. (3) Results: A total of 556 patients (184 females [33.1%]) with a median age of 70 (IQR 59-80) were included. Of them, 295 (53%) were admitted to the ICCU during the first three months of the war. Fewer Arab patients and more patients with ST-segment elevation myocardial infraction (STEMI) were admitted during the war period (21.8% vs. 13.2%, p < 0.001, and 31.9% vs. 24.1%, p = 0.04, respectively), whereas non-STEMI (NSTEMI) patients were admitted more frequently in the pre-war year (19.3% vs. 25.7%, p = 0.09). In-hospital mortality was similar in both groups (4.4% vs. 3.4%, p = 0.71; HR 1.42; 95% CI 0.6-3.32, p = 0.4). (4) Conclusions: During the first three months of the war, fewer Arab patients and more STEMI patients were admitted to the ICCU. Nevertheless, in-hospital mortality was similar in both groups.
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Affiliation(s)
- Ranel Loutati
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, and The Ben-Gurion University of the Negev, Ashkelon 7830604, Israel;
| | - Louay Taha
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Mohammad Karmi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Nimrod Perel
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Tomer Maller
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Rafael Hitter
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Nir Levi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Netanel Zacks
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Maayan Shrem
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Motaz Amro
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Mony Shuvy
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Michael Glikson
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Elad Asher
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
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Gumede NAC, Khathi A. The Role of Pro-Opiomelanocortin Derivatives in the Development of Type 2 Diabetes-Associated Myocardial Infarction: Possible Links with Prediabetes. Biomedicines 2024; 12:314. [PMID: 38397916 PMCID: PMC10887103 DOI: 10.3390/biomedicines12020314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/14/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Myocardial infarction is a major contributor to CVD-related mortality. T2DM is a risk factor for MI. Stress activates the HPA axis, SNS, and endogenous OPS. These POMC derivatives increase the blood glucose and cardiovascular response by inhibiting the PI3K/AkT insulin signaling pathway and increasing cardiac contraction. Opioids regulate the effect of the HPA axis and SNS and they are cardioprotective. The chronic activation of the stress response may lead to insulin resistance, cardiac dysfunction, and MI. Stress and T2DM, therefore, increase the risk of MI. T2DM is preceded by prediabetes. Studies have shown that prediabetes is associated with an increased risk of MI because of inflammation, hyperlipidemia, endothelial dysfunction, and hypertension. The HPA axis is reported to be dysregulated in prediabetes. However, the SNS and the OPS have not been explored during prediabetes. The effect of prediabetes on POMC derivatives has yet to be fully explored and understood. The impact of stress and prediabetes on the cardiovascular response needs to be investigated. This study sought to review the potential impact of prediabetes on the POMC derivatives and pathways that could lead to MI.
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Affiliation(s)
- Nompumelelo Anna-Cletta Gumede
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban X54001, South Africa;
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