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Chugh PK, Gupta P, Wasan H, Tripathi CD, Chandy SJ, Ranjalkar J, Bright HR, Badyal DK, Samuel MP, Jhaj R, Banerjee A, Joshi R, Medhi B, Prakash A, Kamat S, Tripathi R, Shetty Y, Parmar U, Dikshit H, Mishra H, Roy SS, Kumar R, Chatterjee S, Bhattacharya M, Samanta K, Trivedi N, Shah P, Chauhan J, Ramasamy R, Mathaiyan J, Gauthaman J, Kaushal S, Jain S, Arora S, Gupta K, Cherian JJ, Chatterjee NS, Kshirsagar NA. Prescription-based cost analysis of medicines for cardiovascular risk factors at Indian Council of Medical Research-Rational Use of Medicine Centre Hospitals of India. Indian J Pharmacol 2024; 56:97-104. [PMID: 38687313 PMCID: PMC11161000 DOI: 10.4103/ijp.ijp_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 11/10/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES India has taken several initiatives to provide health care to its population while keeping the related expenditure minimum. Since cardiovascular diseases are the most prevalent chronic conditions, in the present study, we aimed to analyze the difference in prices of medicines prescribed for three cardiovascular risk factors, based on (a) listed and not listed in the National List of Essential Medicines (NLEM) and (b) generic and branded drugs. MATERIALS AND METHODS Outpatient prescriptions for diabetes mellitus, hypertension, and dyslipidemia were retrospectively analyzed from 12 tertiary centers. The prices of medicines prescribed were compared based on presence or absence in NLEM India-2015 and prescribing by generic versus brand name. The price was standardized and presented as average price per medicine per year for a given medicine. The results are presented in Indian rupee (INR) and as median (range). RESULTS Of the 4,736 prescriptions collected, 843 contained oral antidiabetic, antihypertensive, and/or hypolipidemic medicines. The price per medicine per year for NLEM oral antidiabetics was INR 2849 (2593-3104) and for non-NLEM was INR 5343 (2964-14364). It was INR 806 (243-2132) for generic and INR 3809 (1968-14364) for branded antidiabetics. Antihypertensives and hypolipidemics followed the trend. The price of branded non-NLEM medicines was 5-22 times higher compared to generic NLEM which, for a population of 1.37 billion, would translate to a potential saving of 346.8 billion INR for statins. The variability was significant for sulfonylureas, angiotensin receptor blockers, beta-blockers, diuretics, and statins (P < 0.0001). CONCLUSION The study highlights an urgent need for intervention to actualize the maximum benefit of government policies and minimize the out-of-pocket expenditure on medicines.
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Affiliation(s)
- Preeta Kaur Chugh
- Department of Pharmacology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pooja Gupta
- Department of Pharmacology, AIIMS, New Delhi, India
| | - Himika Wasan
- Department of Pharmacology, AIIMS, New Delhi, India
| | - C. D. Tripathi
- Department of Pharmacology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Sujith J. Chandy
- Department of Pharmacology and Clinical Pharmacology, CMC, Vellore, Tamil Nadu, India
| | - Jaya Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, CMC, Vellore, Tamil Nadu, India
| | - Heber Rew Bright
- Department of Pharmacology and Clinical Pharmacology, CMC, Vellore, Tamil Nadu, India
| | | | | | - Ratinder Jhaj
- Department of Pharmacology, AIIMS, Bhopal, Madhya Pradesh, India
| | - Aditya Banerjee
- Department of Pharmacology, AIIMS, Bhopal, Madhya Pradesh, India
| | - Rupa Joshi
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Ajay Prakash
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Sandhya Kamat
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Raakhi Tripathi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Yashashri Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Urwashi Parmar
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Hitesh Mishra
- Department of Pharmacology, IGIMS, Patna, Bihar, India
| | | | - Rajiv Kumar
- Department of Pharmacology, IGIMS, Patna, Bihar, India
| | - Suparna Chatterjee
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Manjari Bhattacharya
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Kalyan Samanta
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Niyati Trivedi
- Department of Pharmacology, Medical College and SSG Hospital, Vadodara, Gujarat, India
| | - Prashant Shah
- Department of Pharmacology, Medical College and SSG Hospital, Vadodara, Gujarat, India
| | - Janki Chauhan
- Department of Pharmacology, Medical College and SSG Hospital, Vadodara, Gujarat, India
| | | | | | | | | | - Samriti Jain
- Department of Pharmacology, DMCH, Ludhiana, Punjab, India
| | - Shalini Arora
- Department of Pharmacology, DMCH, Ludhiana, Punjab, India
| | - Kanchan Gupta
- Department of Pharmacology, DMCH, Ludhiana, Punjab, India
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Jalepalli SK, Gupta P, Dekker ALAJ, Bermejo I, Kar S. Development and validation of multicentre study on novel Artificial Intelligence-based Cardiovascular Risk Score (AICVD). Fam Med Community Health 2024; 12:e002340. [PMID: 38238156 PMCID: PMC10806469 DOI: 10.1136/fmch-2023-002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Cardiovascular diseases (CVD) are one of the most prevalent diseases in India amounting for nearly 30% of total deaths. A dearth of research on CVD risk scores in Indian population, limited performance of conventional risk scores and inability to reproduce the initial accuracies in randomised clinical trials has led to this study on large-scale patient data. The objective is to develop an Artificial Intelligence-based Risk Score (AICVD) to predict CVD event (eg, acute myocardial infarction/acute coronary syndrome) in the next 10 years and compare the model with the Framingham Heart Risk Score (FHRS) and QRisk3. METHODS Our study included 31 599 participants aged 18-91 years from 2009 to 2018 in six Apollo Hospitals in India. A multistep risk factors selection process using Spearman correlation coefficient and propensity score matching yielded 21 risk factors. A deep learning hazards model was built on risk factors to predict event occurrence (classification) and time to event (hazards model) using multilayered neural network. Further, the model was validated with independent retrospective cohorts of participants from India and the Netherlands and compared with FHRS and QRisk3. RESULTS The deep learning hazards model had a good performance (area under the curve (AUC) 0.853). Validation and comparative results showed AUCs between 0.84 and 0.92 with better positive likelihood ratio (AICVD -6.16 to FHRS -2.24 and QRisk3 -1.16) and accuracy (AICVD -80.15% to FHRS 59.71% and QRisk3 51.57%). In the Netherlands cohort, AICVD also outperformed the Framingham Heart Risk Model (AUC -0.737 vs 0.707). CONCLUSIONS This study concludes that the novel AI-based CVD Risk Score has a higher predictive performance for cardiac events than conventional risk scores in Indian population. TRIAL REGISTRATION NUMBER CTRI/2019/07/020471.
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Affiliation(s)
| | | | - Andre L A J Dekker
- Department of Radiation Oncology (Maastro), Maastricht University, Maastricht, Netherlands
| | - Inigo Bermejo
- Department of Radiation Oncology (Maastro), Maastricht University, Maastricht, Netherlands
| | - Sujoy Kar
- Apollo Hospitals, Hyderabad, Telangana, India
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Narayan I, Chopra RC, Sarkar S, Chakrabarthi S. Financial burden of coronary artery bypass grafting in India: implications for catastrophic health expenditure and healthcare access. Indian J Thorac Cardiovasc Surg 2024; 40:78-82. [PMID: 38125315 PMCID: PMC10728036 DOI: 10.1007/s12055-023-01612-6] [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: 07/10/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023] Open
Abstract
Cardiovascular diseases (CVD) have become a leading cause of mortality in India. High costs of coronary artery bypass grafting (CABG) impose a financial burden in patients often resulting in catastrophic health expenditure (CHE). CHE and distressed financing have significant microeconomic and macroeconomic implications. CHE depletes savings, forces asset disposal, and perpetuates poverty. At a macroeconomic level, the burden of CVD impacts gross domestic product, economic productivity, healthcare budgets, and social welfare. Addressing these challenges requires a multifaceted approach. Prioritizing accessible and affordable healthcare systems with robust financial risk protection is essential. Widespread adoption of health insurance, including government-sponsored schemes, can provide financial protection. Expanding public healthcare infrastructure, implementing price regulations, promoting generic medicines, and encouraging preventive measures for coronary artery disease (CAD) are crucial steps to reduce the burden of CABG costs and improve healthcare access.
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Affiliation(s)
- Ishir Narayan
- Indus Valley World School, 488, Ajoy Nagar EM Bypass, Kolkata, West Bengal 700094 India
| | - Ryka C Chopra
- Mission San Jose High School, 41717 Palm Avenue, Fremont, CA 94539 USA
| | - Sivasis Sarkar
- Peerless Hospital and B.K. Roy Research Centre, 360, Pancha Sayar Rd, Kolkata, West Bengal 700094 India
| | - Suma Chakrabarthi
- Peerless Hospital and B.K. Roy Research Centre, 360, Pancha Sayar Rd, Kolkata, West Bengal 700094 India
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Shah M, Gupta A, Talekar M, Chaaithanya K, Doctor P, Fernandes S, Doctor R, Marita AR. The 'Insertion/Deletion' Polymorphism, rs4340 and Diabetes Risk: A Pilot Study from a Hospital Cohort. Indian J Clin Biochem 2024; 39:124-129. [PMID: 38223004 PMCID: PMC10784238 DOI: 10.1007/s12291-022-01076-2] [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: 01/06/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
The insertion/deletion, I/D polymorphism, in the gene encoding Angiotensin Converting Enzyme, ACE is a popular genetic marker for cardiovascular disease, CVD. With alarming rise in diabetes, the risk of CVD among Indian subjects is further enhanced. The present study explored the role of ACE I/D polymorphism, rs4340 as a genetic marker and its association with diabetes. Genomic DNA, isolated from a cohort of 410 urban subjects attending our hospital, was genotyped using polymerase chain reaction followed by electrophoresis. Among the subjects, 84 had type-2 diabetes and 68 had hypertension while 258 were free from these risk factors. Majority (57/84) of diabetic subjects were also suffering from hypertension. Genotype frequencies of ACE I/D polymorphism, of diabetic (84) patients were not different from that of non-diabetic subjects (258). In sharp contrast, we found significant differences, in genotype frequencies of women with diabetes (n = 38) compared to non-diabetic women (70). Diabetic women had significantly higher prevalence of the high risk 'D' allele. Analysis of odds ratio, OR revealed that women with 'D/D' genotype, exhibited threefold risk (OR 3.12, 95% CI 1.21-8.05; p = 0.018) of diabetes, in the recessive model (D/D vs I/I + I/D). Further when we analysed Odds ratio of diabetic women (8) who were free from hypertension, the results revealed even a greater, 6- fold (OR 6.0, 95% CI 1.29-27.96, p = 0.027) risk of diabetes for D/D homozygous women (D/D vs I/I + I/D). These results suggest 'sex-specific' association of ACE 'I/D' polymorphism, with type-2 diabetes, affecting women while there was no influence observed among men. In view of the increased cardiovascular mortality among Indians, data from our pilot study if confirmed in a larger cohort, could add value to our future intervention efforts.
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Affiliation(s)
- Manali Shah
- Bayview Advisory Services Pvt. Ltd, 3rd Floor, Backbayview Building, 3A Mama Parmanand Marg, Opera house, Mumbai, 400004 Maharashtra India
| | - Anjali Gupta
- Bayview Advisory Services Pvt. Ltd, 3rd Floor, Backbayview Building, 3A Mama Parmanand Marg, Opera house, Mumbai, 400004 Maharashtra India
| | - Mitali Talekar
- Bayview Advisory Services Pvt. Ltd, 3rd Floor, Backbayview Building, 3A Mama Parmanand Marg, Opera house, Mumbai, 400004 Maharashtra India
| | - Krishna Chaaithanya
- National Institute for Research in Reproductive Health (NIRRH), Mumbai, India
| | - Priyanka Doctor
- Bayview Advisory Services Pvt. Ltd, 3rd Floor, Backbayview Building, 3A Mama Parmanand Marg, Opera house, Mumbai, 400004 Maharashtra India
| | - Sandra Fernandes
- Bayview Advisory Services Pvt. Ltd, 3rd Floor, Backbayview Building, 3A Mama Parmanand Marg, Opera house, Mumbai, 400004 Maharashtra India
| | - Rahul Doctor
- Bayview Advisory Services Pvt. Ltd, 3rd Floor, Backbayview Building, 3A Mama Parmanand Marg, Opera house, Mumbai, 400004 Maharashtra India
| | - A. Rosalind Marita
- Bayview Advisory Services Pvt. Ltd, 3rd Floor, Backbayview Building, 3A Mama Parmanand Marg, Opera house, Mumbai, 400004 Maharashtra India
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Sharma VC, Vidyasagar S, Sukumar CA, Krishna B N, Shree S. Association between serum osteocalcin and atherosclerosis in Type-2 diabetes mellitus: a cross-sectional study. BMC Endocr Disord 2023; 23:269. [PMID: 38053107 PMCID: PMC10699002 DOI: 10.1186/s12902-023-01462-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/17/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The past few decades have seen a marked increase in the macrovascular complications of Type-2 diabetes mellitus (T2DM) such as coronary heart disease, peripheral arterial disease, and cerebrovascular disease. This has been predominantly attributed to the increased atherosclerosis in these patients. Atherosclerosis usually remains an asymptomatic condition and this poses a significant challenge in its early diagnosis and timely intervention. Hence, there is an immediate need for exploring novel tools to aid in the early detection of atherosclerosis, especially in T2DM patients. Osteocalcin (OC), synthesized by osteoblasts, is a protein hormone found in the skeletal system. This protein is considered as a marker for bone density and in recent times has been gaining interest due to its protective role in cerebrovascular diseases(CVD). METHODS We conducted a cross-sectional study and evaluated the association between serum OC levels and atherosclerosis in 113 T2DM patients. Carotid intima-media thickness (CC-IMT) was used as an estimate of atherosclerosis and patients were divided into two groups (CC-IMT < 0.9 and ≥ 0.9). Correlation of serum OC levels and glycemic parameters and lipid profiles were studied and compared between both groups. RESULTS There is a significant negative correlation between the CC-IMT estimates and serum OC levels. CC-IMT also has a significant association with other biochemical parameters such as fasting blood sugar, glycated hemoglobin and high-density lipoprotein. CONCLUSION Although the independent association of serum OC could not be established in the T2DM patient population, overall, the results favor low serum OC as a prognostic marker for atherosclerosis.
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Affiliation(s)
- Vishal Chandra Sharma
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sudha Vidyasagar
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Cynthia Amrutha Sukumar
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Nanda Krishna B
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sharanya Shree
- Department of Medicine, Trinity Health, Oakland, CA, USA
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Ahmed N, Islam NS. The Health Implications of Perceived Anti-Muslim Discrimination Among South Asian Muslim Americans. AJPM FOCUS 2023; 2:100139. [PMID: 37928060 PMCID: PMC10624581 DOI: 10.1016/j.focus.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Introduction Anti-Muslim discrimination in the U.S. has increased exponentially since 2001, but the impact of anti-Muslim discrimination has yet to be fully examined because of limited data available on this topic and population. The objectives of this study were to (1) examine the association between perceived anti-Muslim discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans and (2) examine the association between other forms of perceived discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans. Methods Data were collected using an online survey, which was disseminated on subscriber e-mail lists for organizations that serve South Asian or Muslim communities. Participants were asked about perceived discrimination, depressive symptoms, diet, physical activity, tobacco use, and alcohol consumption. Data were analyzed using structural equation modeling in Mplus 8. Results Societal anti-Muslim discrimination had a positive association with depressive symptoms (0.19, p<0.05), as did interpersonal anti-Muslim discrimination (0.20, p<0.05) and other forms of discrimination (0.22, p<0.05). None of the discrimination scales were associated with dietary patterns, tobacco use, or alcohol consumption. Conclusions Study results demonstrated a link between discrimination and depressive symptoms. Further research is needed to examine associations with other adverse health outcomes and potential buffers against discrimination.
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Affiliation(s)
- Naheed Ahmed
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
| | - Nadia S. Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
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Manikandan A, Jeevitha S, Vusa L. Peptidomimetics for CVD screened via TRADD-TRAF2 complex interface assessments. In Silico Pharmacol 2023; 11:28. [PMID: 37899969 PMCID: PMC10611682 DOI: 10.1007/s40203-023-00166-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
The main aim of this study is to screen and develop Peptidomimetics to treat atherosclerosis (AS) which is a Cardio Vascular Disease (CVD). Peptidomimetics were obtained from the protein-protein interaction interface of TRADD (Tumor necrosis factor receptor type 1-associated DEATH domain protein) and TRAF2 (TNF receptor-associated factor 2) complex. TRADD-TRAF2 interaction is critical in AS pathogenesis since it assists a series of signal transducers that activate NF-κB. Conceptually, the triggered NF-κB makes an extensive amount of nitric oxide (NO) synthesized by inducible nitric oxide synthase (iNOS), which boons the progress of AS. The examined TRADD-TRAF2 complex (PDB ID: 1F3V) and its interaction details revealed that the sequence range W11-G165 of TRADD highly interacts with TRAF2. The sequence range W11-G165 was selected for the design and preparation of the inhibitory peptide in silico. The selected sequence was mutated with the alanine scanning method to have a range of inhibitory peptides. With the help of different in silico tools, the top three, namely MIP11-25 L, MIP131-143 h, and MIP149-164 m peptides showed the best interaction with the critical residues of TRAF2. Thus, these three peptides were used for generating peptidomimetics using pepMMsMIMIC, a peptidomimetics virtual screening tool. Around 600 peptidomimetics were identified & and retrieved for further screening by employing molecular docking tools and MD (Molecular Dynamics) simulations. Density Functional Theory (DFT) and ADMET predictions were applied to validate the screened peptidomimetics druggability. In the results, peptidomimic compounds MMs03918858 and MMs03927281 with binding energy values of -9.6 kcal/mol and - 9.1 kcal/mol respectively were screened as the best and are proposed for further pre-clinical studies.
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Affiliation(s)
- A Manikandan
- Dept. of Microbiology, M.S. Ramaiah College of Arts, Science and Commerce, Bengaluru, 560054 India
| | - S Jeevitha
- Dept. of Biochemistry, M.S. Ramaiah College of Arts, Science and Commerce, Bengaluru, 560054 India
| | - Laharika Vusa
- Dept. of Microbiology, M.S. Ramaiah College of Arts, Science and Commerce, Bengaluru, 560054 India
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Ambade M, Kim R, Subramanian SV. Socio-economic distribution of modifiable risk factors for cardiovascular diseases: An analysis of the national longitudinal ageing study in India. Prev Med 2023; 175:107696. [PMID: 37666306 DOI: 10.1016/j.ypmed.2023.107696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/13/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
The association of socioeconomic status (SES) with modifiable risk factors for cardiovascular diseases (CVDs) is unclear in developing nations. We studied SES variations in major risk factors and their percentage distribution for adults aged 45 years or above in India. Using individual records of 59,672 individuals aged 45 years or above from the Longitudinal Ageing Study in India Wave 1 (cross-sectional study design), 2017-18, we chart age-and-sex-adjusted prevalence of clinical risk factors such as measured high blood pressure, hypertension, overweight, obesity, central adiposity and self-reported high blood glucose; and lifestyle risk factors such as excessive use of alcohol, current use of smoking and smokeless tobacco and physical inactivity across SES variables of education, quintiles of mean per capita expenditure and social caste. Multivariable analysis was used to explore the SES gradient of risk factors. The sample used in the study is predominantly rural (69.9%), illiterate (50.7%), has more females (54.2%), and belongs to other backward classes (45.6%). Prevalence of high blood pressure, overweight, obesity, central adiposity, high blood glucose, and physical inactivity increased; and excessive alcohol consumption and current use of smoking/smokeless tobacco decreased with income, education, and social caste. However, no significant income gradient was noted for lifestyle risk factors except the use of smokeless tobacco. The income gradient was largest for central adiposity (waist-circumference) with a difference of 23.4 percentage points as it increased from 38.7% among the poorest to 62.1% among the richest. The major burden of CVDs risk factors among older adults aged 45+ years falls among high SES.
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Affiliation(s)
- Mayanka Ambade
- Indian Institute of Technology Mandi, Himachal Pradesh, India.
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
| | - S V Subramanian
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
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Das U, Kar N. Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave. BMC Endocr Disord 2023; 23:170. [PMID: 37568234 PMCID: PMC10416355 DOI: 10.1186/s12902-023-01421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The complication of Diabetes is one of the important health issues among the older adult population in any region. The higher risks of diabetes prevalence among older adult people in the countries was due to social-cultural changes such as increasing urbanization, dietary changes, without physical activity, and unhealthy lifestyle behavior. The present study examines the prevalence and associated risk factors of diabetes among older adults in the state of West Bengal. METHODS The first wave of the Longitudinal Ageing Study in India 2017-18 was used to achieve the study objectives. Descriptive statistics with multinomial logistic regression models were used to carry out crude and adjusted odds ratios with 95% confidence intervals and examine the associated risk factors of diabetes prevalence among older adults. RESULTS The findings of the study indicate that the overall prevalence of diabetes among the study participants was found to be 12.4% which was significantly higher in urban areas (19%) compare to rural areas (6%). The socio-economic and bio-demographic factors like educational status, richest background family, marital status, obesity, and family history of diabetes were significantly associated with higher risks of diabetes prevalence among the older adult population in West Bengal. The risks of diabetes in the richest adult people were significantly higher than in the poorest adult people (OR = 2.78; 95% CI: 1.974-3.917). The higher risks of diabetes mellitus among the richest wealthy people are because of lifestyle behavior, smoking, and tobacco consumption respectively. CONCLUSION The study needs to policy and awareness program to reduce economic inequality and prevention of diabetes care and treatment-seeking behavior, especially for the older adult population in West Bengal.
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Affiliation(s)
- Ujjwal Das
- Dept. of Geography in, Rajiv Gandhi University, Doimukh, Arunachal Pradesh India
- Dept. of Geography, Fakir Mohan University, Balasore, Odisha India
| | - Nishamani Kar
- Dept. of Geography in, Rajiv Gandhi University, Doimukh, Arunachal Pradesh India
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Kundu J, James KS, Hossain B, Chakraborty R. Gender differences in premature mortality for cardiovascular disease in India, 2017-18. BMC Public Health 2023; 23:547. [PMID: 36949397 PMCID: PMC10035272 DOI: 10.1186/s12889-023-15454-9] [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: 05/23/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The present study tries to provide a comprehensive estimate of gender differences in the years of life lost due to CVD across the major states of India during 2017-18. METHODS The information on the CVD related data were collected from medical certification of causes of death (MCCD reports, 2018). Apart from this, information from census of India (2001, 2011), SRS (2018) were also used to estimate YLL. To understand the variation in YLL due to CVD at the state level, nine sets of covariates were chosen: share of elderly population, percentage of urban population, literacy rate, health expenditure, social sector expenditure, labour force participation, HDI Score and co-existence of other NCDs such as diabetes, & obesity. The absolute number of YLL and YLL rates were calculated. Further, Pearson's correlation had been calculated and to understand the effect of explanatory variables on YLL due to CVD, multiple linear regression analysis had been applied. RESULTS Men have a higher burden of premature mortality in terms of Years of life lost (YLL) due to CVD than women in India, with pronounced differences at adult ages of 50-54 years and over. The age pattern of YLL rate suggests that the age group 85 + makes the highest contribution to the overall YLL rate due to CVD. YLL rate showed a J-shaped relationship with age, starting high at ages below 1 years, dropping to their lowest among children aged 1-4 years, and rising again to highest levels at 85 + years among both men and women. In all the states except Bihar men had higher estimated YLL due to CVD for all ages than women. Among men the YLL due to CVD was higher in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. On the other hand, the YLL due to CVD among men was lowest in Jharkhand followed by Assam. Similarly, among women the YLL due to CVD was highest in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. While, the YLL due to CVD among women was lowest in Jharkhand. Irrespective of gender, all factors except state health expenditure were positively linked with YLL due to CVD, i.e., as state health expenditure increases, the years of life lost (YLL) due to CVDs falls. Among all the covariates, the proportion of a state's elderly population emerges as the most significant predictor variable for YLL for CVDs (r = 0.42 for men and r = 0.50 for women). CONCLUSION YLL due to cardiovascular disease varies among men and women across the states of India. The state-specific findings of gender differences in years of life lost due to CVD may be used to improve policies and programmes in India.
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Affiliation(s)
- Jhumki Kundu
- International Institute for Population Sciences, 400088, Mumbai, India
| | - K S James
- International Institute for Population Sciences, 400088, Mumbai, India
| | - Babul Hossain
- International Institute for Population Sciences, 400088, Mumbai, India.
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Patel P, Muhammad T, Sahoo H. The burden of disease-specific multimorbidity among older adults in India and its states: evidence from LASI. BMC Geriatr 2023; 23:53. [PMID: 36710322 PMCID: PMC9885687 DOI: 10.1186/s12877-023-03728-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Around the world, advances in public health and changes in clinical interventions have resulted in increased life expectancy. Multimorbidity is becoming more of an issue, particularly in countries where the population is rapidly ageing. We aimed to determine the prevalence of multimorbidity and disease-specific multimorbidity and examine its association with demographic and socioeconomic characteristics among older adults in India and its states. METHODS The individual data from the longitudinal ageing study in India (LASI) were used for this study, with 11 common chronic conditions among older adults aged 60 and above years (N = 31,464). Descriptive statistics were used to report the overall prevalence of multimorbidity and disease-specific burden of multimorbidity. Multinomial logistic regression has been used to explore the factors associated with multimorbidity. RESULTS Prevalence of single morbidity was 30.3%, and multimorbidity was 32.1% among older people in India. Multimorbidity was higher among females and in urban areas and increased with age and among those living alone. Hypertension, arthritis and thyroid were highly prevalent among females and chronic lung diseases and stroke were highly prevalent among males. The older people in the state of Kerala had a high prevalence of multimorbidity (59.2%). Multimorbidity was found to be more likely in older age groups of 75-79 years (RR-1.69; CI: 1.53-1.87) and 80 years and above (RR-1.40; CI: 1.27-1.56) and in the Western (RR-2.16; CI: 1.90-2.44) and Southern regions (RR-2.89; CI: 2.57-3.24). Those who were living with a spouse (RR-1.60; CI: 1.15-2.23) were more likely to have multimorbidity. Disease-specific multimorbidity was high in chronic heart disease (91%) and low in angina (64.8%). CONCLUSIONS The findings suggest that multimorbidity has a positive relationship with advancing age, and disease-specific burden of multimorbidity is higher among chronic heart patients. Comorbidity, especially among those who already have chronic heart disease, stroke, cholesterol or thyroid disorder can have severe consequences on physical functioning, therefore, disease-specific health management needs to be enhanced.
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Affiliation(s)
- Priyanka Patel
- grid.419349.20000 0001 0613 2600Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088 Maharashtra India
| | - T. Muhammad
- grid.419349.20000 0001 0613 2600Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088 Maharashtra India
| | - Harihar Sahoo
- grid.419349.20000 0001 0613 2600Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088 Maharashtra India
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12
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B G, Sujata S, Thakur R. Cardiovascular diseases and ageing in India: A propensity score matching analysis of the effects of various risk factors. Curr Probl Cardiol 2023; 48:101606. [PMID: 36682392 DOI: 10.1016/j.cpcardiol.2023.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
Cardiovascular diseases (CVDs) are one of the major causes of mortality and morbidity worldwide, with a significant burden, especially on older adults. This analysis aims to estimate the exclusive effects of various risk factors of CVDs among 59,073 older adults aged 45 years and above in India. Using data from wave 1 of the Longitudinal Ageing Study in India (LASI), the exposure effects of various risk factors on CVDs are estimated through propensity score matching. This analysis is further extended to different components of CVDs, such as hypertension, heart disease, and stroke. Results indicate that risk factors groups such as environmental, behavioral, physiological, and genetic risk factors have a positive and significant impact on CVDs. In the case of independent risk factor effects, diabetes has the highest effect on CVDs, followed by overweight, cholesterol, family history, alcohol consumption, and depression. We conclude that physiological risk factors among older adults are more severe than other factors.
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Affiliation(s)
- Gayathri B
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Himachal Pradesh, India
| | - Sujata Sujata
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Himachal Pradesh, India
| | - Ramna Thakur
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Himachal Pradesh, India.
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Jariwala P, Padmavathi A, Patil R, Chawla KD, Jadhav K. The prevalence of risk factors and pattern of obstructive coronary artery disease in young Indians (< 45 years) undergoing percutaneous coronary intervention: A gender-based multi-center study. Indian Heart J 2022; 74:282-288. [PMID: 35843268 PMCID: PMC9453019 DOI: 10.1016/j.ihj.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females <45 years of age compared to males of the same age group who underwent percutaneous coronary intervention (PCI). Materials and Methods This was a retrospective, observational, multi-centre study of young Indian females and males (<45 years) who underwent PCI as per the guidelines at three high-volume centres in India. Results In a group of 3656 patients under the age of 45 who had PCI, 3.1% of those with obstructive CAD were young women (n = 113), while 6.9% were young men (n = 254). Traditional risk factors such as hypertension (p = 0.73), diabetes (p = 0.61), and family history of premature CAD (p = 0.63) were equally common in both genders, whereas dyslipidaemia (p < 0.001), overweight (p < 0.006), smoking (p = 0.004) and, alcoholism (p < 0.001) were more common in young males. Acute coronary syndrome was the most common clinical presentation. Single-vessel disease was common, with the involvement of the left anterior descending artery as the most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males, while the in-hospital mortality rate was 1.77% in young females and 2% in young males. Conclusions Obstructive CAD in young men and women accounted for 10% of all CAD cases requiring PCI. Although men account for the majority of patients, CAD in women under the age of 45 is not uncommon. Traditional risk factors are becoming more prevalent in younger women.
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Affiliation(s)
- Pankaj Jariwala
- Yashoda Hospitals, Somajiguda, Hyderabad, Telangana 500082, India.
| | | | - Rahul Patil
- Ruby Hall Clinic, Sangamvadi, Pune, Maharashtra 411001, India
| | - Kamal Deep Chawla
- Sterling Hospitals, Race Course Road, Opposite Inox Cinema Hari Nagar, Circle West, Vadodara, Gujarat 390007, India
| | - Kartik Jadhav
- Yashoda Hospitals, Somajiguda, Hyderabad, Telangana 500082, India
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Barure R, Shanthaiah DM, Atluri S, Channabasappa S, Kolla G, Reddy SLS, Sarathi V. High Prevalence of Additional Cardiovascular Risk Factors in Eastern-Indian Young Adults with Type 2 Diabetes Mellitus. Indian J Endocrinol Metab 2022; 26:372-375. [PMID: 36185959 PMCID: PMC9519843 DOI: 10.4103/ijem.ijem_155_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS The American Diabetes Association recommends statin therapy for young type 2 diabetes mellitus (T2DM) adults only if one additional cardiovascular (CV) risk factor coexists. The data regarding CV risk factors in young Indian T2DM adults is limited. Hence, we assessed the prevalence of CV risk factors in young adults with T2DM from eastern India. METHODS In this cross-sectional study, diabetic medical health check records of eastern-Indian T2DM patients performed between March 2018 and March 2019 were retrospectively reviewed and the relevant data of T2DM patients (n = 3564) including CV risk factors [serum LDL-cholesterol of ≥100 mg/dL, hypertension (>140/90 mmHg), smoking, chronic kidney disease (eGFR of <60 ml/min), microalbumin to creatinine ratio of ≥30 mg/mg, and obesity/overweight (body mass index ≥23 kg/m2)] were analysed. RESULTS There were 3280 T2DM patients from eastern India and 679 (20.7%) were ≤40 years of age. Overweight/obesity (74.3%) and serum LDL-cholesterol of ≥100 mg/dL (69.2%) were the two most common additional CV risk factors. At least one additional CV risk factor was present in 576 (95.36%) patients, whereas at least two additional CV risk factors were present in 409 (67.7%) patients. At least one non-obesity/overweight CV risk factor was present in 472 (78.1%) patients. CONCLUSIONS The study demonstrates a high prevalence of additional CV risk factors in young eastern-Indian adults with T2DM. Hence, there is a need for an intensive approach to managing the CV risk factors in young Indian adults with T2DM.
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Affiliation(s)
- Ramdas Barure
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | | | - Sridevi Atluri
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Shivaprasad Channabasappa
- Department of Endocrinology, Sapthagiri Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Gautam Kolla
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - S. L. Sagar Reddy
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
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15
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Zhang S, Chourase M, Sharma N, Saunik S, Duggal M, Danaei G, Duggal B. The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence. BMC Cardiovasc Disord 2022; 22:238. [PMID: 35606724 PMCID: PMC9125829 DOI: 10.1186/s12872-022-02677-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence and burden of coronary heart disease (CHD) has increased substantially in India, accompanied with increasing need for percutaneous coronary interventions (PCI). Although a large government-funded insurance scheme in Maharashtra, India covered the cost of PCI for low-income patients, the high cost of post-PCI treatment, especially Dual Antiplatelet Therapy (DAPT), still caused many patients to prematurely discontinue the secondary prevention. Our study aimed to investigate the effectiveness of DAPT adherence on all-cause mortality among post-PCI patients and explore the potential determinants of DAPT adherence in India. METHOD We collected clinical data of 4,595 patients undergoing PCI in 110 participating medical centers in Maharashtra, India from 2012 to 2015 by electronic medical records. We surveyed 2527 adult patients who were under the insurance scheme by telephone interview, usually between 6 to 12 months after their revascularization. Patients reporting DAPT continuation in the telephone survey were categorized as DAPT adherence. The outcome of the interest was all-cause mortality within 1 year after the index procedure. Multivariate Cox proportional hazard (PH) model with adjustment of potential confounders and standardization were used to explore the effects of DAPT adherence on all-cause mortality. We further used a multivariate logistic model to investigate the potential determinants of DAPT adherence. RESULTS Out of the 2527 patients interviewed, 2064 patients were included in the analysis, of whom 470 (22.8%) discontinued DAPT prematurely within a year. After adjustment for baseline confounders, DAPT adherence was associated with lower one-year all-cause mortality compared to premature discontinuation (less than 6-month), with an adjusted hazard ratio (HR) of 0.52 (95% Confidence Interval (CI) = (0.36, 0.67)). We also found younger patients (OR per year was 0.99 (0.97, 1.00)) and male (vs. female, OR of 1.30 (0.99, 1.70)) had higher adherence to DAPT at one year as did patients taking antihypertensive medications (vs. non medication, OR of 1.57 (1.25, 1.95)). CONCLUSION These findings suggest the protective effects of DAPT adherence on 1-year mortality among post-PCI patients in a low-income setting and indicate younger age, male sex and use of other preventive treatments were predictors of higher DAPT adherence.
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Affiliation(s)
- Shuqi Zhang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | | | - Nupur Sharma
- Health Technology Assessment Hub, AIIMS Rishikesh, Rishikesh, India
| | | | - Mona Duggal
- Department of Community Medicine, PGIMER, Chandigarh, India
| | - Goodarz Danaei
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Bhanu Duggal
- Department of Cardiology, AIIMS Rishikesh, Rishikesh, India.
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16
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Ahmed N, De Silva D, Kanaya AM, Kandula NR. Psychological Symptoms as Mediators in the Association between Discrimination and Health among South Asian Americans. JOURNAL OF ASIAN HEALTH 2022; 2:e202209. [PMID: 36304714 PMCID: PMC9605410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Objective To examine psychological symptoms (symptoms of depression, anger, anxiety) as potential mediators between discrimination and health outcomes among South Asian Americans. We hypothesized that psychological symptoms would be significant mediators in the pathways between discrimination and health. Research Design and Methods The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study examines risk factors for heart disease among South Asian Americans using self-reported and medical data collected from participants in the San Francisco Bay Area and Chicago regions of the U.S. (N=1164). For this study we assessed the associations among the everyday discrimination scale, symptoms of depression, anxiety, and anger, and health outcomes using structural equation modeling. Results We found significant positive associations between discrimination and symptoms of depression (ß .69, p<.0001), anger (ß .38, p<.0001), and anxiety (ß .64, p<.0001). Exposure to discrimination had a direct negative association with HDL level (ß -.37, p=.01). Indirect associations between discrimination and health outcomes were seen via depression (tobacco use: ß 1.08, p=.007), via anger (triglyceride level: 11.88, p=.03; alcohol consumption: ß 1.66, p=.002; calories consumed per day: ß 108.04, p=.02), and via anxiety (tobacco use: ß -1.05, p=.004; alcohol consumption: ß -1.88, p=.03). Conclusion Our hypothesis was partially confirmed with proximate health indicators (tobacco use, alcohol consumption, caloric intake) and triglyceride levels. These results suggest that psychological symptoms mediate the association between discrimination and adverse health risk behaviors among South Asian Americans.
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Affiliation(s)
- Naheed Ahmed
- University of Maryland School of Public Health, 2242 Valley Dr, College Park, MD 20742
| | - Dane De Silva
- University of Maryland School of Public Health, 2242 Valley Dr, College Park, MD 20742
| | - Alka M Kanaya
- School of Medicine, University of California, San Francisco
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17
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Garg R, Agrawal P, Singh AP, Agrawal M, Gupta P. Glimpse into the Lifestyle of Doctors. J Midlife Health 2022; 13:115-120. [PMID: 36276628 PMCID: PMC9583376 DOI: 10.4103/jmh.jmh_201_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/04/2022] Open
Abstract
Background Lifestyle disorders are on rise world over. Also, the role of doctors as leaders in propagating healthy lifestyles needs to get a reality check. Aims and Objectives: This study aimed to investigate the prevalence of lifestyle disorders, eating habits, nutrition patterns, and lifestyle of doctors by assessing health-related behaviours considering gender and other relevant demographic parameters. The objectives of the present study are to find out the relationship of lifestyle disorders among doctors and to study lifestyle disorders and related behaviour among male and female doctors and other subgroups. Materials and Methods Online survey was conducted using Googledoc in June to August 2021. Descriptive statistical analysis has been carried out in the present study. The student's t-test (two tailed, independent) has been used. Results About 50% rated a happiness quotient of 7 and 8. Surgeons had more diabetes and hypertension than physicians. Prevalence of hypertension was more in self-employed males versus males in job. About two-third participants scored ≥ 80% on healthy lifestyle score. Conclusion Our results call for a well-thought strategy to overcome the financial and technological hindrances to accurately identify health risk factors and plan corrective interventions. A healthy lifestyle both in terms of diet and exercise should be incorporated into the schedules of doctors.
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Affiliation(s)
- Ruchika Garg
- Department of Obs and Gynecolgy, SN Medical College, Agra, Uttar Pradesh, India
| | - Prabhat Agrawal
- Department of Medicine, SN Medical College, Agra, Uttar Pradesh, India
| | | | - Mohita Agrawal
- Department of Obs and Gynecolgy, SN Medical College, Agra, Uttar Pradesh, India,Address for correspondence: Dr. Mohita Agrawal, Department of Obs and Gynecolgy, SN Medical College, Agra, Uttar Pradesh, India. E-mail:
| | - Prashant Gupta
- Department of Surgery, SN Medical College, Agra, Uttar Pradesh, India
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18
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Tyagi N, Kaur C. Role of serum adiponectin levels and IL-10 as a marker for angiographic stenosis in coronary artery disease. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2022. [DOI: 10.4103/ijca.ijca_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Circulating Levels of IL-13, TGF- β1, and Periostin as Potential Biomarker for Coronary Artery Disease with Acute Heart Failure. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1690421. [PMID: 34721618 PMCID: PMC8550830 DOI: 10.1155/2021/1690421] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 01/10/2023]
Abstract
Objective Coronary artery disease (CAD) and associated comorbidities such as heart failure (HF) remain the leading cause of morbidity and mortality worldwide, attributed to, at least partially, the lack of biomarkers for efficient disease diagnosis. The study intended to explore potential biomarkers for predicting the presence of HF in CAD patients. Methods According to the presence of HF, 83 CAD patients with HF were assigned to the AHF group and 52 CAD patients without HF to the CAD group. Additionally, healthy controls (n = 52) were those who had received physical examinations at the same period. The serum levels of IL-13, TGF-β1, and periostin were detected by the enzyme-linked immunosorbent assay (ELISA). Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left ventricle-end diastolic volume (LVEDV), and left ventricular mass index (LVMI) were detected 3 times by color Doppler ultrasound. The predictive values of IL-13, TGF-β1, and periostin methods were compared by receiver-operating characteristic (ROC) analysis and the area under the curve (AUC). Results Increased levels of IL-13, TGF-β1, and periostin were noted in the AHF group than in the control and CAD groups (p < 0.001); the CAD group showed higher levels of IL-13, TGF-β1, and periostin than the control group (p < 0.001). Based on the NYHA classification, there were 33 cases with grade II, 28 cases with grade III, and 22 cases with grade IV among 83 CAD patients with HF. It was found that the serum levels of IL-13, TGF-β1, and periostin were higher in the AHF-IV group than in the AHF-III and AHF-II groups (p < 0.001); these levels were also higher in the AHF-III group than in the AHF-II group (p < 0.001). The periostin level was positively correlated with the levels of IL-13 (r = 0.458) and TGF-β1 (r = 0.569) in CAD patients with AHF. Besides, the serum levels of periostin (r = -0.425), IL-13 (r = -0.341), and TGF-β1 (r = -0.435) were negatively correlated with the LVEF of CAD patients with AHF, respectively. When IL-13, TGF-β1, and periostin levels were used to predict the presence of AHF in CAD patients in combination, the sensitivity and specificity were 75.9% and 90.38%, respectively, with the AUC of 0.906 (95% CI: 0.912–0.996). Conclusion These data reveal that IL-13, TGF-β1, and periostin levels might be associated with the occurrence of AHF in CAD patients and their combination shows the predictive value for the presence of AHF in CAD patients.
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Menon J, Numpeli M, Kunjan SP, Karimbuvayilil BV, Sreedevi A, Panniyamakkal J, Suseela RP, Thachathodiyil R, Banerjee A. A Sustainable Community-Based Model of Noncommunicable Disease Risk Factor Surveillance (Shraddha-Jagrithi Project): Protocol for a Cohort Study. JMIR Res Protoc 2021; 10:e27299. [PMID: 34677141 PMCID: PMC8571687 DOI: 10.2196/27299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND India has a massive noncommunicable disease (NCD) burden, at an enormous cost to the individual, family, society, and health system at large, despite which prevention and surveillance are relatively neglected. If diagnosed early and treated adequately, risk factors for atherosclerotic cardiovascular disease would help decrease the mortality and morbidity burden. Surveillance for NCDs, creating awareness, positive lifestyle changes, and treatment are the proven measures known to prevent the progression of the disease. India is in a stage of rapid epidemiological transition, with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country in the future. A previous study done by the same investigators in a population of >100,000 revealed poor awareness, treatment of NCDs, and poor adherence to medicines in individuals with CVD. OBJECTIVE This study aimed at assessing a sustainable, community-based surveillance model for NCDs with corporate support fully embedded in the public health system. METHODS Frontline health workers will check all individuals in the target group (≥age 30 years) with further follow-up and treatment planned in a "spoke and hub" model using the public health system of primary health centers as spokes to the hubs of taluk or district hospitals. All data entry done by frontline health workers will be on a tablet PC, ensuring rapid acquisition and transfer of participant health details to primary health centers for further follow-up and treatment. RESULTS The model will be evaluated based on the utilization rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centers for risk stratification and care, and community-level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow-up treatment at no cost to the individual entirely through the tiered public health system of the state and country. CONCLUSIONS Surveillance for NCDs is an essential facet of health care presently lacking in India. Atherosclerotic cardiovascular disease has a long gestation period in progression to the symptomatic phase of the disease, during which timely preventive and lifestyle measures would help prevent disease progression if implemented. Unfortunately, several asymptomatic individuals have never tested their plasma glucose, serum lipid levels, or blood pressure and are unaware of their disease status. Our model, implemented through the public health system using frontline health workers, would ensure individuals aged≥30 years at risk of disease are identified, and necessary lifestyle modifications and treatments are given. In addition, the surveillance at the community level would help create a general awareness of NCDs and lead to healthier lifestyle habits. TRIAL REGISTRATION Clinical Trial Registry India CTRI/2018/07/014856; https://tinyurl.com/4saydnxf. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27299.
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Affiliation(s)
- Jaideep Menon
- Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | | | | | | | - Jeemon Panniyamakkal
- Sree Chitra Thirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Rakesh P Suseela
- Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rajesh Thachathodiyil
- Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
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Raza ST, Singh SP, Rizvi S, Zaidi A, Srivastava S, Hussain A, Mahdi F. Association of eNOS (G894T, rs1799983) and KCNJ11 (E23K, rs5219) gene polymorphism with coronary artery disease in North Indian population. Afr Health Sci 2021; 21:1163-1171. [PMID: 35222579 PMCID: PMC8843271 DOI: 10.4314/ahs.v21i3.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Endothelial nitric oxide synthase (eNOS) and potassium voltage-gated channel subfamily J member 11 (KCNJ11) could be the candidate genes for coronary artery disease (CAD). This study investigated the relationship of the eNOS (rs1799983) and KCNJ11 (rs5219) polymorphisms with the presence and severity of CAD in the North Indian population. Methods This study included 300 subjects, 150 CAD cases and 150 healthy controls. Single nucleotide polymorphism was evaluated by Polymerase chain reaction and Restriction fragment length polymorphism (PCR-RFLP). Analysis was performed by SPSS (version 21.0). Results We observed that KK genotype of KCNJ11E23K (rs5219) polymorphism (P=0.0001) genotypes and K allele (P=0.0001) was found to be a positive risk factor and strongly associated with CAD. In the case of eNOSG894T (rs1799983) there was no association found with CAD. Conclusion These results illustrate the probability of associations between SNPs and CAD although specific genetic polymorphisms affecting ion channel function and expression have still to be clarified by further investigations involving larger cohorts.
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Affiliation(s)
- Syed Tasleem Raza
- Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, India
| | - Sachendra P Singh
- Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, India
| | - Saliha Rizvi
- Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, India
| | - Alina Zaidi
- Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, India
| | - Sanchita Srivastava
- Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, India
| | - Arif Hussain
- Department of Molecular biology, Manipal Academy of Higher Education
| | - Farzana Mahdi
- Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, India
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Singh G, Prakash J, Ray SK, Yawar M, Habib G. Development and evaluation of air pollution-linked quality of life (AP-QOL) questionnaire: insight from two different cohorts. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:43459-43475. [PMID: 33835344 DOI: 10.1007/s11356-021-13754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
In this study, the air pollution-related quality of life (AP-QOL) questionnaire was carried out in two geographically and economically different groups including New Delhi (Megacity) and Hamirpur, Himachal Pradesh (town), and APE scores were linked with respiratory and cardiovascular illness. The APE-Score was developed by AP-QOL questionnaire responses using Delphi technique and further analyzed using principal component analysis (PCA). For reliability of APE-Score and AP-QOL questionnaire, α-Cronbach's test and basic statistics were performed. The linear mixed-effect model and odds ratios were used to evaluate air pollution exposure and health outcomes. Overall, 720 academicians and 276 security guards were invited to participate in the questionnaire. Cronbach's α coefficients ranged from 0.70 to 0.84 indicated significant reliability in the AP-QOL questionnaire conducted in this study. Substantial variation in respiratory symptoms and their medical history were found - 76.9% ([95% confidential interval (CI)]: (- 83.8, - 66.9) (p < 0.05)) and - 28.6% (95% CI: (- 37.8, - 18.0) (p < 0.05)), respectively, with interquartile range (IQR) increase of APE score. The odds ratios (ORs) of respiratory medical history (MH Res.) showed a significant increase from 1.01 to 1.35 for low to high air pollution exposure in the academic group of IIT Delhi. Interestingly, for an academic group of NITH, the ORs for medical history of cardiovascular (MH Card.) showed an increase from 1.08 to 1.13 for low to high APE which was not the case for IIT Delhi academicians.
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Affiliation(s)
- Gaurav Singh
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India
- Department of Local Self-Government, Barmer, Rajasthan, India
| | - Jai Prakash
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India
- Aerosol and Air Quality Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA
| | - Sanjeev Kumar Ray
- Department of Civil Engineering, National Institute of Technology, Hamirpur, India
| | - Mohammad Yawar
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - Gazala Habib
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi, 110016, India.
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Sun YV, Liu C, Staimez L, Ali MK, Chang H, Kondal D, Patel S, Jones D, Mohan V, Tandon N, Prabhakaran D, Quyyumi AA, Narayan KMV, Agrawal A. Cardiovascular disease risk and pathophysiology in South Asians: can longitudinal multi-omics shed light? Wellcome Open Res 2021; 5:255. [PMID: 34136649 PMCID: PMC8176264 DOI: 10.12688/wellcomeopenres.16336.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in South Asia, with rapidly increasing prevalence of hypertension, type 2 diabetes (T2DM) and hyperlipidemia over the last two decades. Atherosclerotic CVD (ASCVD) affects South Asians earlier in life and at lower body weights, which is not fully explained by differential burden of conventional risk factors. Heart failure (HF) is a complex clinical syndrome of heterogeneous structural phenotypes including two major clinical subtypes, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). The prevalence of HF in South Asians is also rising with other metabolic diseases, and HFpEF develops at younger age and leaner body mass index in South Asians than in Whites. Recent genome-wide association studies, epigenome-wide association studies and metabolomic studies of ASCVD and HF have identified genes, metabolites and pathways associated with CVD traits. However, these findings were mostly driven by samples of European ancestry, which may not accurately represent the CVD risk at the molecular level, and the unique risk profile of CVD in South Asians. Such bias, while formulating hypothesis-driven research studies, risks missing important causal or predictive factors unique to South Asians. Importantly, a longitudinal design of multi-omic markers can capture the life-course risk and natural history related to CVD, and partially disentangle putative causal relationship between risk factors, multi-omic markers and subclinical and clinical ASCVD and HF. In conclusion, combining high-resolution untargeted metabolomics with epigenomics of rigorous, longitudinal design will provide comprehensive unbiased molecular characterization of subclinical and clinical CVD among South Asians. A thorough understanding of CVD-associated metabolomic profiles, together with advances in epigenomics and genomics, will lead to more accurate estimates of CVD progression and stimulate new strategies for improving cardiovascular health.
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Affiliation(s)
- Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.,Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Lisa Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.,Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | | | - Shivani Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Dean Jones
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, 30322, USA
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Anurag Agrawal
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, New Delhi, India
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24
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Patel J, Kulkarni S, Doshi D, Poddar P, Srilatha A, Reddy KS. Periodontal disease among non-diabetic Coronary Heart Disease patients. A case-control study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021030. [PMID: 33682819 PMCID: PMC7975955 DOI: 10.23750/abm.v92i1.8891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is well documented scientific evidence supporting the association between Coronary Heart Disease (CHD) and periodontitis. It is however, uncertain if this association is causal or is mediated by the common inflammatory pathways. Hence, the study assessed and compared the Periodontal Health Status among CHD patients with age and gender matched controls. METHODS A total of 808 medically confirmed CHD patients were compared with 808 age and gender matched controls. Oral examination was conducted using Simplified Oral Hygiene Index (OHI-S) and modified World Health Organization (WHO) Oral Health Assessment form, 1997. Mean scores were compared using Mann- Whitney-U test and Analysis of Variance (ANOVA). Logistic regression analysed the association between the risk factors and CHD. RESULTS Cases had significantly higher mean sextants with pockets and attachment loss ≥4mm compared to controls (p≤0.05). The cases also had significantly poor oral hygiene mean scores compared to controls (p=0.0001*). There was a lower and insignificant association between age (p=0.99), gender (p=0.84) and CHD. Risk factors education (p=0.001), lesser frequency of dental visit (p=0.001) also showed a lower, yet significant association. Risk of CHD was higher among tobacco (Odds ratio (OR) - 2.26) and alcohol (OR-1.83) users. Presence of poor oral hygiene (OR-5.20), pocket of ≥6 mm (6.70) and attachment loss of ≥9 mm (OR-11.31) also showed higher risk of CHD. CONCLUSION The study results support the association between periodontal disease and CHD. To halt the epidemic of CHD, emphasis on screening of wide age range, reinforcement of public health systems and early detection is recommended. (www.actabiomedica.it).
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Affiliation(s)
- Jenisha Patel
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
| | - Suhas Kulkarni
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
| | - Dolar Doshi
- Government Dental College and Hospital, Hyderabad, India.
| | - Pawan Poddar
- Department of Cardiology, Yashoda Hospital, Hyderabad, India.
| | - Adepu Srilatha
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
| | - Kommuri Sahithi Reddy
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
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25
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Salis S, Joseph M, Agarwala A, Sharma R, Kapoor N, Irani AJ. Medical nutrition therapy of pediatric type 1 diabetes mellitus in India: Unique aspects and challenges. Pediatr Diabetes 2021; 22:93-100. [PMID: 32666666 DOI: 10.1111/pedi.13080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
Medical nutrition therapy (MNT) is a vital aspect of management of type 1 diabetes mellitus (T1DM) and should be tailored to ethnic and family traditions and the socioeconomic and educational status of the patient. In this article, we discuss the unique aspects of MNT in children and adolescents with T1DM in the Indian setting, with focus on the challenges faced by patients, dieticians and physicians and how these can be overcome. The authors reviewed the available literature on MNT in T1DM from India and prepared the document based on their vast collective clinical experience in treating patients with T1DM from different regions in India. Indian diets are predominantly carbohydrate-based with high glycemic index (GI) and low protein content. Various methods are available to increase the protein and fiber content and reduce the GI of food in order to limit glycemic excursions. Insulin regimens need to be tailored to the child's school timings, meal schedule, and the availability of a responsible adult to supervise/administer insulin. All patients, irrespective of economic and education background, should be taught the broad principles of healthy eating, balanced diet and carbohydrate counting. There are various barriers to dietary compliance, including joint family system, changing lifestyles, and other factors which need to be addressed. There is a need to customize dietary management according to patient characteristics and needs and develop standardized patient educational material on principles of healthy eating in various regional languages.
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Affiliation(s)
- Sheryl Salis
- Department of Nutrition, Nurture Health Solutions, Mumbai, Maharashtra, India
| | - Mini Joseph
- Department of Home Science, Government College for Women, Trivandrum, Kerala, India
| | - Anuja Agarwala
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajni Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Kapoor
- Deptartment of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.,NCD Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Aspi J Irani
- Department of Pediatrics, Nanavati Super Speciality Hospital, Mumbai, India.,Juvenile Diabetes Foundation, Maharashtra Chapter, Mumbai, Maharashtra, India
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26
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Aggarwal P, Sinha SK, Khanra D, Nath RK, Gujral J, Reddy KK, Mukherjee A. Comparison of original and modified Q risk 2 risk score with Framingham risk score - An Indian perspective. Indian Heart J 2021; 73:353-358. [PMID: 34154755 PMCID: PMC8322747 DOI: 10.1016/j.ihj.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE No study among Indian population has proposed modification of existing cardiovascular disease (CVD) risk scores or novel risk scores as risk estimation using conventional risk calculators can't be generalized because of epidemiological differences. MATERIAL AND METHODS A single center observational study was performed at a tertiary care center among participants having no evidence of CVD. Prevalence of various cardiac risk factors were analysed and 10-year risk was estimated using Framingham risk score (FRS), Q risk 2 score calculator (QRISK2) and Modified Q risk 2 (mQRISK2) which included smokeless tobacco consumption. QRISK2 and mQRISK2 were compared with FRS and participant's eligibility for statin therapy as primary preventive measure was assessed. RESULTS Total of 4045 participants were enrolled from August 2016 to July 2019. 3520(87%) had no history of smoking in their lifetime while smokeless tobacco consumption was seen in 1153(28.5%), diabetes in 422(10.4%), hypertension in 1096(27.1%), obesity in 2035(50.3%), and family history of CVD in 353(8.7%) participants. High risk participants were found to be 826(20.4%), 627(15.5%), and 509(12.6%) by using FRS, mQRISK2 and QRISK2, whereas those eligible for statin therapy were maximum by mQRISK2 among 1323(32.7%) participants compared to QRISK2 (n = 1191; 29.4%) and FRS (n = 826; 20.4%) model. Krippendorff's alpha for mQRISK2 was in better agreement with body mass index (BMI) and lipid FRS CVD scoring system as compared to QRISK2 risk model. CONCLUSION CVD risk stratification based on smokeless tobacco use is first of its kind from this part of world and should be part of CV risk assessment.
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27
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Riaz BK, Islam MZ, Islam ANMS, Zaman MM, Hossain MA, Rahman MM, Khanam F, Amin KMB, Noor IN. Risk factors for non-communicable diseases in Bangladesh: findings of the population-based cross-sectional national survey 2018. BMJ Open 2020; 10:e041334. [PMID: 33247026 PMCID: PMC7703434 DOI: 10.1136/bmjopen-2020-041334] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To determine the national prevalence of risk factors of non-communicable diseases (NCD) in the adult population of Bangladesh. DESIGN The study was a population-based national cross-sectional study. SETTING This study used 496 primary sampling units (PSUs) developed by the Bangladesh Bureau of Statistics. The PSUs were equally allocated to each division and urban and rural stratum within each division. PARTICIPANTS The participants were adults aged 18 to 69 years, who were usual residents of the households for at least 6 months and stayed the night before the survey. Out of 9900 participants, 8185 (82.7%) completed STEP-1 and STEP-2, and 7208 took part in STEP-3. PRIMARY AND SECONDARY OUTCOME The prevalence of behavioural, physical and biochemical risk factors of NCD. Data were weighted to generate national estimates. RESULTS Tobacco use was significantly (p<0.05) higher in the rural (45.2%) than the urban (38.8%) population. Inadequate fruit/vegetable intake was significantly (p<0.05) higher in the urban (92.1%) than in the rural (88.9%) population. The mean salt intake per day was higher in the rural (9.0 g) than urban (8.9 g) population. Among all, 3.0% had no, 70.9% had 1 to 2 and 26.2% had ≥3 NCD risk factors. The urban population was more likely to have insufficient physical activity (adjusted OR (AOR): 1.2, 95% CI: 1.2 to 1.2), obesity (AOR: 1.5, 95% CI: 1.5 to 1.5), hypertension (AOR: 1.3, 95% CI: 1.3 to 1.3), diabetes (AOR: 1.6, 95% CI: 1.6 to 1.6) and hyperglycaemia (AOR: 1.1, 95% CI: 1.1 to 1.1). CONCLUSIONS Considering the high prevalence of the behavioural, physical and biochemical risk factors, diverse population and high-risk group targeted interventions are essential to combat the rising burden of NCDs.
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Affiliation(s)
- Baizid Khoorshid Riaz
- Public Health and Hospital Administration, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Md Ziaul Islam
- Community Medicine, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - A N M Shamsul Islam
- Public Health and Hospital Administration, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - M M Zaman
- Country Office, Bangladesh, WHO Regional Office for South-East Asia, Dhaka, Bangladesh
| | - Md Akram Hossain
- Microbiology, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | | | - Fahmida Khanam
- Public Health and Hospital Administration, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - K M Bayzid Amin
- Public Health and Hospital Administration, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Irfan Nowroze Noor
- Public Health and Hospital Administration, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
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28
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Jayawardena R, Swarnamali H, Lanerolle P, Ranasinghe P. Effect of coconut oil on cardio-metabolic risk: A systematic review and meta-analysis of interventional studies. Diabetes Metab Syndr 2020; 14:2007-2020. [PMID: 33096510 DOI: 10.1016/j.dsx.2020.09.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS High total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) could be major risk factors for cardiovascular disease burden among high risk populations especially in South Asians. This systematic review and meta-analysis aimed to quantify the effects of coconut oil compared with other oils and fats on cardio-metabolic parameters. METHODS PubMed, Scopus and Web of Science were systematically searched. The main outcomes included are lipid and glycemic parameters. Subgroup analyses were performed to evaluate individual comparisons of vegetable oils and animal fat with coconut oil. Data were pooled using random-effects meta-analysis. RESULTS Coconut oil consumption significantly increased TC by 15.42 mg/dL (95% CI, 8.96-21.88, p < 0.001), LDL-C by 10.14 mg/dL (95% CI, 4.44-15.84, p < 0.001) and high density lipoprorein cholesterol (HDL-C) by 2.61 mg/dL (95% CI, 0.95-4.26, p = 0.002), and significantly decreased glycosylated hemoglobin (HbA1c) by 0.39 mg/dL (95% CI, -0.50 to -0.27, p < 0.001) but, it had no effects on triglycerides (TG), (4.25 mg/dL; 95% CI, -0.49-8.99, p = 0.08) when compared with the control group. Sub-group analysis demonstrated that coconut oil significantly increased TC and LDL-C over corn, palm, soybean and safflower oils and not over olive oil. Compared with butter, coconut oil showed a better pattern in cardio-metabolic markers by significantly increasing HDL-C (4.38 mg/dL, 95% CI, 0.40 to 8.36, p = 0.03) and decreasing LDL-C (-14.90 mg/dL, 95% CI, -23.02 to-6.77, p < 0.001). CONCLUSIONS Our results suggest that coconut oil consumption results in significantly higher TC, LDL-C and HDL-C than other oils. Consumption of coconut oil can be one of the risk factors for CVDs in South Asians.
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Affiliation(s)
- Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Hasinthi Swarnamali
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Pulani Lanerolle
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka
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29
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Manoj MT, Joseph KA, Vijayaraghavan G. Type D Personality and Myocardial Infarction: A Case-Control Study. Indian J Psychol Med 2020; 42:555-559. [PMID: 33354082 PMCID: PMC7735234 DOI: 10.1177/0253717620941157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is an impending global pandemic in developed countries as well as developing countries and economies in transition, such as India. A significant increase in the incidence of myocardial infarction (MI), one of the most common types of CHD, is being reported in India, and the incidence and severity of the disease are more among the youth in Kerala. Studies assessing the association between psychological factors and MI are few in India. METHODS We adopted a case-control study design. A total of 150 cases (with MI) and 150 controls (without MI and matched for age and gender) from a tertiary care hospital in Trivandrum, Kerala, India, were selected using convenient sampling method, between September 2016 and August 2017. RESULTS As compared to 33.3% of the controls, 50.7% of patients with MI had type D personality characteristics. Multivariate logistic regression analysis after adjusting for the confounders indicated a positive and statistically significant association between type D personality and MI: OR = 4.14, 95% CI = 2.19-8.85, P = 0.003. CONCLUSION Type D personality is associated with MI.
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Affiliation(s)
- M T Manoj
- Society for Continuing Medical Education and Research, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - K A Joseph
- Loyola College of Social Sciences, Trivandrum, Kerala, India
| | - Govindan Vijayaraghavan
- Society for Continuing Medical Education and Research, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.,Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
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30
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Sun YV, Liu C, Staimez L, Ali MK, Chang H, Kondal D, Patel S, Jones D, Mohan V, Tandon N, Prabhakaran D, Quyyumi AA, Narayan KMV, Agrawal A. Cardiovascular disease risk and pathophysiology in South Asians: can longitudinal multi-omics shed light? Wellcome Open Res 2020; 5:255. [DOI: 10.12688/wellcomeopenres.16336.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in South Asia, with rapidly increasing prevalence of hypertension, type 2 diabetes and hyperlipidemia over the last two decades. Atherosclerotic CVD (ASCVD) affects South Asians earlier in life and at lower body weights, which is not fully explained by differential burden of conventional risk factors. Heart failure (HF) is a complex clinical syndrome of heterogeneous structural phenotypes including two major clinical subtypes, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). The prevalence of HF in South Asians is also rising with other metabolic diseases, and HFpEF develops at younger age and leaner body mass index in South Asians than in Whites. Recent genome-wide association studies, epigenome-wide association studies and metabolomic studies of ASCVD and HF have identified genes, metabolites and pathways associated with CVD traits. However, these findings were mostly driven by samples of European ancestry, which may not accurately represent the CVD risk at the molecular level, and the unique risk profile of CVD in South Asians. Such bias, while formulating hypothesis-driven research studies, risks missing important causal or predictive factors unique to South Asians. Importantly, a longitudinal design of multi-omic markers can capture the life-course risk and natural history related to CVD, and partially disentangle putative causal relationship between risk factors, multi-omic markers and subclinical and clinical ASCVD and HF. In conclusion, combining high-resolution untargeted metabolomics with epigenomics of rigorous, longitudinal design will provide comprehensive unbiased molecular characterization of subclinical and clinical CVD among South Asians. A thorough understanding of CVD-associated metabolomic profiles, together with advances in epigenomics and genomics, will lead to more accurate estimates of CVD progression and stimulate new strategies for improving cardiovascular health.
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31
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Prakash B, Jaiswal A, Shah MM. Demographic & angiographic profile of young patients aged 40 year & less undergoing coronary angiography in a tier II city of Eastern India. J Family Med Prim Care 2020; 9:5183-5187. [PMID: 33409185 PMCID: PMC7773102 DOI: 10.4103/jfmpc.jfmpc_1063_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) and its complications are on an increasing trend in the younger age group. In this study, we aimed to identify the different risk factor profile and coronary angiographic characteristics of young adults presenting with coronary artery disease. METHODS We conducted this retrospective observational study at Tata Main Hospital, Jamshedpur, Jharkhand, for 5 years between April 2015 and March 2020. Inclusion criteria being patients admitted for acute coronary syndrome or chronic stable angina, aged ≤40 years, who underwent coronary angiography. Those below 40 years of age who underwent angiography in non-CAD (coronary artery disease) setting were excluded. RESULTS Among the 117 cases included in this study, 81.1% were males and 18.8% were females. Majority of cases, i.e., 52.2% were in the age group of 36-40 years. Risk factor evaluation showed hypertension as the major risk factor, present in 30.76% of patients, followed by diabetes mellitus in 21.36%, Dyslipidaemia was noted in 7.6%. History of smoking was present in 8.54%, history of smokeless tobacco use was in 7.69%, family history of CAD was noted in 9.4% of patients. Among 117 cases, SVD (single-vessel disease) was most prevalent, seen in 55.5% cases. 21.3% had normal or recanalized coronaries. Among SVD, LAD (Left anterior descending artery) was the most commonly involved vessel (80%). CONCLUSIONS Young patients with CAD are mainly males, and SVD in the form of LAD is more commonly involved. In this vulnerable age group, more emphasis should be given on diagnosis and management of risk factors.
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Affiliation(s)
- Binayendu Prakash
- Department of Cardiology, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Anurag Jaiswal
- Department of Cardiology, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Mandar M. Shah
- Department of Cardiology, Tata Main Hospital, Jamshedpur, Jharkhand, India
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32
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Patil RS, Shetty LH, Krishnan S, Trivedi AS, Raghu TR, Manjunath CN. Profile of coronary artery disease in indian rural youth (< 35 yrs). Indian Heart J 2020; 72:394-397. [PMID: 33189200 PMCID: PMC7670274 DOI: 10.1016/j.ihj.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/19/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022] Open
Abstract
AIMS To study the risk factors, clinical and angiographic profile of Indian rural youth (under 35yrs) presenting with Premature Coronary Artery Disease (PCAD). SUBJECTS and Methods: The PCAD registry had 1628 patients who were aged below 35 years, of which 681 patients satisfied the entry criteria. The data was analysed by statistical software R version 3.5.0. RESULTS The study enrolled 681 patients after satisfying the entry criteria. The mean age of patients was 30.85 years. There were 405 (59.5%) aged between 30 and 35 yrs, 205 (30.1%) between 25 and 30 yrs, 64 (9.4%) between 20 and 25 yrs and 7 (1.0%) were aged less than 20 yrs. Majority of them were males, 617 (90.6%). Nearly 411 (60.4%) were smokers, 56patients (8.2%) were diabetics and 97 (14.2%) were hypertensives. Around 441 (64.8%) patients had low HDL cholesterol levels and 218 (32.0%) had elevated triglyceride levels. Abdominal obesity was seen in 443 (65.1%) patients. Most common clinical presentation was ST elevation myocardial infarction (STEMI) seen in 536 (78.7%) patients. Around 40% patients had recanalized/non obstructive/thrombotic/normal coronaries on coronary angiogram. CONCLUSIONS Conventional risk factors such as smoking, low HDL levels and abdominal obesity play a major role in the causation of premature coronary artery disease among the rural youth. Thrombotic milieu in the coronaries was commonly noted in coronary angiograms. Lack of awareness, combined with urbanisation of rural lifestyle could be responsible for increasing incidence of premature coronary artery disease in rural youth.
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Affiliation(s)
- Rahul S Patil
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - Laxmi H Shetty
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - Shanmugam Krishnan
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - Anindya Sundar Trivedi
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - T R Raghu
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
| | - C N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
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Rathore S, Kumar B, Tehrani S, Khanra D, Duggal B, Chandra Pant D. Cardiac rehabilitation: Appraisal of current evidence and utility of technology aided home-based cardiac rehabilitation. Indian Heart J 2020; 72:491-499. [PMID: 33357636 PMCID: PMC7772588 DOI: 10.1016/j.ihj.2020.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses exercise training, health behaviour modification, medication adherence and psychological counselling to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, following coronary intervention, heart failure, or cardiac surgery. These are significantly underused, with only a minority of eligible patients participating in CR in India. Novel delivery strategies and CR endorsement by healthcare organizations are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). Differing from centre-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision. It is provided mostly or entirely outside of the traditional centre-based setting and could be facilitated by the aid of technology and web based applications. The purpose of this appraisal is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR. This appears to hold promise in expanding the use of CR to eligible patients. Additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and people in remote and rural areas. HBCR may be a reasonable option for a selected group of patients and could be a game changer in low- and middle-income countries who are eligible for CR.
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Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, Frimley Health NHS Foundation Trust, Camberley, Surrey, UK; Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shana Tehrani
- Department of Cardiology, Frimley Health NHS Foundation Trust, Camberley, Surrey, UK
| | - Dibbendhu Khanra
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhanu Duggal
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Dinesh Chandra Pant
- Department of Medicine, Krishna Hospital and Research Centre, Haldwani, Uttarakhand, India
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Madavanakadu Devassy S, Webber M, Scaria L, Amuthavalli Thiyagarajan J, Fendt-Newlin M, Joubert J, Benny AM, Nannatt A, Joubert L. Social and behavioural risk factors in the prevention and management of cardiovascular disease in Kerala, India: a catchment area population survey. BMC Cardiovasc Disord 2020; 20:327. [PMID: 32641078 PMCID: PMC7346640 DOI: 10.1186/s12872-020-01595-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality in India. Social and behavioural factors are strongly interrelated in the prevention and control of CVD. The ability to make lifestyle changes to control hypertension and diabetes (major risk factors for CVD) is determined by factors such as education, gender, caste, poverty, and urbanicity. This study aimed to improve our understanding of the inter-relationship of social and behavioural factors in the management of elevated serum glucose and high blood pressure and co-morbid mental health conditions. METHODS A population-based catchment area cross sectional survey was conducted in Kerala, India. Data were collected from residents aged over 30 years (n = 997) using standardized tools and clinical measures. We performed latent class analysis incrementally to extract homogeneous latent classes of individuals based on their responses to social and behavioural risk factors in the survey. Using structural equation models, we assessed the mediating effect of depression and anxiety, and social or behavioural risk factors, on management of high blood pressure and raised serum glucose levels. RESULTS The prevalence of high blood pressure and blood glucose in the sample was 33 and 26% respectively. Latent class analysis found three clusters of risk factors. One had a predominance of behavioural characteristics, another of social risk factors and the third was a low risk group. Age, female sex, and marital status had an effect on high blood pressure and high glucose, though were mediated by mental health, social and behavioural risk factors. CONCLUSIONS Interventions to improve the management of risk factors for CVD need to address social risk factors and be sensitive to the needs of population sub-groups that may require additional support to access health services. An integration of social and health services may be required to achieve this.
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Affiliation(s)
- Saju Madavanakadu Devassy
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
| | - Martin Webber
- International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, Heslington, YO10 5DD, UK.
| | - Lorane Scaria
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
| | - Jotheeswaran Amuthavalli Thiyagarajan
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Meredith Fendt-Newlin
- International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, Heslington, YO10 5DD, UK.,World Health Organization, Ankara, Turkey
| | | | - Anuja Maria Benny
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
| | - Anjana Nannatt
- Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India
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Gaidhane S, Khatib N, Zahiruddin QS, Bang A, Choudhari S, Gaidhane A. Cardiovascular disease risk assessment and treatment among person with type 2 diabetes mellitus at the primary care level in rural central India. J Family Med Prim Care 2020; 9:2033-2039. [PMID: 32670961 PMCID: PMC7346927 DOI: 10.4103/jfmpc.jfmpc_1192_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 12/25/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Despite evidence in support of assessment and treatment of risk factors to prevent cardiovascular disease (CVD) among people with type 2 diabetes mellitus (T2DM), studies have shown gaps in practises at the primary care level. The study was undertaken to find out the prevalence and management of risk factors for CVD in patients with T2DM from rural area India. METHODOLOGY A crosssectional study was conducted in a tertiary care hospital in rural India. Around 192 persons with T2DM over 35 years of age were interviewed and examined using a structured questionnaire to determine the presence of CVD risk factors, previous assessment and management of these risk factors. RESULTS The mean age was 58.91 (SD 11.30) years. Tobacco use and harmful consumption of alcohol were reported by 67.7% and 27%, respectively. Nearly 43.8% were doing moderateintensity physical activity, 2.1% were consuming more than 6 servings of green leafy vegetables/fruits per week, 22.9% were overweight and 5.2% were obese. A family history of CVD was present in 12.5%. About 75% of participants were having one or more risk factors for CVD, and a comprehensive CVD risk assessment was done by 15%. The most commonly assessed risk factor was blood pressure (84.3%) and blood sugar (40%). Around 30% were advised for weight reduction and 23.4% were advised to quit tobacco. Dietary counseling and diet plan were prepared for 17 (8.9%) participants. CONCLUSION Nearly threefourths were receiving treatment for hypertension. The majority of people with T2DM in rural areas had one or more CVD risk factors; however, very few were assessed and treated for CVD risk factors at the primary care level. Patient education and training of the diabetes care providers at the primary care level may be useful for comprehensive CVD risk assessment and treatment to prevent CVD complications in patients of T2DM.
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Affiliation(s)
- Shilpa Gaidhane
- Department of General Medicine, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
- Faculty in Clinical Epidemiology, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Nazli Khatib
- Physiology, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
- Evidence Synthesis, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Quazi Syed Zahiruddin
- Community Medicine, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
- Global Health, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Anand Bang
- Intern, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sonali Choudhari
- Community Medicine, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
- Coordinator MPH Program, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Abhay Gaidhane
- Community Medicine, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
- Social Epidemiology, School of Epidemiology and Public Health, Sawangi (Meghe), Wardha, Maharashtra, India
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Agrawal T, Fathima F, Nidhin P, Xavier D. Situational analysis of practice patterns and challenges in cardiovascular disease management: A qualitative study. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_55_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Patil R, Satvic CM, Shetty L, Natraj Setty HS, Komma S, Jain A, Raghu TR, Manjunath CN. Clinical and angiographic profile of premature heart attack in patients with family history of premature coronary heart disease: A substudy of the PCAD registry (Registered under the Clinical Trials Registry of India [CTRI/2018/03/012544]). Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_15_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nag K, Karmakar N, Ghosh B, Datta A. An Epidemiological Study on the Assessment of Cardiovascular Health Status among Adults in an Urban Area of Teliamura Municipality Area, Khowai, Tripura. Indian J Community Med 2019; 44:332-336. [PMID: 31802795 PMCID: PMC6881879 DOI: 10.4103/ijcm.ijcm_386_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: In India, cardiovascular disease (CVD) is the largest cause of mortality and morbidity in all regions of the country. Now, to reduce the burden of CVD in our country, we first need to assess cardiovascular health status of the adult population. Objective: The aim of this study is to assess cardiovascular health status among adults and to find the influence of sociodemographic factors on it. Methodology: In a cross-sectional study, cardiovascular health status of 100 sampled adult population of urban area of Teliamura Municipality area, Tripura, was assessed using a pre-designed and pre-tested semi-structured schedule from July 2017 to August 2017. Samples were taken from the adult population by simple random sampling. Collected data were compiled and analyzed using the Statistical Package for the Social Sciences (SPSS 16.0.). The Chi-square and Fisher's exact test were applied to find association. Results: The mean age of the study participants was 44.89 (±13.76) years, comprised 52.0% males and 48% females. Hypertension was seen among 58% of the study population and 77% had ideal (<100 mg/dl) level of fasting blood sugar (FBS). The present study showed obesity, hypertension, high level of total cholesterol, high level of FBS was mostly prevalent among 42–61 years age group. Married people were more obese, hypertensive compared to unmarried. Conclusion: Middle age group population were worst affected by high blood pressure, high blood sugar, poor body mass index, and poor level of cholesterol. Healthy lifestyle measures might reduce the burden of CVD which could be evaluated in future research.
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Affiliation(s)
- Kaushik Nag
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Nabarun Karmakar
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Bivek Ghosh
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Anjan Datta
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
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Ghose S, Ghosh S, Tanwar VS, Tolani P, Kutum R, Sharma A, Bhardwaj N, Shamsudheen K, Verma A, Jayarajan R, Dash D, Sivasubbu S, Scaria V, Seth S, Sengupta S. Investigating Coronary Artery Disease methylome through targeted bisulfite sequencing. Gene 2019; 721:144107. [DOI: 10.1016/j.gene.2019.144107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/02/2023]
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Mishra S, Perkins JM, Khan PK, Kim R, Mohanty SK, Subramanian SV. Variation in Chronic Diseases Across Households, Communities, Districts, and States in India. Am J Prev Med 2019; 57:721-731. [PMID: 31630764 DOI: 10.1016/j.amepre.2019.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Globally, chronic noncommunicable diseases are the leading cause of death and accounted for 6 million deaths in India in 2016. However, the extent to which variation in chronic disease can be attributed to different population levels in India is unknown, as is whether variation in individual-level factors explains outcome variation at different population levels. METHODS Cross-sectional data from the District Level Household and Facility Survey 2012-2013 conducted across 21 states, 275 districts, 14,235 villages, 378,487 households, and 1,098,940 individuals aged ≥18 years in India were analyzed in 2018‒2019. Multilevel logistic models were used to partition variation in outcomes and attribute it to individual, household, village, district and state population levels. Outcomes included experiencing respiratory, cardiovascular, musculoskeletal, or eye symptoms; reporting a positive diagnosis by a doctor for chronic heart disease, hypertension, diabetes, or vision problems; and objectively assessed real-time measures of hypertension and diabetes. RESULTS For reported diagnosis of hypertension or diabetes, a much larger percentage of variation in these outcomes was attributed to differences among households as compared to differences among units within other population levels. However, for objectively measured hypertension and diabetes, variation in these outcomes was important at the village level, followed by variation at the household level. Wealth status was positively associated with respiratory and cardiovascular symptoms, as well as all reported diagnoses and real-time measurements except for vision problems. Inclusion of individual-level sociodemographic variables explained 0%-30% of variation attributed to the household level for most chronic disease symptoms and diagnoses, but almost none at the higher levels. CONCLUSIONS These findings imply that household- and village-level factors explain substantial variation in the prevalence of chronic disease symptoms and reported diagnoses in India.
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Affiliation(s)
- Suyash Mishra
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee; Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Pijush Kanti Khan
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Rockli Kim
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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β-Glucan, a dietary fiber in effective prevention of lifestyle diseases – An insight. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.bcdf.2019.100187] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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The Young Myocardial Infarction Study of the Western Indians: YOUTH
Registry. Glob Heart 2019; 14:27-33. [DOI: 10.1016/j.gheart.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 11/06/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
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Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol 2019; 234:16812-16823. [PMID: 30790284 DOI: 10.1002/jcp.28350] [Citation(s) in RCA: 434] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/19/2022]
Abstract
Coronary artery disease (CAD) is one of the major cardiovascular diseases affecting the global human population. This disease has been proved to be the major cause of death in both the developed and developing countries. Lifestyle, environmental factors, and genetic factors pose as risk factors for the development of cardiovascular disease. The prevalence of risk factors among healthy individuals elucidates the probable occurrence of CAD in near future. Genome-wide association studies have suggested the association of chromosome 9p21.3 in the premature onset of CAD. The risk factors of CAD include diabetes mellitus, hypertension, smoking, hyperlipidemia, obesity, homocystinuria, and psychosocial stress. The eradication and management of CAD has been established through extensive studies and trials. Antiplatelet agents, nitrates, β-blockers, calcium antagonists, and ranolazine are some of the few therapeutic agents used for the relief of symptomatic angina associated with CAD.
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Affiliation(s)
- Arup Kr Malakar
- Department of Biotechnology, Assam University, Silchar, Assam, India
| | | | - Binata Halder
- Department of Biotechnology, Assam University, Silchar, Assam, India
| | - Prosenjit Paul
- Department of Biotechnology, Assam University, Silchar, Assam, India
| | - Arif Uddin
- Department of Zoology, Moinul Hoque Choudhury Memorial Science College, Hailakandi, Assam, India
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Albracht-Schulte K, Rosairo S, Ramalingam L, Wijetunge S, Ratnayake RMCJ, Kotakadeniya HMSRB, Dawson JA, Kalupahana NS, Moustaid-Moussa N. Obesity, adipocyte hypertrophy, fasting glucose, and resistin are potential contributors to nonalcoholic fatty liver disease in South Asian women. Diabetes Metab Syndr Obes 2019; 12:863-872. [PMID: 31354322 PMCID: PMC6573778 DOI: 10.2147/dmso.s203937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose: Nonalcoholic fatty liver disease (NAFLD) is often referred to as the hepatic manifestation of the metabolic syndrome. The relationship between body weight, NAFLD, and insulin resistance is not well characterized in humans. Additionally, it is unclear why South Asians develop these complications at lower levels of obesity compared to their Western counterparts. Patients and methods: To address this question, we performed a cross-sectional study using a convenience sample of Sri Lankan adult females (n=34) and collected anthropometric data, adipose tissue specimens (for histology), and fasted serum samples (for metabolic and inflammatory markers). Hepatic steatosis was assessed by ultrasound scanning and used to classify participants as NAFL 0, NAFL 1, and NAFL 2. Results: Waist circumference significantly increased with increasing NAFL grade. Participants with NAFL had significantly higher body mass index, hip circumference, and fasting plasma glucose, as well as a higher mean adipocyte area in both abdominal subcutaneous and visceral areas, indicating a higher degree of adipocyte hypertrophy associated with fatty liver. There were, however, no differences in measures of dyslipidemia. Of the multiple adipokines measured, resistin was the only proinflammatory adipokine significantly elevated in NAFL 2. Conclusion: These findings indicate that measures of adiposity, fasting serum glucose, and resistin may be important indicators of NAFLD in South Asian women.
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Affiliation(s)
- Kembra Albracht-Schulte
- Department of Nutritional Sciences and Obesity Research Institute, Texas Tech University, Lubbock, TX, USA
| | - Shanthini Rosairo
- Department of Radiology, University of Peradeniya, Peradeniya, Sri Lanka
| | - Latha Ramalingam
- Department of Nutritional Sciences and Obesity Research Institute, Texas Tech University, Lubbock, TX, USA
| | | | - RMCJ Ratnayake
- Department of Obstetrics and Gynecology, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - John A Dawson
- Department of Nutritional Sciences and Obesity Research Institute, Texas Tech University, Lubbock, TX, USA
| | - Nishan S Kalupahana
- Department of Nutritional Sciences and Obesity Research Institute, Texas Tech University, Lubbock, TX, USA
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Naima Moustaid-Moussa
- Department of Nutritional Sciences and Obesity Research Institute, Texas Tech University, Lubbock, TX, USA
- Correspondence: Naima Moustaid-MoussaDepartment of Nutritional Sciences, Obesity Research Institute, College of Human Sciences, Texas Tech University, 1301 Akron Street, Lubbock, TX79409-1270, USATel +1 806 834 7946Email
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Faiz Karnam A, Riyazuddeen M, Gopinath L, Iqbal N. Association of cardiovascular risk estimate with degree of atherosclerosis in patients with type 2 diabetes mellitus. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2019. [DOI: 10.4103/jcrsm.jcrsm_20_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ptushkina V, Jacobs E, Schipf S, Völzke H, Markus MRP, Nauck M, Meisinger C, Peters A, Maier W, Herder C, Roden M, Rathmann W. Regional differences of macrovascular disease in Northeast and South Germany: the population-based SHIP-TREND and KORA-F4 studies. BMC Public Health 2018; 18:1331. [PMID: 30509230 PMCID: PMC6276210 DOI: 10.1186/s12889-018-6265-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Previous studies found regional differences in the prevalence and incidence of type 2 diabetes between Northeast and South of Germany. The aim of this study was to investigate if regional variations are also present for macrovascular disease in people with type 2 diabetes and in the general population. A further aim was to investigate if traditional risk factors of macrovascular complications can explain these regional variations. METHODS Data of persons aged 30-79 from two regional population-based studies, SHIP-TREND (Northeast Germany, 2008-2012, n = 2539) and KORA-F4 (South Germany, 2006-2008, n = 2932), were analysed. Macrovascular disease was defined by self-reported previous myocardial infarction, stroke or coronary angiography. Multivariable logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for prevalence of macrovascular disease in persons with type 2 diabetes and in the general population. RESULTS The prevalence of macrovascular disease in persons with type 2 diabetes and in the general population was considerably higher in the Northeast (SHIP-TREND: 32.8 and 12.0%) than in the South of Germany (KORA-F4: 24.9 and 8.8%), respectively. The odds of macrovascular disease in persons with type 2 diabetes was 1.66 (95% CI: 1.11-2.49) in the Northeast in comparison to the South after adjustment for sex, age, body mass index, hypertension, hyperlipidemia and smoking. In the general population, SHIP-TREND participants also had a significantly increased odds of macrovascular disease compared to KORA-F4 participants (OR = 1.63, 95% CI: 1.33-2.00). After excluding coronary angiography (myocardial infarction or stroke only), the ORs for region decreased in all models, but the difference between SHIP-TREND and KORA-F4 participants was still significant in the age- and sex-adjusted model for the general population (OR = 1.34, 95% CI: 1.01-1.78). CONCLUSIONS This study provides an indication for regional differences in macrovascular disease, which is not explained by traditional risk factors. Further examinations of other risk factors, such as regional deprivation or geographical variations in medical care services are needed.
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Affiliation(s)
- Violetta Ptushkina
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Esther Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Marcello Ricardo Paulista Markus
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Matthias Nauck
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Reddy S, Kaur N, Singh J. A novel study to examine the association of PCSK9 rs505151 polymorphism and coronary artery disease in north Indian population. J Genet 2018; 97:1371-1378. [PMID: 30555085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is a drastic increase in the number of people suffering from coronary artery disease (CAD) worldwide with Indians being no exception. Being a developing country and experiencing a dramatic shift in lifestyle and eating habits, urbanization and industrialization, all these factors have collectively predisposed the Indian population towards CAD and the prevalence data arequite alarming. Genetic studies have disclosed the role of genes in CAD susceptibility and severity. One such gene is proprotein convertase subtilisin/kexin type 9 (PCSK9) which is sought to modulate the cholesterol levels and hence, has implications in CAD. We aim to explore the association of PCSK9 A/G (rs505151) polymorphism and hence, the susceptibility towards CAD in the north Indian population. Five-hundred angiographically confirmed CAD patients and 500 healthy individuals as control were genotyped by polymerase chain reaction-restriction fragment length polymorphism. Statistical analysis revealed a significant association with the G allele with odds ratio (OR)=1.50, 95% confidence interval (CI)=1.22-1.85 and P=0.000. Also, a strong association was observedfor CAD risk with OR=1.590, 95% CI=1.106-2.284 and P=0.012. However, the homozygous GG mutant genotype was found to be completely absent from our population. Analysis of the dominant model also revealed an association with CAD risk. Our work demonstrated for the first time the association of PCSK9 A/G (rs505151) polymorphism with CAD risk in the north Indian population.
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Affiliation(s)
- S Reddy
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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Gupta R, Khedar RS, Gaur K, Xavier D. Low quality cardiovascular care is important coronary risk factor in India. Indian Heart J 2018; 70 Suppl 3:S419-S430. [PMID: 30595301 PMCID: PMC6309144 DOI: 10.1016/j.ihj.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023] Open
Abstract
Global Burden of Disease study has reported that cardiovascular and ischemic heart disease (IHD) mortality has increased by 34% in last 25 years in India. It has also been reported that despite having lower coronary risk factors compared to developed countries, incident cardiovascular mortality, cardiovascular events and case-fatality are greater in India. Reasons for the increasing trends and high mortality have not been studied. There is evidence that social determinants of IHD risk factors are widely prevalent and increasing. Epidemiological studies have reported low control rates of hypertension, hypercholesterolemia, diabetes and smoking/tobacco. Registries have reported greater mortality of acute coronary syndrome in India compared to developed countries. Secondary prevention therapies have significant gaps. Low quality cardiovascular care is an important risk factor in India. Package of interventions focusing on fiscal, intersectoral and public health measures, improvement of health services at community, primary and secondary healthcare levels and appropriate referral systems to specialized hospitals is urgently required.
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Affiliation(s)
- Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Raghubir S Khedar
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Kiran Gaur
- Department of Statistics, SKN Agricultural University, Jobner, Jaipur, India
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore, India
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Reddy S, Kaur N, Singh J. A novel study to examine the association of PCSK9 rs505151 polymorphism and coronary artery disease in north Indian population. J Genet 2018. [DOI: 10.1007/s12041-018-1043-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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50
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Borges JMDM, de Carvalho FO, Gomes IA, Rosa MB, Sousa ACS. Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend? Ther Clin Risk Manag 2018; 14:1887-1895. [PMID: 30323611 PMCID: PMC6178938 DOI: 10.2147/tcrm.s172591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND When prescribing antiplatelet agents, physicians face the challenge of protecting patients from thromboembolic events without inducing bleeding damage. However, especially in the perioperative period, the use of these medications requires a carefully balanced assessment of their risks and benefits. OBJECTIVE To conduct a systematic review to check whether the antiplatelet agent is to be maintained or suspended in the perioperative period of noncardiac surgeries. SEARCH STRATEGY A comprehensive literature search using Science Direct, Scopus, MEDLINE-PubMed, and Web of Science was undertaken. SELECTION CRITERIA Clinical trials of noncardiac surgeries with patients taking regular anti-platelet therapy, published between 2013 and 2018. RESULTS A total of 1,302 studies were initially identified, with only four meeting the inclusion criteria. The selected studies were conducted in different countries such as, including India (2), Serbia (1), and the USA (1). The age group was similar in all studies, from 61 to 75 years. The most frequent surgery was related to tooth extraction and transurethral resection of bladder cancer. There was a group of patients who used single antiplatelet agents and groups who used single therapy and double therapy. Acetylsalicylic acid was the common drug in all studies. CONCLUSION It was concluded that the clinical trials were classified as good quality and that it was not necessary to suspend antiplatelet therapy prior to surgical procedures such as dental extraction and transurethral resection of bladder cancer. It should be noted that it is necessary to jointly evaluate the type of antiplatelet agent, the thrombotic risk of the patient, and the hemorrhagic risk of the surgical procedure.
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Affiliation(s)
- Juliana Maria Dantas Mendonça Borges
- Nucleus of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil,
- Nucleus of Pharmacy, Tiradentes University, Aracaju, Brazil,
| | | | - Isla Alcântara Gomes
- Nucleus of Post-Graduation in Pharmaceutical Sciences, Federal University of Sergipe, São Cristóvão, Brazil
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