BACKGROUND:
One of the main causes of mortality worldwide is Coronary artery disease (CAD) 1.
In developing countries, cardiovascular diseases caused about eighty percent of deaths 2. In 2014, CAD was responsible for about 23.14% of total deaths in Egypt3.
Atherosclerosis is the underlying cause of CAD. Inflammation contributes to the process of atherosclerosis from the plaque formation till its rupture. Hence, biochemical markers of inflammation were investigated as noninvasive indicators of underlying atherosclerosis and as a success marker of therapeutic and preventive interventions.4
High sensitivity C-reactive protein (hs-CRP) is currently the best validated inflammatory biomarker. it has become as an independent predictor of vascular risk similar to systolic blood pressure ,even more, it was superior to non-HDL-C5.
There has been a positive correlation between levels of hs-CRP, plaque ruptures risk and coronary artery remodeling grade6. Hence, hsCRP has been used clinically to detect that risk in both primary and secondary prevention settings7.
Cardiac rehabilitation programs is a recommended intervention by the American College of Cardiology the American Heart Association in reducing coronary events and mortality in CAD patients8.
Cardiac rehabilitation impact on inflammation was previously documented by the reduction of serum hs-CRP concentrations in CAD patients9.
Despite their benefits, these programs are still underutilized. Although cardiac rehabilitation programs have significantly lowered CAD mortality, we are constantly searching for new modalities to further improve outcome and influence disease progression.
Whereas previous studies have repeatedly proved the favorable effects of clinical pharmacist interventions on outcomes of chronic diseases patients 10, none of these studies have evaluated the impact of clinical pharmacist services added to cardiac rehabilitation program on inflammatory marker , hs-CRP, in post-acute coronary syndrome (ACS) patients.
The aim of our study was to assess the impact of clinical pharmacist services addition to cardiac rehabilitation program, on inflammation and echo-cardiographic evidence.