Nishtar Medical College

Aim Cardiovascular diseases (CVD) are one of the leading causes of morbidity and mortality in the global population and cause notable psychosocial and psychological repercussions, including psychological distress and cognitive impairment. This research examines the correlation between psychological distress, cognitive impairment, and disease severity in patients with chronic CVD. The study seeks to establish interrelations between these factors and functional activity, quality of life, and general health by comparing specific demographic and clinical variables. Method This cross-sectional study was conducted among 100 chronic CVD patients aged 35 and above, recruited from cardiovascular care units and outpatient clinics. The sample included 43 (43%) males and 57 (57%) females. The Perceived Stress Scale was used to assess psychological distress, the Duke Activity Status Index for functional activity, the EQ-5D-5L for health-related quality of life, and the Mini-Mental State Examination for cognitive function. Data were analyzed using IBM SPSS Statistics software version 26 (IBM Corp., Armonk, NY, USA) to perform correlation studies on stress, cognition, activities, and quality of life and to compare these results between groups based on marital status, education level, employment status, and disease duration. Results The results revealed a significant positive relationship between stress and functional activity, r = 0.521, and quality of life, r = 0.698, indicating that moderate stress levels can positively impact activity levels and perceived quality of life. The level of stress was negatively related to cognition (r = -0.318, demonstrating the toxic impact of stress. Mentally compensated participants were stressed and showed weaker cognitive results than non-compensated individuals, especially those hospitalized. Comparing stress and mental performance by marital status, employment status, and education showed that education status affected stress and cognition in different ways, and widowed and retired individuals had higher stress levels and lower cognitive scores. Conclusion This study highlights the complex interplay between psychological distress, cognitive impairment, and disease severity in chronic CVD patients. Findings emphasize the need for integrated interventions that address psychological and mental health to improve overall patient care and health-related quality of life. These findings suggest the potential for developing targeted psychological and cognitive support interventions to enhance functional activity, reduce distress, and improve quality of life in chronic CVD patients. Tailored strategies for vulnerable groups, such as widowed and retired individuals, could help mitigate stress, preserve cognitive function, and enhance health outcomes in chronic disease settings.

Silent myocardial ischemia (SMI) is a significant concern for diabetic patients, often remaining undetected until severe complications arise. Prolonged hyperglycemia, poor glycemic control, and lifestyle factors contribute to its risk, with older adults and those with long-standing diabetes particularly vulnerable.

To assess the prevalence and predictors of SMI in adults with diabetes, emphasizing long-term management and monitoring.

A longitudinal observational study was conducted at Nishtar Medical University, Multan, from October 2020 to September 2022, involving 388 adults with diabetes for at least five years. Patients with significant cardiovascular diseases or recent medication-affecting biomarkers were excluded. Data collection included demographics, medical history, and clinical assessments such as HbA1c levels, 12-lead resting ECGs, and treadmill exercise stress tests, with myocardial perfusion imaging (MPI) for those unable to perform stress tests. Statistical analyses using IBM SPSS (version 22) incorporated univariate and multivariate logistic regression to identify predictors of SMI, adjusting for confounders such as age, sex, smoking, and blood pressure. Thresholds included microalbuminuria at 30-300 mg/24 hours and HbA1c ≥7%, with missing data addressed through multiple imputations.

Among the participants, the prevalence of SMI was 48%, increasing to 58% in those with microalbuminuria. Significant predictors included the duration of diabetes (OR 1.28, 95% CI: 1.08-1.52, p=0.001), HbA1c levels (OR 1.75, 95% CI: 1.42-2.16, p<0.001), age (OR 1.05, 95% CI: 1.01-1.09, p=0.035), and smoking status (OR 1.42, 95% CI: 1.05-1.92, p=0.025). Smoking status was based on self-report. Notably, microalbuminuria showed a strong association with SMI (OR 2.89, 95% CI: 2.10-3.98, p<0.001). The distribution of participants was balanced in terms of age and gender, with a mean age of 58 years (SD 9.4), and 52% were male. No unexpected findings were observed, and the results aligned with the anticipated relationships between the variables.

This study highlights a concerning prevalence of SMI among diabetic patients, emphasizing the importance of monitoring diabetes duration and glycemic control, particularly in individuals with microalbuminuria. Regular follow-up care, including routine ECGs, stress tests, and biomarker assessments, is crucial for improving cardiovascular outcomes in this high-risk population. Limitations such as the observational design and potential self-report bias in smoking status may affect the generalizability of the findings. Future research should focus on large-scale, multicenter studies to validate these findings and explore interventions that could reduce the burden of SMI in diabetic patients.