Cardiovascular disease (CVD) and its associated risk factors among older adults in India: Evidence from LASI Wave 1

Agreement Between Office-Based and Laboratory-Based Globorisk Models and their Prediction of Cardiovascular Diseases in Turkish Population: A Nationwide Cohort Study

Globorisk is a country-specific risk prediction model that estimates 10-year cardiovascular disease (CVD) risk. This study aims to evaluate the agreement between different versions of Globorisk and their ability to predict CVD in a nationwide Turkish cohort. Baseline data from 5449 participants aged 40-74 were obtained from Türkiye Chronic Diseases and Risk Factors Survey 2011. Office- and laboratory-based Globorisk risk scores were calculated using age, gender, systolic blood pressure (SBP), current smoking status, body mass index (BMI), diabetes, and total cholesterol levels. Correlation and Bland-Altman analysis were employed to assess the agreement between 10-year risk scores. Multivariable logistic regression models were estimated with Globorisk variables to predict the presence of CVD over a 6-year follow-up period. Model calibration was performed. The study identified 515 incident CVD cases during the 6-year follow-up period. There was a strong positive correlation between 10-year Globorisk versions (r = 0.89). The limit of the agreement was narrower in males (- 6.11 to 6.89%) compared to females (- 7.01 to 7.73%). Age and systolic blood pressure were associated with 6-year CVD in both office- and laboratory-based models. The models showed similar discriminative performance (AUC: 0.68) and predictive accuracy (mean absolute error: 0.009) for 6-year CVD. Both Globorisk models were strongly correlated, had similar discrimination power and predictive accuracy. The office-based Globorisk can be used instead of the laboratory-based model, especially where resources are limited.

Bayesian spatial-temporal analysis and determinants of cardiovascular diseases in Tanzania mainland

BACKGROUND

Cardiovascular Diseases (CVDs) are health-threatening conditions that account for high mortality in the world. Approximately 23.6 million deaths due to CVD is expected in the year 2030 worldwide. The CVD burden is more severe in developing countries, including Tanzania.

OBJECTIVES

This study analyzed the spatial-temporal trends and determinants of cardiovascular diseases in Tanzania from 2010 to 2019.

METHODS

Individual data were extracted from Jakaya Kikwete Cardiac Institute (JKCI), Mbeya Zonal Referral Hospital (MZRH), Kilimanjaro Christian Medical Centre (KCMC) and Bugando hospitals and the geographical data from TMA. The model containing spatial and temporal components was analyzed using the Bayesian hierarchical method implemented using Integrated Nested Laplace Approximation (INLA).

RESULTS

The results found that the incidence of CVD increased from 2010 to 2014 and decreased from 2015 to 2019. The southern highlands, lake, central and coastal zones were more likely to have CVD problems than others. It was also revealed that people aged 60-64 years OR = 1.49, females OR = 1.51, smokers OR = 1.76, alcohol drinkers OR = 1.48, and overweight OR = 1.89 were more likely to have CVD problems. Additionally, a 1oC increase in the average annual air maximum temperature was related to a 14% risk of developing CVD problems. The study revealed that the model, which included spatial and temporal random effects, was the best-predicting model.

CONCLUSION

The study shows a decreased CVD incidence rate from 2015 to 2019. The CVD incidences occurred more in Tanzania's coastal and lake areas between 2010 and 2019. The demographic, lifestyle and geographical risk factors were significantly associated with the CVD.

The distribution of cardiovascular diseases in Tanzania: a spatio-temporal investigation

Cardiovascular Disease (CVD) is currently the major challenge to people's health and the world's top cause of death. In Tanzania, deaths due to CVD account for about 13% of the total deaths caused by the non-communicable diseases. This study examined the spatio-temporal clustering of CVDs from 2010 to 2019 in Tanzania for retrospective spatio-temporal analysis using the Bernoulli probability model on data sampled from four selected hospitals. Spatial scan statistics was performed to identify CVD clusters and the effect of covariates on the CVD incidences was examined using multiple logistic regression. It was found that there was a comparatively high risk of CVD during 2011-2015 followed by a decline during 2015-2019. The spatio-temporal analysis detected two high-risk disease clusters in the coastal and lake zones from 2012 to 2016 (p<0.001), with similar results produced by purely spatial analysis. The multiple logistic model showed that sex, age, blood pressure, body mass index (BMI), alcohol intake and smoking were significant predictors of CVD incidence.

Impact of cardiopulmonary resuscitation duration on functional outcome, level of independence, and survival among patients with in-hospital cardiac arrests: A pilot study

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of cardiac arrest (CA), which are presented as sudden cardiac arrest (SCA) and sudden cardiac death (SCD). To assess the impact of CPR duration on the functional outcome, level of independence, and survival among patients with in-hospital cardiac arrest (IHCA).

MATERIAL AND METHODS

This prospective longitudinal pilot study was conducted at a tertiary care hospital in South India. Data were collected using consecutive sampling techniques from nine patients with IHCA, and outcomes were measured using the cerebral performance category (CPC) and Katz level of independence (LOI) during the immediate post-CPR, 30th day, and 90th day. Based on the principles of pilot study design, descriptive statistics was used to analyze the results. Inferential statistics analysis was not applicable based on the sample size of the pilot study.

RESULTS

Nine patients were included in this pilot study. The mean and median age of the patients were 48.11 ± 8.66 (46, IQR, 32-67 years) and 77.8% were male patients. The primary medical diagnosis was cardiology and neurology conditions among 44.4% and 22.2% of patients. The mean and median CPR duration was 12.11 ± 4.59 minutes (IQR, 8-15.50) and 44.4% achieved a return of spontaneous circulation (ROSC) with a mean ROSC time of 5.56 ± 7.418. The mean CPC score in the immediate post-CPR period and 30th day was 4 ± 1.732 and 4.56 ± 1.33, with mortality of 66.7% and 33.3% survivors in the immediate post-CPR period. While the mean LOI score among the survivors during the immediate post-CPR and 30th day was zero and four. which highlights the complete dependency of patients during the immediate post-CPR with significant improvement by the 30th day and unchanged until the 90th day.

CONCLUSIONS

The overall mortality and survival were 88.8% and 11.1%, respectively, by the 90th day. The pilot study is feasible at the end of the study. However, due to the difficulty in obtaining CA, an additional tertiary hospital was included in the larger study.

Cardiovascular Diseases Among Indian Older Adults: A Comprehensive Review

Cardiovascular diseases (CVDs) constitute an important cause of morbidity and mortality globally, and India is no exception to this trend. With the ongoing aging of the population in India, there is a notable surge in the prevalence and impact of CVDs among older adults. This review is aimed at providing a comprehensive overview of the current knowledge concerning the prevalence, risk factors, and management of CVDs in the context of Indian older adults. The incidence of CVDs in India is not only alarming but also exhibits an upward trajectory with advancing age. Primary risk factors contributing to the elevated incidence among older adults include hypertension (HT), diabetes, dyslipidemia, obesity, smoking, a sedentary lifestyle, and poor dietary habits. Additionally, stress and genetic predisposition emerge as noteworthy contributors to CVDs in this population. Effectively identifying and managing these risk factors among older adults in India is imperative to alleviate the burden of these diseases and enhance overall quality of life. Strategies aimed at mitigating the impact of CVDs in the country necessitate a comprehensive approach, integrating lifestyle interventions, public health initiatives, and a robust healthcare system. In summary, CVDs represent a significant health concern in both rural and urban areas of India. However, variations exist in the prevalence, risk factors, and accessibility to healthcare between these regions. Therefore, addressing the prevalence of CVDs in India necessitates a complex, multidimensional strategy that takes into account the unique opportunities and challenges that come with living in both rural and urban areas.

Production of Nattokinase from Bacillus amyloliquefaciens MRS18: A Bacterial Strain Isolated from Fermented Beans

BACKGROUND

Nattokinase (NK) is a naturally occurring fibrinolytic protease enzyme obtained from the traditional Japanese food called Natto and has several uses in the pharmaceutical and medical industries. Nowadays, the most often used thrombolytic agent in the clinical field is NK, in part because it is less expensive than other thrombolytic medicines.

OBJECTIVES

The objective of this study is to investigate the screening, isolation and characterization of the NK enzyme-producing Bacillus strain from fermented Soya beans.

METHODS

The sample of fermented soya beans were tested for the presence of fibrinolytic protease- producing bacteria, followed by the screening, extraction, characterization and clot lysis assays.

RESULTS

A total of three isolates were screened for caseinolytic activities by casein hydrolysis assay. Out of those isolates, MRS18 was found to be potent in producing the enzyme proteinase. To determine the taxonomy and phylogeny of these isolates, biochemical and molecular characterization has been carried out. Bacillus amyloliquefaciens MRS18 has been found with the highest caseinolytic activity. The clot lysing ability of the potent strain Bacillus amyloliquefaciens was found to be 61.7% after 120 min, and on further purification, by ammonium sulphate precipitation method, the lysis percentage was found to be 656% after 120 min.

CONCLUSION

From the results of the present study, we concluded that Bacillus amyloliquefaciens isolated from the fermented soya beans produced an NK enzyme that exhibits immense potential to lyse blood clots.

Prediction of Different Risk Factors in Relation to Hyperlipidemia Using Framingham Risk Score and Cholesterol Risk Score in a Tertiary Care Hospital

BACKGROUND

A condition that affects the circulatory system of the human body is referred to as a cardiovascular disease (CVD). Cardiovascular diseases (CVDs) are responsible for a significant number of fatalities globally. Annually, CVDs result in the demise of 17.9 million people, which accounts for 31% of all fatalities on a global scale.

OBJECTIVE

The objective of the study was to assess the demographic profile of diabetic and nondiabetic patients suffering from cardiovascular disease. The aim of the study is to predict risk factors in relation to hyperlipidaemia using two different scales, the Framingham Risk Scale (FRS) and the Cholesterol Risk Calculator (CRC), and to determine the frequency of hypercholesterolemia in relation to CVD.

METHODS

A cross-sectional study was conducted in Guru Gobind Singh Medical College and Hospital, Punjab, India.

RESULTS

The mean age of patients was found to be M= (51.23), SD= (9.348) years, and among 331 patients (52.6%) were female patients. The mean of Framingham Risk Score was found to be (29.07%). The Framingham Risk Score was found significant with gender and calorie intake below the recommended dietary allowances of the patient (p=0.001). The Framingham Risk Score was found significant with physical activity and employment status of the patients (p= 0.001). In linear regression, the Framingham Risk Score was found significant with the lipid profile of the patients (p=0.001) i.e., the higher the value of cholesterol level, the higher the Framingham Risk Score. The chi-square test showed a significant relation between Cholesterol Risk Score and employment status, physical activity, calorie intake, gender, and occupation of the patients (p=0.001, p=0.001, p=0.001, p=0.004) respectively.

CONCLUSION

The present study demonstrated that patients with high Framingham risk score and cholesterol risk score are at increased risk of diabetes and cardiovascular disease. The present study concludes that the FRS is higher in patients below RDA, patients doing low physical activity, and sedentary workers. In order to provide proper assistance and counselling, healthcare professionals must continuously analyze each patient's risk factor for CVD and barriers to healthy and preventive behaviors. There is a lack of comprehensive studies comparing the effectiveness of the Framingham Risk Score and Cholesterol Risk Score in predicting hyperlipidemia and associated cardiovascular risks within the context of a tertiary care hospital setting.

Relationship between Framingham Cardiovascular Risk Score and cognitive performance among ageing rural Indian participants: a cross-sectional analysis

OBJECTIVE

The burden of cardiovascular risk factors is increasing in India, which, in turn, can adversely impact cognition. Our objective was to examine the effect of cardiovascular risk factors measured by Framingham Risk Score (FRS) on cognitive performance among a cohort of healthy, ageing individuals (n=3609) aged ≥45 years from rural India.

DESIGN

A cross-sectional analysis.

SETTING

A rural community setting in southern India.

PARTICIPANTS

Healthy, ageing, dementia-free participants, aged 45 years and above, belonging to the villages of Srinivaspura (a rural community located around 100 km from Bangalore, India), were recruited.

PRIMARY OUTCOME MEASURES

Using a locally adapted, validated, computerised cognitive test battery, we assessed cognitive performance across multiple cognitive domains: attention, memory, language, executive functioning and visuospatial ability.

RESULTS

The median (IQR) age of the sample was 57 (50.65) and 50.5% were women. Multiple linear regression analysis showed that participants with higher FRS performed poorly in attention (visual attention (β=-0.018, p=0.041)), executive functioning (categorical fluency (β=-0.064, p<0.001)), visuospatial ability (form matching (β=-0.064, p<0.001) and visuospatial span (β=-0.020, p<0.001)), language (reading and sentence comprehension (β=-0.010, p=0.013), word comprehension (β=-0.021, p<0.001) and semantic association (β=-0.025, p<0.001)), and memory (episodic memory IR (β=-0.056, p<0.001), episodic memory DR (β=-0.076, p<0.001) and name-face association (β=-0.047, p<0.001)).

CONCLUSION

Increased cardiovascular risk as evidenced by FRS was associated with poorer cognitive performance in all cognitive domains among dementia-free middle-aged and older rural Indians. It is imperative to design and implement appropriate interventions (pharmacological and lifestyle-based) for cardiovascular risk reduction and thereby, prevent or mitigate accelerated cognitive impairment in ageing individuals.

Utilization of Quince (Cydonia oblonga) Peel and Exploration of Its Metabolite Profiling and Cardioprotective Potential Against Doxorubicin-Induced Cardiotoxicity in Wistar Rats

Quince (Cydonia oblonga Mill.) is a pomaceous fruit that is typically processed into jams, jellies, and marmalade. The byproduct, i.e., the quince peel emanated from the processing industry, can be upcycled, ensuring zero waste policy and resulting in a sustainable food system. In our study, the quince peel was explored for in vitro phytochemical analysis and in vivo cardioprotective potential. Two diverse extractions (ultrasonication and reflux) and four different solvents (aqueous, ethanolic, hydroethanolic, and methanolic) were used for the extraction of quince peel and assessed for the phytochemical and antioxidant study. Among all the evaluated extracts, hydroethanolic quince extract extracted through the reflux extraction method showed the maximum phenolic (27.23 ± 0.85 mg GAE/g DW) and flavonoid (16.5 ± 1.02 mg RE/g DW) content. The maximum antioxidant potential (DPPH) with an IC50 value of 204.8 ± 2.24 μg/mL was noted for the hydroethanolic extract. This best active extract was then subjected to HPTLC, UPLC-MS, mineral, and FTIR analysis to study the metabolic profiling and inorganic composition and to confirm the presence of bioactives. Additionally, the in vivo study was done in rats using doxorubicin (DOX)-induced cardiotoxicity. The rats were given extracts orally at 160 and 320 mg/kg bw for 30 days. ECG analysis was done at the termination of the experiment. Besides this, the lipid profile, blood serum parameters (CK-MB, LDH, AST), and tissue parameters (MDA, SOD, GSH, CAT) were analyzed. The DOX-treated group unveiled a substantial variance (p < 0.001) in all the parameters in contrast to the normal control group and extract control groups. However, the pretreated groups substantially alleviated the DOX-induced changes in all the parameters. Additionally, recuperation in histopathological alterations of the cardiac tissue in contrast to the DOX-induced toxicity was also seen in the pretreated groups. Thus, it could be said that the cardioprotective activity of the quince peel extract attributed to the presence of phytoconstituents counteracted the DOX-induced cardiotoxicity and assisted in the restoration of the cardiac injury in rats.

Ten-year risk assessment for cardiovascular diseases using ASCVD risk estimator plus: outcomes from hypertension and diabetes patients

BACKGROUND

Cardiovascular risk prediction models encompass numerous CVD risk factors. Available prediction models were developed from non-Asian cohorts hence we decided to evaluate the performance of the ASCVD risk estimator model and the associated 10-year CVD predisposing factors in Punjab.

METHODS

We carried out a cross-sectional study among patients having hypertension and diabetes mellitus in a tertiary hospital in Punjab, India. 201 participants without ASCVD who were ≥ 40 years old and had been admitted to the medical ward were assessed. a pre-validated questionnaire was used to collect data on the socio-demographics and behavioral patterns. Lipid profile and blood pressure measurements were collected as per standard protocols. The respondents' CVD risk was assessed using ASCVD Risk Estimator Plus. Data were analyzed using IBM SPSS version 26; bivariate analysis was done using Chi-square and binary logistic regression was used to identify the predictors of 10-year risk for CVD at a 5% level of significance.

MEASUREMENTS

We examined the stratification of the predicted outcomes and evaluated the associations between individual risk factors and the predicted cardiovascular events. Our study categorized the results of these outcomes into 4 categories: low category (1-5%), borderline category (6-9%) intermediate category (10-20%), and high category (21-95%).

RESULTS

Out of the 201 participants that enrolled in our study, the majority 76 (37.8%) were in the intermediate category, 56 (27.9%) were in the high category, 41 (20.4%) were in the borderline category, 28 (13.9%) were in the low category. The median ASCVD percentage was 14.20%. Respondents who were alcoholics, smokers, and drug abusers (OR = 5.8, 95% CI 0.397-83.584) were associated with the highest likelihood of developing CVDs. Furthermore, males had a significantly higher mean predicted CVD outcome % (M = 23.18%) compared to females (M = 14.91%).

CONCLUSION

According to our prediction study, it was discovered that 145 (72.1%) participants were not likely to have had an ASCVD in the next 10 years. However, middle-aged males should be more cautious with their lifestyle habits, particularly in dealing with risk factors that can expose them to CVDs.

Study on depletion of ovarian function and late-life chronic diseases in India

OBJECTIVE

The current study aims to understand premature and early menopausal age in association with chronic conditions.

METHODS

The present cross-sectional study analyzed nationally representative data from LASI (Longitudinal Aging Study in India) from 2017 to 2018. Bivariate analysis including cross-tabulation and χ2 tests were performed. Further multiple regression analysis was performed, using the generalized linear model of logit link.

RESULTS

Approximately 2533 (8%) older women reported that they had experienced premature menopause (before age 40), while 3889 (12.4%) reported having early menopause (age 40-44). The likelihood of a woman with premature menopause developing cardiovascular diseases (CVDs) is 15% higher (adjusted odds ratio [AOR], 1.15; P < 0.05) than those who do not experience premature menopause, while women with early menopause have a 13% higher risk (AOR, 1.13; P < 0.05). For women who experienced premature menopause and were also smokers, the probability of developing CVDs was higher. Other chronic diseases such as bone or joint problems, diabetes, and eye vision problems were also shown to be significant health problems among women who had premature ovarian failure.

CONCLUSION

Our results show significant association between women with premature or early depletion of ovarian function and chronic health conditions such as cardiovascular diseases, bone or joint problems, vision problems, and neurological or psychiatric disorders at their later life ages. Comprehensive strategies in the form of lifestyle changes may regulate hormonal levels and allow the body to reach menopause at the appropriate age.

Progonostic effect of GSTM1/GSTT1 polymorphism in determining cardiovascular diseases risk among type 2 diabetes patients in South Indian population

BACKGROUND

Cardiovascular disease (CVD) is a significant complication of type 2 diabetes mellitus (T2DM), with oxidative stress playing a significant role. Glutathione S-transferase (GST) polymorphisms - GSTM1, GSTT1 - have been linked to CVD and T2DM. The role of GSTM1 and GSTT1 in CVD development among T2DM patients in the South Indian population is investigated in this study.

MATERIALS AND METHODS

The volunteers were grouped as Group 1: control, Group 2: T2DM, Group 3: CVD, and Group 4: T2DM with CVD (n = 100 each). Blood glucose, lipid profile, plasma GST, MDA, and total antioxidants were measured. GSTM1 and GSTT1 were genotyped using PCR.

RESULTS

GSTT1 plays a significant role in the development of T2DM and CVD [OR 2.96(1.64-5.33), < 0.001 and 3.05(1.67-5.58), < 0.001] while GSTM1 null genotype was not associated with disease development. Individuals with dual null GSTM1/GSTT1 genotype had the highest risk of developing CVD [3.70(1.50-9.11), 0.004]. Group 2 and 3 individuals showed higher lipid peroxidation and lower total antioxidant levels. Pathway analysis further indicated that GSTT1 significantly affects GST plasma levels.

CONCLUSION

GSTT1 null genotype may be considered a contributing factor that increases the susceptibility and risk of CVD and T2DM in the South Indian population.

Prevalence and factors associated with undiagnosed and uncontrolled heart disease: A study based on self-reported chronic heart disease and symptom-based angina pectoris among middle-aged and older Indian adults

BACKGROUND

This study aimed to examine the prevalence of heart diseases and angina pectoris and associated factors among middle-aged and older Indian adults. Additionally, the study examined the prevalence and associated factors of undiagnosed and uncontrolled heart disease among middle-aged and older adults based on self-reported chronic heart disease (CHD) and symptom-based angina pectoris (AP).

METHODS

We used cross-sectional data from the first wave of the Longitudinal Ageing Study of India, 2017-18. The sample consists of 59,854 individuals (27, 769 males and 32,085 females) aged 45 years and above. Maximum likelihood binary logistic regression models were employed to examine the associations between morbidities, other covariates (demographic factors, socio-economic factors and behavioral factors) and heart disease and angina.

RESULTS

A proportion of 4.16% older males and 3.55% older females reported the diagnosis of heart diseases. A proportion of 4.69% older males and 7.02% older females had symptom-based angina. The odds of having heart disease were higher among those who were hypertensive and who had family history of heart disease, and it was higher among those whose cholesterol levels were higher. Individuals with hypertension, diabetes, high cholesterol and family history of heart disease were more likely to have angina than their healthy counterparts. The odds of undiagnosed heart disease were lower but the odds of uncontrolled heart disease were higher among those who were hypertensive than non-hypertensive individuals. Those having diabetes were less likely to have undiagnosed heart disease while among the diabetic people the odds of uncontrolled heart disease were higher. Similarly, higher odds were observed among people with high cholesterol, having stroke and also among those who had a history of heart disease than their counterparts.

CONCLUSIONS

The present study provided a comparative prevalence of heart disease and agina and their associations with chronic diseases among middle-aged and older adults in India. The higher prevalence of undiagnosed and uncontrolled heart disease and their risk factors among middle-aged and older Indians manisfest alarming public health concerns and future health demand.

Awareness and recommendation of home blood pressure measurement among physicians in India: Results from Asia HBPM survey 2020

BACKGROUND

Awareness of hypertension and blood pressure (BP) control rates are still low in India. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including the prevention of cardiovascular diseases(CVD) and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India.

MATERIALS AND METHODS

As part of Asia HBPM Survey 2020, a cross-sectional survey was conducted among healthcare providers from India between June 2020 to June 2021. The questionnaire consisted of 37 questions and sub-questions related to HBPM awareness and recommendations to patients.

RESULTS

A total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. 31.3% of physicians instruct their patients to measure their BP before taking antihypertensive drugs, while around 30% of physicians gave no instructions. The reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34.4%) and home BP (15.1%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 34.9% of their patients own HBPM device and 30.4% of the patients measure their own BP at home.

CONCLUSION

The survey reveals that HBPM instructions to the patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM use among patients. Clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians.

Aspects of Phage-Based Vaccines for Protein and Epitope Immunization

Because vaccine development is a difficult process, this study reviews aspects of phages as vaccine delivery vehicles through a literature search. The results demonstrated that because phages have adjuvant properties and are safe for humans and animals, they are an excellent vaccine tool for protein and epitope immunization. The phage genome can easily be manipulated to display antigens or create DNA vaccines. Additionally, they are easy to produce on a large scale, which lowers their manufacturing costs. They are stable under various conditions, which can facilitate their transport and storage. However, no medicine regulatory agency has yet authorized phage-based vaccines despite the considerable preclinical data confirming their benefits. The skeptical perspective of phages should be overcome because humans encounter bacteriophages in their environment all the time without suffering adverse effects. The lack of clinical trials, endotoxin contamination, phage composition, and long-term negative effects are some obstacles preventing the development of phage vaccines. However, their prospects should be promising because phages are safe in clinical trials; they have been authorized as a food additive to avoid food contamination and approved for emergency use in phage therapy against difficult-to-treat antibiotic-resistant bacteria. Therefore, this encourages the use of phages in vaccines.

Older PLHIV are at Higher Cardiovascular Risk with Poor Quality of Life

BACKGROUND

People with HIV (PLHIV) face increased cardiovascular disease (CVD) risk due to inflammation and immune activation. Aging further amplifies this risk. Limited data exist on CVD risk in older PLHIV in India despite 2.14 million PLHIV with higher CVD risk factors.

METHODS

In a cross-sectional study in Bihar, India, 73 PLHIV and 30 control participants were enrolled. Demographics, social factors, clinical information, and CVD risk factors were collected. HbA1c levels and lipid profiles were analyzed, and 10-year CVD risk scores were calculated using the Framingham risk score (FRS) and Qrisk3. Quality of life (QoL) was assessed using WHOQOL- HIV-BREF.

RESULTS

Results showed higher LDL levels in non-HIV older participants and higher HDL levels in younger PLHIV participants. BMI differed significantly, with higher BMI in non-HIV older individuals and lower BMI in younger PLHIV individuals. Older PLHIV participants had significantly higher mean FRS and Q-Risk scores compared to older non-PLHIV and younger PLHIV groups. Among older PLHIV participants, six had higher CVD risk per FRS, while none in the other groups were classified as high CVD risk. Psychological, social relations and spirituality domains were highly deteriorated in older PLHIV, scoring 44.48, 42.72, and 41.2, respectively. The physical domain scored 57.6, and the environment scored 52.72 in the WHOQOL-HIV bref.

CONCLUSION

In conclusion, older PLHIV in Bihar, India, face higher CVD risk compared to younger PLHIV and non-HIV individuals. FRS and Q-Risk scores effectively assessed CVD risk, identifying higher risk in older PLHIV. Age and BMI were significant predictors of high CVD risk. These findings emphasize CVD risk assessment and tailored management for older PLHIV. The QoL assessment findings indicate moderate deterioration in psychological, social relations, and spirituality domains among older PLHIV individuals. These results suggest greater challenges in psychological well-being, social interactions, and spirituality compared to the overall sample. Further research with larger samples and longitudinal designs is needed to confirm and extend these findings.

Circulatory T-cadherin is a potential biomarker for atherosclerosis

T-cadherin, a special member of cadherin family, expresses with blood circulation involving the heart i.e. CVS. Cadherin is connected with the healthy conditions of an individual and normal functioning of cardio-vascular metabolism. T-cadherin is mainly associated with blood vascular system of human. Previous studies analysed this cadherin been unexpressed within the fat storing tissues i.e. adipose tissue of peri-aortic and peri-coronary, it is present within endothelium as well as in vascularized smooth muscular cells which includes the area nearby coronary vessels and aorta. The area and site of this cadherin is attention-grabbing because it particularly related to atherosclerosis and cardiovascular disease (CVD). T-cadherin - a protein acting as the receptor for low density lipoproteins (LDL). It may act as a special biomarker for atherosclerosis. Previous studies on T-cadherin showed that it has cardio-protective role. Furthermore, research is essential to enumerate the cardio-protective function of T-cadherin. It can be an important therapeutic target in developing new medicine to decrease incident of heart disease and its complications.

Determinants of Adherence to Antihypertensives Among Elderly: A Multifactorial Concern

PURPOSE

The aim of the study was to assess the predictors of adherence among elderly on antihypertensives and to examine the difference in adherence among males and females.

PATIENTS AND METHODS

Cross-sectional survey design was adopted for the study. The data were collected from 800 patients of age 60 years and above using demographic proforma, clinical proforma and Morisky Medication Adherence Scale (MMAS-8) with due approval from the institutional ethical clearance committee and written informed consent from the participants.

RESULTS

The findings revealed no significant difference in the non-adherence rates among males and females. Number of medications was identified as the major predictor of adherence.

CONCLUSION

Awareness of factors influencing medication adherence is crucial for health professionals to provide appropriate advice for patients to maintain quality health. The findings of the study highlight the importance of nurses' role towards imparting knowledge on hypertension and emphasizing on the importance of adherence to antihypertensives among elderly.