Emerging risk factors for cardiovascular diseases: Indian context

Regional and socio-demographic variation in laboratory-based predictions of 10-year cardiovascular disease risk among adults in north and south India

OBJECTIVE

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in India. There is no laboratory-based CVD risk data among Indians from different regions and backgrounds. This study estimated laboratory-based 10-year CVD risk across different population sub-groups.

METHODS

Data from UDAY derived from cross-sectional surveys of rural and urban populations of northern (Haryana) and southern (Andhra Pradesh) India were analysed. World Health Organization/International Society of Hypertension laboratory-based equations calculated 10-year CVD risk among participants without CVD history. Wilcoxon rank sum test analyzed average CVD risk across subgroups. Chi-square test compared population proportions in different CVD risk categories. Regression analysis assessed the association between CVD risk and participant characteristics.

RESULTS

The mean (SD) age of the participants (n = 8448) was 53.2 (9.2) years. Males in Haryana had increased CVD risk compared to those in Andhra Pradesh (p < 0.01). In both states, female gender was shown to have a protective effect on CVD risk (p < 0.01). Age correlated with increased risk (p < 0.01). Education level did not affect CVD risk however employment status may have. Hypertension, diabetes, hyperlipidemia, smoking, and insufficient exercise were associated with increased CVD risk (p < 0.01). Residence (urban versus rural) and wealth index did not largely affect CVD risk.

CONCLUSION

Minor differences exist in the distribution of laboratory-based CVD risk across Indian population cohorts. CVD risk was similar in urban wealthy participants and rural poor and working-class communities in northern and southern India. Public health efforts need to target all major segments of the Indian population to curb the CVD epidemic.

Prevalence and clustering of cardiovascular risk factors among resident of coastal areas in Qinzhou, Guangxi, China

OBJECTIVE

We aimed to estimate the prevalence of CRFs and investigate its associated social-economic factors among adults in coastal areas of Qinzhou, Guangxi.

METHODS

A representative sample of 1836 participants aged 20 to 70 years was included in Qinzhou, Guangxi in 2020. Data were collected by the questionnaire, anthropometric and laboratory measurements. The prevalence of CRFs, including hypertension, dyslipidemia, diabetes, overweight or obesity, alcohol consumption, and smoking were calculated by standardization. The multivariate logistic regression analysis was performed to explore the independent factors associated with the presence of CRFs.

RESULTS

The age-standardized prevalence of hypertension, dyslipidemia, diabetes, overweight or obesity alcohol consumption, and smoking was 42.7%, 39.5%, 0.9%, 38.5%, 18.4% and 15.7%, respectively. The prevalence of clustering of at least one and at least two cardiovascular disease risk factors were 82.2% and 45.3% in total. There were differences in the aggregation of cardiovascular risk factors among different age, education, and income levels. There appeared higher clustering of at least one and at least two CRFs among adults with lower education level, higher income level and those elderly.

CONCLUSIONS

Compared with other regions in China, a higher prevalence of CRFs exists among adults in Guangxi and several social-economic factors were associated with the presence of CRFs. These findings suggest that we should implement effective measures to control the CRFs, to reduce the risk of cardiovascular disease in adults.

Burden of COVID-19 infection and lockdown measures on individuals with chronic diseases in Saudi Arabia: A national population-based study

BACKGROUND

The recent COVID-19 crisis has placed a huge strain on the global health and economy. The toll of the damage on the human society exceeds the morbidity and mortality of the pandemic and the associated burden, considering the multidimensional impact on all aspects of life.

OBJECTIVES

The present study assessed the specific impact of COVID-19 on individuals with chronic diseases including the Years Lost for Disability (YLD) burden of COVID-19 infection, and multidimensional impact on the disease management, adaptive lifestyle, and socioeconomic dimensions.

METHOD

A national, population-based cross-sectional study was conducted among adult Saudi population. An internet-based questionnaire was used to collect sociodemographic characteristics, medical history, impact of COVID-19 lockdown on the management of the chronic disease, adaptive lifestyle, and impact of COVID-19 on family members. Additionally, data regarding eventual COVID-19 infection, severity and management were collected. YLD was estimated and normalized per 100,000 persons.

RESULT

Having a chronic disease was not associated with a greater risk of COVID-19 (relative risk [RR]=0.83, p = 0.153); however, it was associated with higher risk of declined physical activity (RR=1.30, p < 0.0001), deteriorated eating habit (RR=1.20, p = 0.002), sleep quality (RR=1.25, p < 0.0001), and overall health perception (RR=1.61, p < 0.0001), loss of family members due to COVID-19 (RR=1.96, p = 0.0001), and impacted household income (RR=1.11, p = 0.010). In case of COVID-19 infection, having a chronic disease was associated with increased risk of hospitalization (RR=5.04, p = 0.005) and having a moderate-to-severe form of COVID-19 (RR=6.00, p = 0.013). The overall YLD was estimated to be 17.7 per 100,000 individuals, and there was no significant difference between individuals with chronic diseases and those without.

CONCLUSION

COVID-19 entailed a substantial burden on the Saudi society in 2020, and individuals with preexisting chronic diseases suffered more important multidimensional impact, which need further research to assess the real impact of the pandemic and draw the pertinent lessons from the experience for future possible epidemics.

Exploring barriers of quitting smokeless tobacco among coronary artery disease patients of India: A qualitative study

BACKGROUND

Cessation of all forms of tobacco is necessary for controlling mortality associated with coronary artery diseases (CADs). In India, smokeless tobacco (SLT) is the most used form of tobacco. With around 60% of the world's smokeless tobacco users living in India, the task of tobacco cessation has become daunting and complicated for Indian researchers and policy makers.

OBJECTIVE

We conducted the present study to understand CAD patients' perspectives towards their SLT use and to identify barriers of SLT cessation.

METHODS

Using a semi-structured interview method, we obtained data from 12 CAD patients who were currently using some form of SLT.

RESULTS

Thematic analysis suggests that CAD patients were unable to quit SLT addiction due to (a) certain socio-environmental factors that support SLT, (b) prevalence of misconceptions about the link between SLT use and their cardiac condition, (c) perceived lower self-efficacy to quit, (d) fatalistic attitude towards health outcomes and (e) substituting addiction with perceived lesser harmful products.

DISCUSSION

The findings reveal that factors responsible for the continuation of SLT usage are multipronged. Current SLT users' perspectives can facilitate the development of effective intervention and rehabilitation programs aimed at de-addiction of cardiac patients.

Assessment of Drug Related Problems and Pharmacist Interventions in Inpatients with Cardiovascular Disease

Aim. To identify and evaluate the nature and incidence of drug-related problems (DRPs) and to manifest the role of a pharmacist in ensuring safe and efficient use of medications with cardiovascular disease patients by using PCNE Classification to assess and report drug-related problems.Material and Methods. An Observational and Prospective study was conducted in a tertiary care hospital of medicine department of general and intensive/critical care units for a period of 6 months to identify and evaluate the nature and incidence of DRP’s and to manifest the role of a pharmacist in ensuring safe and efficient use of medications with cardiovascular disease patients by using PCNE Classification to assess and report drug-related problems.Results. Of 94 Patient profiles were evaluated out of which 78 (82.9%) patient profiles were identified with 208 DRPs. Among 208, 140 (67.3%) drug interactions, 15 (7.2%) untreated indication, 12 (5.8%) adverse drug reactions, 10 (4.8%) drug use without indication, 8 (3.8%) drug underused, 8 (3.8%) duration of treatment too short, 5 (2.4%) dose unclear, 4 (1.9%) inappropriate drug form, 3 (1.4%) duration of treatment too long, 2 (1.0%) too many drugs prescribed for an indication, 1 (0.5%) drug overused. For 208 DRPs identified and provided with 74 interventions which includes 30 (41.6%) drug discontinuation, 24 (33.3%) addition of a new drug, 4 (5.55%) change of dosage form, and 14 (19.4%) decrease the dose.Conclusion. The present study revealed that patients with cardiovascular diseases suffer from numerous DRPs that can be identified, resolved, or prevented to some extent by pharmacist intervention. Hence the study addresses the importance of clinical pharmacist in the management of DRPs among cardiovascular patients.

Association of Low-Density Lipoprotein-Cholesterol and Its Small, Dense Phenotype with Six-Month Cardiovascular Morbidity

BACKGROUND

Globally, cardiovascular diseases (CVDs) are the leading cause of death and disability. Elevated low-density lipoprotein-cholesterol (LDL-C) and more specifically, elevation of its small, dense phenotype (sdLDL-C) has been regarded as the key modifiable risk factors associated with atherogenesis. This study aimed to determine the association of LDL-C and sdLDL-C with the development of CVDs in the next six months to establish their predictive efficacy.

METHODS

A batch of 162 anonymized serum samples sent for analysis of lipid profile parameters, were classified into tests and controls based on the calculated LDL-C values obtained by Fried Ewald formula. Direct LDL-C was also estimated automatically using assay kits. Using the formula provided by Srisawasdi et al., sdLDL-C was then computed for all samples. Six months later, samples were deanonymized, and the lipid profiles were compared with cardiovascular outcomes of these patients, to determine which parameter had the greatest correlation.

RESULTS

Four control group patients and three test group patients developed the outcome (any cardiovascular event) during the 6-month follow-up period. Binary logistic regression analysis showed that none of the lipid profile parameters: calculated LDL-C (OR= 0.99; 95% CI= 0.97-1.01; p= 0.826), direct LDL-C (OR= 0.99; 95% CI= 0.97-1.01; p= 0.818) or sdLDL-C (OR= 0.99; 95% CI= 0.93-1.04; p= 0.734), were significantly associated with the occurrence of outcome. The median % sdLDL-C both with respect to direct and calculated LDL-C was slightly higher in patients with the outcome.

CONCLUSION

The levels of LDL-C or its individual phenotypes may not be used singly as indicator of cardiovascular morbidity in the next six months.

Safety profile of adenosine stress cardiac MRI in a tertiary hospital in India

Background:

Coronary artery disease (CAD) is a major cause of morbidity and mortality in India. Stress Cardiac Magnetic Resonance (CMR) using vasodilator agent is well established in assessing the functional significance of CAD. Adenosine is the preferred agent, but can have severe side effects including dyspnoea, chest pain, atrioventricular block or bronchospasm. The stress CMR examination is not routinely performed in many of the clinical imaging departments in India.

Objective:

The aim of this study was to establish safety of adenosine as a pharmacological stressor agent for CMR in a tertiary care radiology department in India.

Methods:

A review of all patients undergoing stress CMR in our institution from May 2018 to May 2019 was made. Records were reviewed to collect response parameters and documented adverse reactions.

Results:

A total of 1057 patients underwent stress CMR during this period. No death, myocardial infarction or atrio-ventricular block related complications were seen. Transient hypotension was seen in 20 patients (1.8') with spontaneous recovery after stopping infusion. Chest pain and breathlessness severe enough to discontinue the scan were seen in 6 (0.5') and 10 (0.9') patients, respectively. All patients with breathlessness recovered on low flow oxygen therapy with three requiring bronchodilator. Out of six patients with chest pain, three had immediate relief with sublingual nitroglycerin, and three required hospital admission for unstable angina. Of the latter three, 1 underwent revascularization on the same day and other two later in the week.

Conclusion:

Stress CMR using adenosine in appropriately selected patients is a highly safe procedure with significant side effects seen in less than 1’ of patients. Therefore, it is safe to perform stress CMR studies in a fully equipped and well-trained radiology department in India.

The association of food quality score and cardiovascular diseases risk factors among women: A cross-sectional study

Introduction: Limited studies are available regarding the relationship between Food Quality Score (FQS) and cardiovascular disease (CVD) risk factors. Thus, this study was aimed to investigate the association of FQS with CVD risk factors in women.

Methods: This cross-sectional study was carried out among 368 women aged 20-50 years who randomly selected from health centers across Tehran, Iran. Dietary intake was collected using a reliable and validated food frequency questionnaire (FFQ). The FQS includes vegetables, fruits, whole grains, yogurt, nuts and legumes, coffee, refined grains, desserts and ice cream, sugar-sweetened beverages, red meats, fried food consumed outside the home, processed meats, potato and potato chips. Standard methods were used to assess blood pressure, biochemical and anthropometric measures. Multivariate logistic regression was used to examine the association between FQS and CVD risk factors.

Results: Participant mean age and body mass index (BMI) were 30.7 ± 6.9 years and 24.3 ± 4.0 kg/m2, respectively. After taking potential confounders into account, FQS had no significant association with risk of overweight and obesity [Odds ratio (OR): 1.1, 95% confidence interval (CI): 0.68, 1.8; P = 0.683], diabetes (OR: 0.62, 95% CI: 0.22, 1.74; P = 0.374), metabolic syndrome (OR: 0.36, 95% CI: 0.10, 1.32; P = 0.127), hypercholesterolemia (OR: 0.54, 95% CI: 0.29, 1.01; P= 0.051), or hypertriglyceridemia (OR: 1.63, 95% CI: 0.71, 3.70; P = 0.244).

Conclusion: The results showed that FQS was not significantly associated with CVD risk factors among women. Prospective cohort studies are warranted to confirm our findings.

Adjuvant chemotherapy in stage II-III operated colon cancer patients from a nontrial cohort in a low colon cancer prevalence country with predominant use of modified CAPOX

BACKGROUND

Data regarding the practice of adjuvant chemotherapy, specifically with modified CAPOX, and survival outcomes in operated colon cancer patients from a nontrial cohort in a lower-middle income and low prevalence nation like India is scarce.

MATERIALS AND METHODS

Patients who underwent upfront curative resection for colon cancer from January 2013 to December 2016 were analyzed for baseline variables and outcomes.

RESULTS

A total of 491 patients underwent curative resection in the predefined time period. The median age of the patients was 53 years (range: 17-87). Patients with Stage I, Stage II, and Stage III disease comprised 7.9%, 44.8%, and 45.4% of the entire cohort, respectively. Patients with Stage I cancer were observed. Adjuvant chemotherapy was planned for 384 patients (78.2%), with the doublet regimens (capecitabine-oxaliplatin, or 5-fluorouracil-oxaliplatin) being used commonly (77.6%). Common toxicities were Hand-foot syndrome (Grade 2/3 - 21.4%) and peripheral neuropathy (Grade 2/3 - 20.1%). About 85% of patients receiving monotherapy (capecitabine or 5 fluorouracil) and 81.2% of patients receiving doublet chemotherapy (mCAPOX or modified FOLFOX-7) completed their planned adjuvant treatment. With a median follow-up of 22 months, estimated 3 years event-free survival was 86%, and overall survival (OS) was 93.6%. Stage, younger age (<50 years), underlying cardiovascular abnormalities, need for dose reductions and noncompletion of planned chemotherapy predicted for inferior estimated 3-year OS on multivariate analysis.

CONCLUSIONS

Adjuvant chemotherapy especially with modified CAPOX appears well tolerated in the Indian population and early survival outcomes appear to be comparable to published literature.

Is lipid goal one-size-fits-all: A review of evidence for recommended low-density lipoprotein treatment targets in Asian patients

The international guideline recommendations for low-density lipoprotein cholesterol (LDL-C) lowering were made based on the results of randomized controlled trials (RCTs), meta-analyses, and observational studies mostly in the White population. It was not clear whether these LDL-C targets could be applicable to other ethnic groups, for example, Asian patients. This review aimed to address major aspects related to the lipid goal and statin therapy in Asia, including the epidemiology of cardiovascular disease, the LDL-C profiles, the lipid goals from localized guidelines, genetics and lifestyles, and the efficacy and safety of statins. Owing to the geographic, ethnic, genetic, and cultural diversity in this region, we observed a geographic pattern of diversity in cardiovascular epidemiology and statin response in Central Asia, East Asia (particularly for Asia-Pacific region), and South Asia. The rapidly growing literature from Asian countries questioning "lower is better" hypothesis was noticed. However, owing to the nature of these dominantly observational data, the conclusion was hardly confirmative. Despite the rapid expansion of the current literature in this region, efforts should be made to ensure an adequate sample size to assess the significance of a given lipid parameter on overall cardiovascular outcomes in this Asian population.

Evaluation of cardiovascular risk factors in women referring to health centers in Tabriz, Iran, 2017

Background: Cardiovascular disease (CVD) is the leading cause of mortality among men and women around the world. The aim of this study was to investigate major cardiovascular risk factors in women living in the Tabriz petrochemical region, Iran during spring 2017.

Methods: In this cross-sectional study, a sample of 152 women aged 30-55 years was selected from who attended health center in Tabriz, Iran. Anthropometric measurements, blood pressure,daily dietary intakes and fasting serum lipid profile, oxidized LDL (ox-LDL) and high sensitivity C-reactive protein (hs-CRP) were evaluated.

Results: The prevalence of overweight, general and abdominal obesity (based on Body mass index [BMI] and waist circumference [WC]) was 34.2%, 52.6%, and 73.7%, respectively. Eleven point two percent and 4.6% of women had pre-hypertension based on systolic blood pressure (SBP)and diastolic blood pressure (DBP). High serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C)were determined in 32.5%, 25.7%, 17.8% and 56.6% of subjects, respectively. The median of serum ox-LDL concentration was 3181.5 ng/L. Sixty-five point eight percent of participants hadhigh hs-CRP levels. In the multiple-adjusted quintile regression analysis, significant relationships were found between serum ox-LDL and age (B = 96.7, P = 0.003) and between serum hs-CRP with diastolic blood pressure (B = 0.1, P = 0.083) and TG (B = 0.01, P = 0.088).

Conclusion: The high prevalence of cardiovascular risk factors in the studied women warrants more public health attention. The results also suggest that aging was associated with high serumox-LDL and increased serum hs-CRP levels, which may reflect enhanced DBP and serum TG.

Cardiovascular Risk and Neurocognitive Assessment in Young Adults and Their Relationship to Body Adiposity

BACKGROUND We assessed body composition, adiposity, cardiovascular risk, and cognitive functions in healthy young adult females and investigated the possible correlation between neurocognitive decline, adiposity, and cardiovascular risk markers. MATERIAL AND METHODS This cross-sectional study was conducted on 83 healthy, young adult, Saudi women (age 19-23 years). Subjects were classified into group (A) with 19 non-obese subjects and negative family history (FH) of cardiovascular diseases (CVD), group (B) with 38 non-obese subjects with a positive FH of CVD, and group (C) with 18 obese subjects with positive FH of CVD. Body composition was analyzed by bioelectrical impedance analysis. Cognitive functions were evaluated using the Cambridge Neuropsychological Automated Battery (CANTAB). The blood samples were tested for lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive Protein (hs-CRP). RESULTS There was significantly prolonged Attention-Switching Task (AST) latency in obese subjects with negative family history of CVD (p=0.014) and those with positive family history of CVD (p=0.026) compared to controls, but the difference in AST Percent Correct Trials, Intra-Extra Dimensional Set Shift (IED) Total Errors, and Simple Reaction Time (SRT) was not significant. Simple response time had a weak but significant inverse correlation with BMI (r=-0.227, p<0.05). BMI was correlated positively with Lp(a) and hs-CRP, while BF% was correlated with hs-CRP only. No correlation was observed between the CANTAB tests, Lp(a), and hs-CRP. CONCLUSIONS Cardiovascular risk increases with higher adiposity and the presence of a positive family history of cardiovascular disease. Neurocognitive function may decline with higher adiposity; however, no relationship was observed between neurocognitive functions and cardiovascular risk markers.

Prevalence and clustering of cardiovascular risk factors: a cross-sectional survey among Nanjing adults in China

OBJECTIVES

To estimate prevalence and clustering of cardiovascular risk factors (CRFs), and investigate the association between relevant characteristics and CRF clustering among adults in eastern China.

DESIGN

Community-based cross-sectional study.

SETTING

Data were collected by interview survey, physical measurements and laboratory examinations from the 2011 Nanjing Chronic Disease and Risk Factor Surveillance.

PARTICIPANTS

A representative sample of 41 072 residents aged ≥18 years volunteered to participate in the survey, with a response rate of 91.3%. We excluded 1232 subjects due to missing data or having a history of cardiovascular diseases; a total of 39 840 participants were included in the analysis.

OUTCOME MEASURES

Prevalence and clustering of five major CRFs including hypertension, diabetes, dyslipidaemia, overweight or obesity and current smoking.

RESULTS

Of 39 840 participants (mean age 47.9±16.2 years), 17 964 (45.1%) were men and 21 876 (54.9%) were women. The weighted prevalence of CRFs ranged between 6.2% for diabetes and 35.6% for overweight or obesity. The proportion of CRFs tended to be higher in men, the elderly, participants who lost a life partner, or lived in rural areas, or had lower level of education and total annual income. Overall, 30.1% and 35.2% of participants had one and at least two CRFs, respectively. Multivariate logistic regression revealed that men, older age, loss of a life partner, lower level of socioeconomic status, rural areas, insufficient physical activity or unhealthy diets were positively associated with CVD risk factor clustering, compared with their counterparts.

CONCLUSIONS

High regional prevalence of hypertension, dyslipidaemia, overweight or obesity and their clustering are present in Nanjing. The Nanjing government should develop effective public health policies at the regional level especially for high-risk groups, such as enhancing the public's health awareness, organising health promotion programmes, implementing smoke-free law, producing healthy nutrient foods, providing free or low-cost public sports and fitness facilities.

Tolerance and adverse event profile with sorafenib in Indian patients with advanced hepatocellular carcinoma

Background

The current standard of treatment for advanced hepatocellular cancer Hepatocellular carcinoma (HCC) is Sorafenib. Data regarding its tolerance and adverse event profile in Indian patients is scarce.

Materials and Methods

The primary aim of this analysis was to assess the adverse events (Grade 3 and Grade 4 as per CTCAE v4.0) and requirements for dose reduction with sorafenib in advanced HCC. Details of consecutive patients started on 800 mg/day dosing were obtained from a prospectively maintained database (over a period of 6 months) and analyzed.

Results

Thirty-nine patients were available for inclusion in the study. Median age was 58 years (range: 20-75). All patients were classified as Barcelona clinic liver cancer C. Common side effects seen were liver dysfunction (38.5%), hand-foot-syndrome-rash (HFSR) (Grade 2 and 3-25.6%), fatigue (Grade 2 and Grade 3-10.3%), and diarrhea (7.7%). Dose reduction was required in 43.6% of patients. Drug interruptions/cessation was required in 38.5% of patients within the first four months of treatment. Nearly 41% of patients required cessation of sorafenib due to intolerable side-effects while 28.2% stopped sorafenib due to progressive disease. At a median follow-up of 4.9 months, median event-free survival (EFS) was 4.20 months (95% confidence interval: 3.343-5.068).

Conclusion

A higher incidence of liver dysfunction and HFSR is seen in Indian patients as compared to published data. A significant proportion of patients required cessation of sorafenib due to adverse events in our series. However, EFS remains on par with that seen in larger studies with sorafenib in advanced HCC.

Dysregulation of microRNAs and renin-angiotensin system in high salt diet-induced cardiac dysfunction in uninephrectomized rats

Uninephrectomy is not associated with major adverse events in cardiovascular and renal functions of live kidney donors. The effect of high salt diet on the quality of life of live kidney donors is largely unknown. Hence in this study, we aimed to determine the effect of high salt diet on the alterations of renin-angiotensin system and microRNAs leading to CV and renal dysfunction in uninephrectomized rats. In order to mimic clinical scenario, uninephrectomized male Sprague Dawley rats were fed initially with normal pellet diet for 12 weeks and then for 20 weeks with high salt (10% w/w NaCl) diet. At the end of the study, biochemical, functional, histological and molecular parameters were measured. High salt diet feeding resulted in renal dysfunction & fibrosis, decreased baroreflex sensitivity, increased in vivo cardiovascular reactivity to angiotensin II owing to upregulation of angiotensin II type 1 receptors and L-type calcium channels leading to cardiovascular dysfunction in uninephrectomized rats (UNX+HSD) worse than that of normal (binephric) rats fed with high salt diet (HSD). Protein expression of functional and hypertrophic protein markers revealed decreased SERCA, p-AMPK and increased p-AKT. Interestingly, levels of miR-25, miR-451 and miR-155 increased and miR-99 decreased in heart of uninephrectomized rats fed with high salt. However, circulating miR-25 and miR-451 levels decreased and miR-99b increased in these animals. Our study points out that since tissue and circulating levels of miRNAs are not similar, caution must be exercised during the usage of miRs as diagnostic or prognostic biomarkers. To our knowledge, we are the first to show that epigenetic alterations result in cardiac dysfunction in uninephrectomized rats fed with high salt diet.

Patterns of Care and Clinical Outcomes in Patients With Metastatic Renal Cell Carcinoma-Results From a Tertiary Cancer Center in India

INTRODUCTION

The current treatment of metastatic renal cell carcinoma (mRCC) revolves around targeted agents, which have resulted in a median overall survival of 22 to 26 months in registration trials. However, the outcomes in a non-trial, real-world Indian population have not yet been evaluated.

MATERIALS AND METHODS

The present study was a part of a prospective Clinical Trials Registry-India-registered study, the Kidney Cancer Registry, a prospectively maintained kidney cancer registry. The data of patients with a diagnosis of mRCC from February 2007 to August 2015 who were potential candidates for systemic therapy were extracted from the database and analyzed for treatment patterns and outcomes.

RESULTS

The data from 212 patients were eligible for analysis. Of these 212 patients, 204 (96.2%) received first-line systemic treatment with sunitinib (40.6%), sorafenib (37.7%), pazopanib (2.8%), temsirolimus (2.8%), or everolimus (1.9%). The risk status of 91% of the patients could be stratified using the Heng criteria into favorable (18.9%), intermediate (43.9%), and poor risk (28.3%) categories. The response rate, clinical benefit rate, median progression-free survival, and median overall survival with first-line targeted therapy were 22.5%, 60.7%, 7.09 months, and 12.87 months, respectively. The common adverse events seen included skin rash (31.7%), hypertension (29.4%), grade 3 hand-foot syndrome (27.4%), mucositis (26.4%), dyslipidemia (20%), and hyperglycemia (17.6%). Patients receiving second-line therapy (22.6%) had superior overall survival to patients who had not (16.46 vs. 10.67 months; P = .032).

CONCLUSION

The present registry-based study is the first, to the best of our knowledge, of its type from India and showed that the overall outcomes in this real-world cohort appear comparable to non-trial data worldwide. An increased incidence of metabolic adverse events that require monitoring during treatment was also found.

Is the peripheral arterial disease in low risk type 2 diabetic patients influenced by body mass index, lipidemic control, and statins?

Objective:

To correlate BMI, lipidemic control, and statin therapy with PAD measured by ABI in low risk type 2 diabetics.

Materials and Methods:

A sample of 101 nonsmoking, asymptomatic type 2 diabetics (50 males, 51 females) with known glycemic (fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin) and lipidemic (total cholesterol, lipoproteins, and triglycerides [TGAs]) control was taken. Vascular Doppler was used to derive ABI and PAD was defined as ABI <0.9. ABI values were compared amongst groups and P < 0.05 was considered statistically significant.

Results:

We found fairly good lipid but poor glycemic control and prevalence of PAD 30%. There was insignificantly low ABI profile in patient having BMI ≥25, hyperlipidemia and absent statin therapy with odds ratio being highest for TGAs ≥150 (3.23) followed by BMI ≥25 (2.61), high-density lipoprotein ≤50 (1.61), low-density lipoprotein ≥100 (1.20), and disuse of statin (1.14) with significance only for BMI.

Conclusion:

We observed small, insignificant PAD risk by dyslipidemia or non-use of statins in low-risk ambulatory T2DM patients, not so by BMI. This suggests importance of good glycemic control, maintenance of optimum weight, and lifestyle modifications as primary prevention rather than opting for costly and inefficient secondary prevention.

Genetic determinants of lipid-lowering response to atorvastatin therapy in an Indian population

WHAT IS KNOWN AND OBJECTIVE

Statins form the backbone of lipid-lowering therapy for the prevention of cardiovascular disease. However, there is large interindividual variability in clinical response to statin treatment. Several gene variants that can be aligned to either the pharmacokinetics or pharmacodynamics of statin have been proposed as potentially important determinants of statin response. We aimed to study the association of known variations in SLCO1B1, CYP3A4, ABCB1, CYP3A5, ABCG5 and CYP7A1 genes with lipid levels in response to atorvastatin therapy.

METHODS

Genotypes were determined using multiplex allele-specific polymerase chain reaction in 177 Indian patients, treated with 10 mg of atorvastatin for 8 weeks. Low-density lipoprotein-cholesterol (LDL-C) levels were recorded at baseline and after 8 weeks of atorvastatin treatment.

RESULTS AND DISCUSSION

A total of 177 hypercholesterolaemic patients were genotyped to study genetic determinants of atorvastatin response. The genotype distribution for all polymorphisms investigated was in Hardy-Weinberg equilibrium. In our study, patients with wild-type genotypes of CYP7A1 (rs3808607), CYP3A4 (rs2740574), SLCO1B1 (rs2306283) and variant allele-carrying genotype of ABCB1 (rs2032582, rs1045642) showed significantly greater LDL-cholesterol reductions in response to atorvastatin therapy.

WHAT IS NEW AND CONCLUSION

The variable response to atorvastatin therapy in terms of LDL-cholesterol lowering due to genetic variations in CYP7A1, CYP3A4, SLCO1B1 and ABCB1 is a promising finding. Further validation in large Indian cohorts is required before it can be assessed for clinical utility.

Cardiovascular Risk in Men Aged Over 40 in Boa Vista, Brazil

Background:

Cardiovascular disease is the most common cause of disease in the developed world. Early detection and risk prediction are a key component in reducing cardiovascular mortality. The Framingham Risk Score uses age, sex, cholesterol, blood pressure, diabetes, and smoking to calculate the 10-year risk probability of developing cardiovascular disease for a given patient. The aim of this study was to examine cardiovascular disease risk in men aged over 40 years in Boa Vista, Brazil and identify socioeconomic factors contributing to the risk.

Methods:

This was an epidemiological, cross-sectional, descriptive study. Physical examination and questionnaire survey were conducted on the participants.

Results:

Of the 598 participants (average age = 55.38 ± 10.77 years), 346 completed all the examinations and answered the survey, while 252 completed the survey and the physical examinations but did not undertake the laboratory tests. A large proportion of participants were overweight (42.6%) or obese (23.6%), 14.5% were hypertensive, and 71.9% were prehypertensive. Consumption of red meat and junk food was high, while participation in the exercise was low. Framingham scores ranged from −3 to 13 (mean score: 3.86 ± 3.16). A total of 204 participants (34.1%) had a low risk of cardiovascular disease, 98 (16.4%) had a medium risk, and 44 (7.4%) possessed high risk. Increased abdominal circumference (P = 0.013), resting pulse (P = 0.002), and prostate-specific antigen levels (P < 0.001) were associated with increased risk of cardiovascular disease.

Conclusions:

Our study highlights a worrying trend in increasing obesity and hypertension, most likely associated with increasingly poor diet and reduced participation in exercises. As the Brazilian population ages, this will drive increasing rates of cardiovascular mortality unless these trends are reversed. This study suggests that such campaigns should focus on men over the age of 40, who are married or divorced and of lower income.

Evaluation of Endothelial and Platelet Derived Microparticles in Patients with Acute Coronary Syndrome

BACKGROUND

Microparticles (MP) are a nuclear fragments of membrane released by the damaged cell during stress. Elevated levels of MP have been found in patients with acute coronary syndrome (ACS) owing to the damage in the endothelium.

AIM

To determine if the levels of endothelial and platelet microparticles (EMP & PMP) in patients with ACS influenced the severity of the disease.

MATERIALS AND METHODS

This was a prospective cohort study performed in 63 ACS patients (ST elevation myocardial infarction- STEMI-28, non ST elevation myocardial infarction -NSTEMI-35). After obtaining consent, blood samples were collected from the patients and processed by flow cytometry.

RESULTS

The NSTEMI group had higher levels of EMP {792.11(327.59-1661.49) vs 300.35 (176.3-550.46), p=0.001} and PMP {218.87(86.65-439.77) vs 114.45(50.34-196.75), p= 0.007} as compared to the STEMI group. However, it was found that the EMP (r=-0.438, p=0.001) and PMP (r= -0.316, p=0.024) negatively correlated with Global Registry of Acute Coronary Events score (GRACE in-hospital score) for the entire cohort.

CONCLUSION

The levels of microparticles are elevated in ACS patients and may reflect a protective effect in patients with acute coronary syndrome.

Genotyping and meta-analysis of KIF6 Trp719Arg polymorphism in South Indian Coronary Artery Disease patients: A case-control study

The KIF6 719Arg allele is an interesting genomic variant widely screened in various populations and is reported to be associated with the risk of Coronary Artery Disease (CAD) and statin treatment outcome. Recent population based clinical studies and large-scale meta-analyses pondered over the role of 719Arg variant in CAD risk and treatment response. We screened the KIF6 Trp719Arg polymorphism (rs20455) in south Indian CAD patients in a case–control approach. A total of 1042 samples (510 CAD patients and 532 controls) were screened for the KIF6 Trp719Arg SNP by TaqMan SNP genotyping assay, followed by meta-analysis of the genotype data of non-Europeans reports. The 719Arg risk genotype (GG) was observed in 29.6% of CAD cases and in 30.1% of controls with an odds ratio (OR) of 1.07 (95% CI: 0.76–1.50), p value = 0.709. No significant difference in the genotype frequency was observed between CAD and controls in both dominant model (AG + GG vs AA) and allelic model (719Arg vs 719Trp) with an OR of 1.11 (p = 0.491) and 1.03 (p = 0.767), respectively. The covariate analysis indicated that smoking & alcohol consumption increased the risk for MI among CAD patients. Meta-analysis showed that the KIF6 719Arg allele is not associated with CAD risk in both fixed effect (p = 0.515, OR = 1.023, 95% CI = 0.956–1.094) and random effect (p = 0.547, OR = 1.022, 95% CI = 0.953–1.096). The symmetrical shape of the Egger's funnel plots revealed that there is no publication bias. These results suggest that there is no association of KIF6 719Arg allele with CAD risk in South Indian population and the meta-analysis confirms the same among non-European population.

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First study to screen for KIF6Trp719Arg SNP in south Indian population

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KIF6Arg variant is not a risk factor for south Indian CAD patients.

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Meta-analysis showed no association of KIF6Arg allele in non-European CAD populations.

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Smoking and alcoholic status were strong risk factors for MI; whereas KIF6 status is not.

Community health orientation of Indian Journal of Endocrinology and Metabolism: A bibliometric analysis of Indian Journal of Endocrinology and Metabolism

BACKGROUND

Endocrine and metabolic diseases especially diabetes have become focus areas for public health professionals. Indian Journal of Endocrinology and Metabolism (IJEM), a publication of Endocrine Society of India, is a peer-reviewed online journal, which covers technical and clinical studies related to health, ethical and social issues in field of diabetes, endocrinology and metabolism. This bibliometric analysis assesses the journal from a community health perspective.

MATERIALS AND METHODS

Every article published in IJEM over a period of 4 years (2011-2014) was accessed to review coverage of community health in the field of endocrinology.

RESULTS

Seven editorials, 30 review articles, 41 original articles, 12 brief communications, 20 letter to editors, 4 articles on guidelines and 2 in the section "endocrinology and gender" directly or indirectly dealt with community health aspects of endocrinology. Together these amounted to 17% of all articles published through these 4 years. There were 14 articles on general, 60 pertaining to pancreas and diabetes, 10 on thyroid, 7 on pituitary/adrenal/gonads, 21 on obesity and metabolism and 4 on parathyroid and bone; all community medicine related.

CONCLUSION

Community health is an integral part of the modern endocrinology diabetology and metabolism practice and it received adequate journal space during the last 4 years. The coverage is broad based involving all the major endocrine disorders.

Emerging risk biomarkers in cardiovascular diseases and disorders

Present review article highlights various cardiovascular risk prediction biomarkers by incorporating both traditional risk factors to be used as diagnostic markers and recent technologically generated diagnostic and therapeutic markers. This paper explains traditional biomarkers such as lipid profile, glucose, and hormone level and physiological biomarkers based on measurement of levels of important biomolecules such as serum ferritin, triglyceride to HDLp (high density lipoproteins) ratio, lipophorin-cholesterol ratio, lipid-lipophorin ratio, LDL cholesterol level, HDLp and apolipoprotein levels, lipophorins and LTPs ratio, sphingolipids, Omega-3 Index, and ST2 level. In addition, immunohistochemical, oxidative stress, inflammatory, anatomical, imaging, genetic, and therapeutic biomarkers have been explained in detail with their investigational specifications. Many of these biomarkers, alone or in combination, can play important role in prediction of risks, its types, and status of morbidity. As emerging risks are found to be affiliated with minor and microlevel factors and its diagnosis at an earlier stage could find CVD, hence, there is an urgent need of new more authentic, appropriate, and reliable diagnostic and therapeutic markers to confirm disease well in time to start the clinical aid to the patients. Present review aims to discuss new emerging biomarkers that could facilitate more authentic and fast diagnosis of CVDs, HF (heart failures), and various lipid abnormalities and disorders in the future.

Effect of non-surgical periodontal therapy on plasma homocysteine levels in Indian population with chronic periodontitis: a pilot study

AIM

Homocysteine (Hcy) is implicated in the development of cardiovascular diseases (CVD). The effect of periodontal disease and periodontal therapy on plasma Hcy remains controversial. Hence, in this pilot study we assessed the effect of periodontal disease and non-surgical periodontal therapy (NSPT) on plasma Hcy in systemically healthy Indian subjects.

MATERIALS AND METHODS

Forty participants (30 to 39 years) were enrolled in the study and were divided into two groups based on gingival index, probing depth, and clinical attachment level (CAL): Healthy (control group; n = 20) and Chronic Periodontitis (test group; n = 20). Plasma samples were collected and quantified at baseline and 12 weeks after scaling and root planing (SRP) for Hcy using High Performance Liquid Chromatography with fluorescent detection (HPLC-fld).

RESULTS

Plasma Hcy levels of chronic periodontitis (17.87 ± 1.21 μmol/l) subjects was significantly higher than healthy subjects (9.09 ± 2.11 μmol/l). Post-therapy, the plasma Hcy concentration reduced significantly (11.34 ± 1.87 μmol/l) (p < 0.05).

CONCLUSION

The rise and descent of plasma Hcy levels with periodontal inflammation and therapy, respectively, indicate a direct relationship of Hcy with chronic periodontitis. NSPT may be employed as an adjunctive Hcy Lowering Therapy, contributing towards primary prevention against CVD's.

The effects of the modulation of NMDA receptors by homocysteine thiolactone and dizocilpine on cardiodynamics and oxidative stress in isolated rat heart

In light of the limited data concerning the role of N-methyl-D-aspartate (NMDA) receptors in cardiac function, the aim of the present study was to determine the role of NMDA receptors in cardiac function, as well as the possible role played by the oxidative stress induced by the overstimulation of NMDA receptors in isolated rat heart. The hearts of male, Wistar albino rats (n = 24, 12 in each experimental group, BM 180-200 g) were retrogradely perfused at a constant perfusion pressure (70 cm H₂O₂), using the Langendorff technique, and cardiodynamic parameters were determined during the subsequent administration of DL-homocysteine thiolactone (DL-Hcy TLHC) alone, the combination of DL-Hcy TLHC and dizocilpine (MK-801), and MK-801 alone. In the second experimental group, the order of the administration of each of the substances was reversed. The oxidative stress biomarkers, including thiobarbituric acid reactive substances (TBARS), NO(2)(-), O(2)(-) and H₂O₂, were each determined spectrophotometrically. DL-Hcy TLHC and MK-801 depressed cardiac function. DL-Hcy TLHC decreased oxidative stress, a finding that contrasted with the results of the experiments in which MK-801 was administered first. The findings of this study were suggestive of the likely role played by NMDA receptors in the regulation of cardiac function and coronary circulation in isolated rat heart.

Low-density lipoprotein electronegativity is a novel cardiometabolic risk factor

BACKGROUND

Low-density lipoprotein (LDL) plays a central role in cardiovascular disease (CVD) development. In LDL chromatographically resolved according to charge, the most electronegative subfraction-L5-is the only subfraction that induces atherogenic responses in cultured vascular cells. Furthermore, increasing evidence has shown that plasma L5 levels are elevated in individuals with high cardiovascular risk. We hypothesized that LDL electronegativity is a novel index for predicting CVD.

METHODS

In 30 asymptomatic individuals with metabolic syndrome (MetS) and 27 healthy control subjects, we examined correlations between plasma L5 levels and the number of MetS criteria fulfilled, CVD risk factors, and CVD risk according to the Framingham risk score.

RESULTS

L5 levels were significantly higher in MetS subjects than in control subjects (21.9±18.7 mg/dL vs. 11.2±10.7 mg/dL, P:0.01). The Jonckheere trend test revealed that the percent L5 of total LDL (L5%) and L5 concentration increased with the number of MetS criteria (P<0.001). L5% correlated with classic CVD risk factors, including waist circumference, body mass index, waist-to-height ratio, smoking status, blood pressure, and levels of fasting plasma glucose, triglyceride, and high-density lipoprotein. Stepwise regression analysis revealed that fasting plasma glucose level and body mass index contributed to 28% of L5% variance. The L5 concentration was associated with CVD risk and contributed to 11% of 30-year general CVD risk variance when controlling the variance of waist circumference.

CONCLUSION

Our findings show that LDL electronegativity was associated with multiple CVD risk factors and CVD risk, suggesting that the LDL electronegativity index may have the potential to be a novel index for predicting CVD. Large-scale clinical trials are warranted to test the reliability of this hypothesis and the clinical importance of the LDL electronegativity index.

Prevalence and clustering of cardiovascular risk factors in adults in Northeast China

AIMS

To estimate the prevalence and clustering of major cardiovascular risk factors in adults in Northeast China.

METHODS

In total, 37 141 individuals undergoing a health screening programme at the International Health Promotion Center at the 1st Hospital of Jilin University were enrolled. Height, weight, blood pressure, fasting serum glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein and low-density lipoprotein were recorded.

RESULTS

Compared with women, the age-standardised prevalence of overweight (44.0% vs 25.0%) and obesity (20.2% vs 7.1%), hypertension (33.7% vs 19.3%), dyslipidaemia (63.8% vs 42.3%), impaired fasting glucose (5.1% vs 4.2%) and diabetes mellitus (8.1% vs 3.5%) was higher in men. Overall, 69.1%, 32.7% and 10.0% of participants had ≥1, ≥2 and ≥3 major cardiovascular risk factors, respectively (obesity, hypertension, dyslipidaemia, diabetes mellitus). For men, the figures were 79.2%, 41.1% and 13.3%, respectively, and for women 53.4%, 19.8% and 5.0%, respectively. With increasing age and increasing body mass index, the prevalence of clustering of cardiovascular risk factors increased in both men and women.

CONCLUSIONS

There is a high prevalence of cardiovascular risk factors in adults in Northeast China: one out of three has at least two risk factors. Prevalence was higher in men than in women. Clustering of risk factors is more common with increasing age and body mass index in both men and women. Prevention of the development of risk factors should be an extremely high priority in this region.