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Zachariah G. Management of triglycerides, non-high density lipoprotein cholesterol and high density lipoprotein cholesterol. Indian Heart J 2024; 76 Suppl 1:S58-S64. [PMID: 37979723 PMCID: PMC11019318 DOI: 10.1016/j.ihj.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023] Open
Abstract
Dyslipidaemia characterised by elevated total cholesterol/LDL-C, triglyceride or both or decreased HDL-C is an important risk factor for the development of ASCVD. Atherogenic dyslipidaemia characterised by high TG, low HDL-C and elevated small dense LDL (sdLDL) is more prevalent in Asian Indians. Normal level of TG is generally considered as <150 mg/dl. Hypertriglyceridemia is closely associated with obesity, metabolic syndrome and diabetes mellitus. Goals of management of hypertriglyceridemia are to lower the risk of atherosclerotic cardiovascular events and reduce the risk of pancreatitis. Lifestyle modification is important. In severe hypertriglyceridemia, TG lowering pharmacotherapy is important to prevent pancreatitis. In mild to moderate hypertriglyceridemia, pharmacotherapy is employed only if associated with ASCVD or high risk factors and not controlled with lifestyle modifications and statins. Non-High Density Lipoprotein Cholesterol which estimates the cholesterol content of the atherogenic apoB containing lipoproteins, measured as total cholesterol minus HDL-C is equivalent to LDL-C in ASCVD risk assessment and superior to it in those with mild to moderate hypertriglyceridemia. Some international guidelines, have included measurement of non-HDL-C as primary therapeutic target for patients with ASCVD. Low HDL cholesterol is common in Indians. Despite evidence of inverse relationship between HDL-C and cardiovascular events, HDL-C as a causative factor for development of atherosclerosis is unproven. Therapeutic strategies directed at increasing HDL-C levels have not been shown to have cardiovascular benefits and hence HDL-C is currently not a target for drug-based treatment.
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Sawhney JP, Ramakrishnan S, Madan K, Ray S, Jayagopal PB, Prabhakaran D, Nair T, Zachariah G, Jain P, Dalal J, Radhakrishnan S, Chopra A, Kalra S, Mehta A, Pancholia AK, Kabra NK, Kahali D, Ghose T, Yadav S, Kerkar P, Yadav A, Roy D, Das MK, Bang VH, Rath PC, Sinha DP, Banerjee PS, Yadav R, Gupta R. CSI clinical practice guidelines for dyslipidemia management: Executive summary. Indian Heart J 2024; 76 Suppl 1:S6-S19. [PMID: 38052658 PMCID: PMC11019331 DOI: 10.1016/j.ihj.2023.11.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the 'CSI: Clinical Practice Guidelines for Dyslipidemia Management' published in this issue of the Indian Heart Journal. The summary is focused on the busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttransplant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also presented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the individual clinician judgement who remains the sole arbiter in management of the patient.
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Affiliation(s)
| | | | | | - Saumitra Ray
- Advanced Medical Research Institute (Dhakuria), Kolkata, West Bengal, India.
| | | | | | - Tiny Nair
- PRS Hospital, Trivandrum, Kerala, India.
| | | | - Peeyush Jain
- Fortis Escorts Heart Institute, New Delhi, India.
| | | | | | | | | | | | | | | | | | - Tapan Ghose
- Fortis Flt Lt Rajan Dhall Hospital, New Delhi, India.
| | | | | | - Ajay Yadav
- Sir Ganga Ram Hospital, New Delhi, India.
| | - Debabrata Roy
- NH- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India.
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre and the Calcutta Medical Research Institute (CMRI), Kolkata, India.
| | - Vijay H Bang
- Lilavati Hospital and Research centre, Mumbai, Maharashtra, India.
| | | | | | | | - Rakesh Yadav
- All India Institute of Medical Sciences, Delhi, India.
| | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India.
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B JP, S R, P MP, A J, K V, Das MK, K S, N S, Ezhilan J, Agarwal R, P R V, Choudhary AH, C B M, Malviya A, Gopi A, V K C, Joseph S, Goyal KK, John JF, Bansal S, S H, Nagula P, Joseph J, Bagawat A, Seth S, Shah U, Goel PK, Asokan PK, Sethi KK, Sharma S, Banerji LGA, Sikdar S, Agarwala M, Chandra S, Bharti B, Ashraf SM, Srivastava S, Kesavamoorthy B, Bali HK, Sarma D, Jain RK, Dani SI, Natesh BH, Chakraborty RN, Gupta V, Khanna NN, Mukhopadhyay D, Mandal S, Majumder B, L S, Girish MP, Das D, Devasia T, Vajifdar B, Bhatia T, Abdullah Z, Sharma S, Kumar S, Lincy M, Naik N, Kahali D, Sinha DP, Dastidar DG, Wander GS, Yadav R, Tewari S, Bhandari S, Chandra Rath P, Bang VH, Roy D, Banerjee P, Shanmugasundaram S, Zachariah G. Impact of COVID-19 on heart failure hospitalization and outcome in India - A cardiological society of India study (CSI-HF in COVID 19 times study - "The COVID C-HF study"). Indian Heart J 2023; 75:370-375. [PMID: 37652199 PMCID: PMC10568052 DOI: 10.1016/j.ihj.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. METHODS Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. RESULTS Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. CONCLUSION The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.
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Affiliation(s)
- Jayagopal P B
- Lakshmi Hospital, Chittur Road, Palakkad, Kerala, India.
| | - Ramakrishnan S
- All India Institute of Medical Sciences, New Delhi, India
| | - Mohanan P P
- West Fort Hi-Tech Hospital, Thrissur, Kerala, India
| | - Jabir A
- Lisie Hospital, Kochi, Kerala, India
| | - Venugopal K
- Pushpagiri Medical College, Thiruvalla, Kerala, India
| | - M K Das
- Birla Heart Research Centre and the Calcutta Medical Research Institute (CMRI), Kolkata, India
| | - Santhosh K
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, India
| | - Syam N
- District Hospital, Kollam, Kerala, India
| | - J Ezhilan
- Madras Medical Mission, Chennai, India
| | | | | | | | - Meena C B
- SMS Hospital, Jaipur, Rajasthan, India
| | | | - Arun Gopi
- Metromed International Cardiac Centre, Calicut, Kerala, India
| | | | - Stigi Joseph
- Little Flower Hospital & Research Centre, Angamaly, Kochi, Kerala, India
| | | | - John F John
- Baby Memorial Hospital, Calicut, Kerala, India
| | - Sandeep Bansal
- Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | | | | | | | - Sandeep Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - P K Asokan
- Fathima Hospital, Kozhikode, Kerala, India
| | - K K Sethi
- Delhi Heart & Lung Institute, Delhi, India
| | | | | | | | | | | | | | - S M Ashraf
- Sahakarana Hridayalaya, Pariyaram Medical College, Kannur, Kerala, India
| | | | | | | | | | | | | | - B H Natesh
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - Vivek Gupta
- Indraprastha Apollo Hospitals, New Delhi, India
| | | | | | - Subroto Mandal
- Ubuntu Heart & Super Speciality Hospital, Ubbuntu, Bhopal, India
| | | | - Sridhar L
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | | | - Tom Devasia
- Kasturba Medical College Manipal, Karnataka, India
| | - Bhavesh Vajifdar
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | - Zia Abdullah
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Mathew Lincy
- Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Dhiman Kahali
- M Birla Heart Research Centre, Kolkata, West Bengal, India
| | | | | | | | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - Debabrata Roy
- N H Rabindranatha Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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4
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Jabir A, Geevar Zachariah, Mohanan PP, Gupta MD, Ramakrishnan S, Meena CB, Sridhar L, Girish MP, Das DR, Gupta A, Praveen Nagula, Tom Devasia, Bhavesh Vajifdar, Kamlesh Thakkar, Urmil Shah, Tanuj Bhatia, Smit Srivastava, Sanjeev Sharma, Priya Kubendiran, Jayagopal PB, Sudeep Kumar, Deepthy Sadanandan, Lincy Mathew, Nitish Naik, Anup Banerji, Ashraf SM, Asokan PK, Bharti BB, Majumder B, Dhiman Kahali, Sinha DP, Sharma D, Dastidar DG, Dipankar Mukhapdhyay, Wander GS, Bali HK, Kesavamoorthy B, Agarwala MK, Khanna NN, Natesh BH, Goel PK, Chakraborty RN, Jain RK, Rakesh Yadav, Sameer Dani L, Satyavan Sharma, Satyendra Tewari, Sethi KK, Sharad Chandra, Mandal S, Bhandari S, Sikdar S, Vivek Gupta, Rath PC, Bang VH, Debabrata Roy, Das MK, Banerjee PS. COVID-19 infected ST-Elevation myocardial infarction in India (COSTA INDIA). Indian Heart J 2023; 75:243-250. [PMID: 37230465 PMCID: PMC10204278 DOI: 10.1016/j.ihj.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. METHODS This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. RESULTS 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) CONCLUSIONS: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.
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Affiliation(s)
| | | | | | | | | | | | - L Sridhar
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
| | | | | | | | | | - Tom Devasia
- Kasturba Medical College Manipal, Karnataka, India.
| | - Bhavesh Vajifdar
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | | | | | - Smit Srivastava
- Dr Bhim Rao Ambedhkar Memorial Hospital, Raipur, Chhattisgarh, India.
| | | | - Priya Kubendiran
- G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India.
| | | | - Sudeep Kumar
- Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | | | | | - Nitish Naik
- All India Institute of Medical Sciences, Delhi, India.
| | - Anup Banerji
- Medica Superspeciality Hospital, Kolkata, West Bengal, India.
| | - S M Ashraf
- Government Medical College, Kannur, Kerala, India.
| | - P K Asokan
- Fathima Hospital, Kozhikode, Kerala, India.
| | | | | | - Dhiman Kahali
- B M Birla Heart Research Centre, Kolkata, West Bengal, India.
| | | | - Dipak Sharma
- Christian Medical Centre Hospital, Jorht, Assam, India.
| | | | | | | | | | - B Kesavamoorthy
- Meenakshi Multispeciality Hospital, Trichy, Tamil Nadu, India.
| | | | | | - B H Natesh
- Sri Jayadeva Institute of Cardiovascular Science and Research, Bengaluru, Karnataka, India.
| | | | | | | | | | - L Sameer Dani
- Apollo CVHF Heart Institute, Ahmedabad, Gujarat, India.
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - K K Sethi
- Delhi Heart and Lung Institute, New Delhi, India.
| | - Sharad Chandra
- King George Medical University, Lucknow, Uttar Pradesh, India.
| | - Subrato Mandal
- Ubuntu Heart and Superspeciality Hospital, Bhopal, Madhya Pradesh, India.
| | | | | | | | | | | | - Debabrata Roy
- N H Rabindranatha Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India.
| | - Mrinal Kanti Das
- The Calcutta Medical Research Institute, Kolkata, West Bengal, India.
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5
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Koshy L, Vb R, M M, Ben MP, Kishor P, Sudhakaran PR, Abdullakutty J, Venugopal K, Zachariah G, Mohanan PP, Harikrishnan S, G S. Pharmacogenetic variants influence vitamin K anticoagulant dosing in patients with mechanical prosthetic heart valves. Pharmacogenomics 2022; 23:475-485. [PMID: 35608144 DOI: 10.2217/pgs-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Vitamin K antagonists (VKAs) are class I oral anticoagulants that are widely prescribed following surgical heart valve implantation. The objective of this study was to quantify the relative effects of VKORC1, CYP2C9 and CYP4F2 genotypes in predicting VKA dosing. Materials & methods: A total of 506 South Indian patients with mechanical prosthetic heart valves who were prescribed oral VKAs, such as warfarin or acenocoumarol, were genotyped. The discriminatory ability of mutant genotypes to predict dose categories and bleeding events was assessed using regression analysis. Results: The VKORC1 rs9923231, CYP2C9*3 and CYP4F2*3 mutant genotypes significantly influenced VKA-dose requirements and explained 27.47% of the observed dose variation. Conclusion: These results support pharmacogenetic screening for initial VKA dosing among South Indian patients with mechanical prosthetic heart valves.
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Affiliation(s)
- Linda Koshy
- Centre for Advanced Research & Excellence in Heart Failure, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Raghu Vb
- Inter-University Centre for Genomics & Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, Kerala, 695581, India
| | - Madhuma M
- Centre for Advanced Research & Excellence in Heart Failure, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Midhuna P Ben
- Inter-University Centre for Genomics & Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, Kerala, 695581, India
| | - Pritam Kishor
- Integrated Science Education & Research Centre, Visva-Bharati, Santineketan, West Bengal, 731235, India
| | - P R Sudhakaran
- Inter-University Centre for Genomics & Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, Kerala, 695581, India
| | | | - K Venugopal
- Department of Cardiology, Pushpagiri Hospital, Thiruvalla, Pathanamthitta, Kerala, 689101, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Hospital, Thrissur, Kerala, 680012, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi-Tech Hospital, Thrissur, Kerala, 680002, India
| | - S Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Sanjay G
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
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Zachariah G, Ramakrishnan S, Das MK, Jabir A, Jayagopal PB, Venugopal K, Mani K, Khan AK, Malviya A, Gupta A, Goyal A, Singh BP, Mohan B, Bharti BB, Majumder B, Wilson B, Karunadas CP, Meena CB, Manjunath CN, Cibu M, Roy D, Choudhary D, Das DR, Sarma D, Girish MP, Wander GS, Wardhan H, Ezhilan J, Tummala K, Katyal VK, Goswami K, Subramanyam K, Goyal KK, Kumar K, Pathak LA, Bansal M, Mandal M, Gupta MD, Khanna NN, Hanumanthappa NB, Bardoloi N, Modi N, Naik N, Hasija PK, Kerkar P, Bhattacharyya PJ, Gadkari P, Chakraborthy RN, Patil RR, Gupta R, Yadav R, Murty RS, Nath RK, Sivakumar R, Sethi R, Baruah R, Tyagi S, Guha S, Krishnappa S, Kumar S, Routray SN, Tewari S, Ray S, Reddy SS, Chandra S, Gupta SB, Chatterjee SS, Siddiqui KKH, Sivabalan M, Yerram S, Kumar S, Nagarajan S, Devasia T, Jadhav U, Narain VS, Garg VK, Gupta VK, Prabhakaran D, Deb PK, Mohanan PP. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic. Indian Heart J 2021; 73:413-423. [PMID: 34474751 PMCID: PMC8424286 DOI: 10.1016/j.ihj.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023] Open
Abstract
AIM Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. METHODS & RESULTS In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. CONCLUSIONS The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.
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Affiliation(s)
| | | | | | | | | | | | - Kalaivani Mani
- Dept. of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amit Malviya
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, India
| | | | | | - B P Singh
- Department of Cardiology, Indra Gandhi Institute of Medical Sciences, Patna, India
| | | | | | | | | | | | | | | | | | - Debabrata Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - Dipak Sarma
- Christian Medical Centre Hospital, Jorhat, India
| | | | | | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - Virender Kumar Katyal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kewal Goswami
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Manoranjan Mandal
- Department of Cardiology, Nil Ratan Sircar Medical College, Kolkata, India
| | | | | | | | | | | | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Rishi Sethi
- King George Medical University, Lucknow, India
| | | | - Sanjay Tyagi
- Department of Cardiology, GB Pant Hospital, New Delhi, India
| | | | - Santhosh Krishnappa
- Cardiology Department, Sri Jayadeva Institute of Cardiovascular Science and Research, Mysore, India
| | | | - Satya Narayan Routray
- Department of Cardiology, Srirama Chandra Bhanja Medical College and Hospital, Odissa, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | | | | | | | | | | | | | - Sreekanth Yerram
- Department of Cardiology, Nizam's Institute of Medical Science, Hyderabad, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Uday Jadhav
- Consultant in Cardiology Department, MGM New Bombay Hospital, Mumbai, India
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7
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Gupta K, Ramakrishnan S, Zachariah G, Rao JS, Mohanan PP, Venugopal K, Sateesh S, Sethi R, Jain D, Bardolei N, Mani K, Kakar TS, Jain V, Gupta P, Gupta R, Bansal S, Nath RK, Tyagi S, Wander GS, Gupta S, Mandal S, Senguttuvan NB, Subramanyam G, Roy D, Datta S, Ganguly K, Routray SN, Mishra SS, Singh BP, Bharti BB, Das MK, Deb PK, Deedwania P, Seth A. Impact of the 2017 ACC/AHA guidelines on the prevalence of hypertension among Indian adults: Results from a cross-sectional survey. Int J Cardiol Hypertens 2021; 7:100055. [PMID: 33465185 PMCID: PMC7803035 DOI: 10.1016/j.ijchy.2020.100055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background The impact of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for diagnosis and management of hypertension on the prevalence of hypertension in India is unknown. Methods We analyzed data from the Cardiac Prevent 2015 survey to estimate the change in the prevalence of hypertension. The JNC8 guidelines defined hypertension as a systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg. The 2017 ACC/AHA guidelines define hypertension as a systolic blood pressure of ≥130 mmHg or diastolic blood pressure of ≥80 mmHg. We standardized the prevalence as per the 2011 census population of India. We also calculated the prevalence as per the World Health Organization (WHO) World Standard Population (2000–2025). Results Among 180,335 participants (33.2% women), the mean age was 40.6 ± 14.9 years (41.1 ± 15.0 and 39.7 ± 14.7 years in men and women, respectively). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%) and 2,878 (1.6%) participants belonged to age group 18–19, 20–44, 45–54, 55–64, 65–74 and ≥ 75 years respectively. The prevalence of hypertension according to the JNC8 and 2017 ACC/AHA guidelines was 29.7% and 63.8%, respectively- an increase of 115%. With the 2011 census population of India, this suggests that currently, 486 million Indian adults have hypertension according to the 2017 ACC/AHA guidelines, an addition of 260 million as compared to the JNC8 guidelines. Conclusion According to the 2017 ACC/AHA guidelines, 3 in every 5 Indian adults have hypertension.
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Affiliation(s)
- Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.,Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Sivasubramanian Ramakrishnan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.,Cardiology Society of India, India
| | | | | | | | | | | | | | | | | | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vardhmaan Jain
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Prakash Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P K Deb
- Cardiology Society of India, India
| | - Prakash Deedwania
- School of Medicine, University of California, San Francisco Fresno, CA, USA
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8
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Bahuleyan CG, Namboodiri N, Jabir A, Lip GYH, Koshy A G, Shifas BM, Viswanathan S K, Zachariah G, Venugopal K, Punnose E, Natarajan KU, Mini GK, Joseph J, Nambiar C A, Jayagopal PB, Mohanan PP, George R, Unni G, Sajeev CG, Muhammed S, Syam N, Roby A, Daniel R, Krishnakumar VV, Pillai AM, Joseph S, Jinbert Lordson A. One-year clinical outcome of patients with nonvalvular atrial fibrillation: Insights from KERALA-AF registry. Indian Heart J 2020; 73:56-62. [PMID: 33714410 PMCID: PMC7961260 DOI: 10.1016/j.ihj.2020.11.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We report patient characteristics, treatment pattern and one-year clinical outcome of nonvalvular atrial fibrillation (NVAF) from Kerala, India. This cohort forms part of Kerala Atrial Fibrillation (KERALA-AF) registry which is an ongoing large prospective study. METHODS KERALA-AF registry collected data of adults with previously or newly diagnosed atrial fibrillation (AF) during April 2016 to April 2017. A total of 3421 patients were recruited from 53 hospitals across Kerala state. We analysed one-year follow-up outcome of 2507 patients with NVAF. RESULTS Mean age at recruitment was 67.2 years (range 18-98) and 54.8% were males. Main co-morbidities were hypertension (61.2%), hyperlipidaemia (46.2%) and diabetes mellitus (37.2%). Major co-existing diseases were chronic kidney disease (42.1%), coronary artery disease (41.6%), and chronic heart failure (26.4%). Mean CHA2DS2-VASc score was 3.18 (SD ± 1.7) and HAS-BLED score, 1.84 (SD ± 1.3). At baseline, use of oral anticoagulants (OAC) was 38.6% and antiplatelets 32.7%. On one-month follow-up use of OAC increased to 65.8% and antiplatelets to 48.3%. One-year all-cause mortality was 16.48 and hospitalization 20.65 per 100 person years. The main causes of death were cardiovascular (75.0%), stroke (13.1%) and others (11.9%). The major causes of hospitalizations were acute coronary syndrome (35.0%), followed by arrhythmia (29.5%) and heart failure (8.4%). CONCLUSIONS Despite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry.
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Affiliation(s)
- C G Bahuleyan
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India.
| | - Narayanan Namboodiri
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - A Jabir
- Lisie Heart Institute, Ernakulam, India
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom; Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - George Koshy A
- Medical College Hospital, Trivandrum, India 8Global Institute of Public Health, 6. Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Babu M Shifas
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Kartik Viswanathan S
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - K Venugopal
- Pushpagiri Medical College, Thiruvalla, India
| | | | - K U Natarajan
- Amrita Institute of Medical Sciences, Ernakulam, India
| | - G K Mini
- Global Institute of Public Health, Trivandrum, Kerala, India
| | | | | | | | - P P Mohanan
- West Fort Hi-Tech Hospital, Ponkunam, Thrissur, India
| | - Raju George
- Government Medical College Hospital, Kottayam, India
| | | | - C G Sajeev
- Government Medical College Hospital, Calicut, India
| | | | - N Syam
- General Hospital, Kollam, India
| | - Anil Roby
- Dr Damodaran Memorial Hospital, Kollam, India
| | - Rachel Daniel
- N S Memorial Institute of Medical Sciences, Kollam, India
| | - V V Krishnakumar
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Anand M Pillai
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Stigi Joseph
- Little Flower Hospital, M C Road, Angamali, India
| | - A Jinbert Lordson
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India; Global Institute of Public Health, Trivandrum, Kerala, India
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9
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Ramakrishnan S, Jabir A, Jayagopal PB, Mohanan PP, Nair VK, Das MK, Mandal M, Roy D, Reddy SS, Malviya A, Singh BP, Bharti BB, Majumder B, Karunadas CP, Meena CB, Girish MP, Ezhilan J, Tummala K, Katyal VK, Subramanyam K, Goyal KK, Kenchappa K, Gupta MD, Hanumanthappa NB, Bardoloi N, Modi N, Bhattacharyya PJ, Gadkari P, Patil RR, Murty RS, Baruah R, Krishnappa S, Kumar S, Routray S, Tewari S, Gupta SB, Maduramuthu S, Yerram S, Kumar S, Jadhav U, Manjunath CN, Prabhakaran D, Kerker P, Yadav R, Guha S, Deb PK, Zachariah G. Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design. Indian Heart J 2020; 72:541-546. [PMID: 33357642 PMCID: PMC7476577 DOI: 10.1016/j.ihj.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | - Manoranjan Mandal
- Department of Cardiology, Nil Ratan Sircar Medical College, Kolkatta, West Bengal, India
| | - Debabrata Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | | | - Amit Malviya
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, India
| | | | | | - Biswajit Majumder
- Department of Cardiology, RG Kar Medical College, Kolkata, West Bengal, India
| | | | | | | | | | | | - Virender Kumar Katyal
- Department of Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | | | | | | | | | | | | | - Nitin Modi
- Convenient Hospitals Ltd, Indore, Madhya Pradesh, India
| | | | - Pushkraj Gadkari
- Srikrishna Hrudayalaya & Critical Care Centre, Nagpur, Maharashtra, India
| | | | | | | | - Santhosh Krishnappa
- Sri Jayadeva Institute of Cardiovascular Science and Research, Mysore, Karnataka, India
| | | | - Satyanarayan Routray
- Department of Cardiology, Srirama Chandra Bhanja Medical College and Hospital, Odissa, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shashi Bhushan Gupta
- Asian Heart Institute & Ex-HOD, Medicine and Cardiology, C Rly HQ Hospital, Mumbai, Maharashtra, India
| | | | - Sreekanth Yerram
- Department of Cardiology, Nizam's Institute of Medical Science, Hyderabad, Telangana, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Uday Jadhav
- MGM New Bombay Hospital, Mumbai, Maharashtra, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, & Vice President, Public Health Foundation of India, Gurugram, India
| | - Prafulla Kerker
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | - Santanu Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
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10
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Chacko M, Sarma PS, Harikrishnan S, Zachariah G, Jeemon P. Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study. Wellcome Open Res 2020; 5:70. [PMID: 32518841 PMCID: PMC7256470 DOI: 10.12688/wellcomeopenres.15829.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7-17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Affiliation(s)
- Manas Chacko
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Heart Care, Mother Hospital, Thrissur, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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11
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Chacko M, Sarma PS, Harikrishnan S, Zachariah G, Jeemon P. Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study. Wellcome Open Res 2020; 5:70. [PMID: 32518841 PMCID: PMC7256470 DOI: 10.12688/wellcomeopenres.15829.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 03/30/2024] Open
Abstract
Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7-17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Affiliation(s)
- Manas Chacko
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Heart Care, Mother Hospital, Thrissur, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Charantharayil Gopalan B, Namboodiri N, Abdullakutty J, Lip GYH, Koshy AG, Krishnan Nair V, Babu S, Muhammed S, Azariah JL, George R, Nambiar A, Govindan U, Zachariah G, Kumaraswamy N, Chakanalil Govindan S, Natesan S, Roby A, Velayudhan Nair K, Pillai AM, Daniel R. Kerala Atrial Fibrillation Registry: a prospective observational study on clinical characteristics, treatment pattern and outcome of atrial fibrillation in Kerala, India, cohort profile. BMJ Open 2019; 9:e025901. [PMID: 31352410 PMCID: PMC6661577 DOI: 10.1136/bmjopen-2018-025901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Limited published data exist on the clinical epidemiology of atrial fibrillation (AF) in South Asia including India. Most of the published data are from the Western countries and the Far East. The Kerala AF registry was initiated to collect systematic, prospective data on clinical characteristics, risk factors, treatment pattern and outcomes of consecutive AF patients who consulted cardiologists across the state of Kerala, India. PARTICIPANTS All newly diagnosed and previously reported patients aged ≥18 years with documented evidence of AF on ECG were included. Patients with transient AF due to infection, acute myocardial infarction, alcohol intoxication, metabolic abnormalities and AF seen in postoperative cases and critically ill patients with life expectancy less than 30 days were excluded. FINDINGS TO DATE A total of 3421 patients were recruited from 53 hospitals across Kerala from April 2016 to April 2017. There were 51% (n=1744) women. The median age of the cohort was 65 (IQR 56-74) years. Hypertension, diabetes mellitus and dyslipidaemia were present in 53.8%, 34.5% and 42.2% patients, respectively. Chronic kidney disease was observed in 46.6%, coronary artery disease in 34.8% and heart failure (HF) in 26.5% of patients. Mean CHA2DS2-VASc score of the cohort was 2.9, and HAS-BLED score was 1.7. Detailed information of antithrombotic and antiarrhythmic drugs was collected at baseline and on follow-up. During 1-year follow-up, 443 deaths (12.9%) occurred of which 332 (9.7%) were cardiac death and 63 (1.8%) were due to stroke. There were 578 (16.8%) hospitalisations mainly due to acute coronary syndrome, arrythmias and HF. FUTURE PLANS Currently, this is the largest prospective study on AF patients from India, and the cohort will be followed for 5 years to observe the treatment patterns and clinical outcomes. The investigators encourage collaborations with national and international AF researchers. TRIAL REGISTRATION NUMBER CTRI/2017/10/010097.
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Affiliation(s)
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - Gregory YH Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Shifas Babu
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, India
| | | | - Jinbert Lordson Azariah
- Department of Clinical Research, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, India
- Department of Research, Global Institute of Public Health, Trivandrum, India
| | - Raju George
- Department of Cardiology, Geovernment Medical College Hospital, Kottayam, India
| | - Ashokan Nambiar
- Department of Cardiology, Baby Memorial Hospital, Calicut, India
| | - Unni Govindan
- Department of Cardiology, Jubilee Mission Hospital Trust, Thrissur, India
| | | | - Natarajan Kumaraswamy
- Department of Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | | | - Syam Natesan
- Department of Cardiology, Government General Hospital, Kollam, India
| | - Anil Roby
- Department of Cardiology, Dr. Damodaran Memorial Hospital, Kollam, India
| | | | - Anand M Pillai
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, India
| | - Rachel Daniel
- Department of Cardiology, NS Memorial Institute of Medical Sciences, Kollam, India
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Tandon N, Anjana RM, Mohan V, Kaur T, Afshin A, Ong K, Mukhopadhyay S, Thomas N, Bhatia E, Krishnan A, Mathur P, Dhaliwal RS, Shukla DK, Bhansali A, Prabhakaran D, Rao PV, Yajnik CS, Kumar GA, Varghese CM, Furtado M, Agarwal SK, Arora M, Bhardwaj D, Chakma JK, Cornaby L, Dutta E, Glenn S, Gopalakrishnan N, Gupta R, Jeemon P, Johnson SC, Khanna T, Kinra S, Kutz M, Muraleedharan P, Naik N, Odell CM, Oommen AM, Pandian JD, Parameswaran S, Pati S, Prasad N, Raju DS, Roy A, Sharma M, Shekhar C, Shukla SR, Singh NP, Thakur JS, Unnikrishnan R, Varughese S, Xavier D, Zachariah G, Lim SS, Naghavi M, Dandona R, Vos T, Murray CJL, Reddy KS, Swaminathan S, Dandona L. The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health 2018; 6:e1352-e1362. [PMID: 30219315 PMCID: PMC6227383 DOI: 10.1016/s2214-109x(18)30387-5] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/18/2018] [Accepted: 08/10/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016. METHODS We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates. FINDINGS The number of people with diabetes in India increased from 26·0 million (95% UI 23·4-28·6) in 1990 to 65·0 million (58·7-71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9-6·1) in 1990 to 7·7% (6·9-8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1-46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6-49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7-9·3) in 1990 to 20·4% (19·9-20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34-42) with diabetes, compared with the global average of 19 adults (17-21) in 2016. INTERPRETATION The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation. FUNDING Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Dicker D, Nguyen G, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdollahpour I, Abdulkader RS, Abdurahman AA, Abebe HT, Abebe M, Abebe Z, Abebo TA, Aboyans V, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya P, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshin A, Agarwal G, Aggarwal R, Aghayan SA, Agrawal S, Agrawal A, Ahmadi M, Ahmadi A, Ahmadieh H, Ahmed MLCB, Ahmed S, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alebel A, Aleman AV, Alene KA, Al-Eyadhy A, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen CA, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Anlay DZ, Ansari H, Ansariadi A, Ansha MG, Antonio CAT, Appiah SCY, Aremu O, Areri HA, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asadi-Lari M, Asayesh H, Asfaw ET, Asgedom SW, Assadi R, Ataro Z, Atey TMM, Athari SS, Atique S, Atre SR, Atteraya MS, Attia EF, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Awuah B, Ayala Quintanilla BP, Ayele HT, Ayele Y, Ayer R, Ayuk TB, Azzopardi PS, Azzopardi-Muscat N, Badali H, Badawi A, Balakrishnan K, Bali AG, Banach M, Banstola A, Barac A, Barboza MA, Barquera S, Barrero LH, Basaleem H, Bassat Q, Basu A, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Belay AG, Belay E, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhala N, Bhatia E, Bhatt S, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bililign N, Bin Sayeed MS, Birlik SM, Birungi C, Bisanzio D, Biswas T, Bjørge T, Bleyer A, Basara BB, Bose D, Bosetti C, Boufous S, Bourne R, Brady OJ, Bragazzi NL, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Britton G, Brugha T, Burke KE, Busse R, Butt ZA, Cahuana-Hurtado L, Callender CSKH, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car M, Cárdenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Çavlin A, Cerin E, Chaiah Y, Champs AP, Chang HY, Chang JC, Chattopadhyay A, Chaturvedi P, Chen W, Chiang PPC, Chimed-Ochir O, Chin KL, Chisumpa VH, Chitheer A, Choi JYJ, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Cohen AJ, Collado-Mateo D, Constantin MM, Conti S, Cooper C, Cooper LT, Cortesi PA, Cortinovis M, Cousin E, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Cucu A, Cunningham M, Daba AK, Dachew BA, Dadi AF, Dandona L, Dandona R, Dang AK, Dargan PI, Daryani A, Das SK, Das Gupta R, das Neves J, Dasa TT, Dash AP, Weaver ND, Davitoiu DV, Davletov K, Dayama A, Courten BD, De la Hoz FP, De leo D, De Neve JW, Degefa MG, Degenhardt L, Degfie TT, Deiparine S, Dellavalle RP, Demoz GT, Demtsu BB, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dhimal M, Ding EL, Djalalinia S, Doku DT, Dolan KA, Donnelly CA, Dorsey ER, Douwes-Schultz D, Doyle KE, Drake TM, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Edessa D, Edvardsson D, Eggen AE, El Bcheraoui C, El Sayed Zaki M, Elfaramawi M, El-Khatib Z, Ellingsen CL, Elyazar IRF, Enayati A, Endries AYY, Er B, Ermakov SP, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Esteghamati S, Fakhar M, Fakhim H, Farag T, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Fazeli MS, Feigin VL, Feigl AB, Feizy F, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Feyissa GT, Fijabi DO, Filip I, Finegold S, Fischer F, Flor LS, Foigt NA, Ford JA, Foreman KJ, Fornari C, Frank TD, Franklin RC, Fukumoto T, Fuller JE, Fullman N, Fürst T, Furtado JM, Futran ND, Galan A, Gallus S, Gambashidze K, Gamkrelidze A, Gankpe FG, Garcia-Basteiro AL, Garcia-Gordillo MA, Gebre T, Gebre AK, Gebregergs GB, Gebrehiwot TT, Gebremedhin AT, Gelano TF, Gelaw YA, Geleijnse JM, Genova-Maleras R, Gessner BD, Getachew S, Gething PW, Gezae KE, Ghadami MR, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghiasvand H, Ghimire M, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Giussani G, Goenka S, Goli S, Gomez RS, Gomez-Cabrera MC, Gómez-Dantés H, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Goulart BNG, Grada A, Grosso G, Gugnani HC, Guimaraes ALS, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haririan H, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hay RJ, Hay SI, He Y, Hedayatizadeh-Omran A, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henok A, Henry NJ, Heredia-Pi I, Herteliu C, Heydarpour F, Heydarpour P, Heydarpour S, Hibstu DT, Hoek HW, Hole MK, Homaie Rad E, Hoogar P, Horino M, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc S, Hostiuc M, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Husseini A, Hussen MM, Hutfless S, Iburg KM, Igumbor EU, Ikeda CT, Ilesanmi OS, Iqbal U, Irvani SSN, Isehunwa OO, Islam SMS, Islami F, Jahangiry L, Jahanmehr N, Jain R, Jain SK, Jakovljevic M, James SL, Javanbakht M, Jayaraman S, Jayatilleke AU, Jee SH, Jeemon P, Jha RP, Jha V, Ji JS, Johnson SC, Jonas JB, Joshi A, Jozwiak JJ, Jungari SB, Jürisson M, K M, Kabir Z, Kadel R, Kahsay A, Kahssay M, Kalani R, Kapil U, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Karimi-Sari H, Kasaeian A, Kassa GM, Kassa TD, Kassa ZY, Kassebaum NJ, Katibeh M, Katikireddi SV, Kaul A, Kawakami N, Kazemeini H, Kazemi Z, Karyani AK, K C P, Kebede S, Keiyoro PN, Kemp GR, Kengne AP, Keren A, Kereselidze M, Khader YS, Khafaie MA, Khajavi A, Khalid N, Khalil IA, Khan EA, Khan G, Khan MS, Khan MA, Khang YH, Khanna T, Khater MM, Khatony A, Khazaie H, Khoja AT, Khosravi A, Khosravi MH, Khubchandani J, Kiadaliri AA, Kibret GDD, Kim CI, Kim D, Kim JY, Kim YE, Kimokoti RW, Kinfu Y, Kinra S, Kisa A, Kissimova-Skarbek K, Kissoon N, Kivimäki M, Kleber ME, Knibbs LD, Knudsen AKS, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosek MN, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krishnaswami S, Kuate Defo B, Kucuk Bicer B, Kudom AA, Kuipers EJ, Kulikoff XR, Kumar GA, Kumar M, Kumar P, Kumsa FA, Kutz MJ, Lad SD, Lafranconi A, Lal DK, Lalloo R, Lam H, Lami FH, Lan Q, Langan SM, Lansingh VC, Lansky S, Larson HJ, Laryea DO, Lassi ZS, Latifi A, Lavados PM, Laxmaiah A, Lazarus JV, Lebedev G, Lee PH, Leigh J, Leshargie CT, Leta S, Levi M, Li S, Li Y, Li X, Liang J, Liang X, Liben ML, Lim LL, Lim SS, Limenih MA, Linn S, Liu S, Liu Y, Lodha R, Logroscino G, Lonsdale C, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Lyons RA, Ma S, Mabika C, Macarayan ERK, Mackay MT, Maddison ER, Maddison R, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malik MA, Malta DC, Mamun AA, Manamo WA, Manda AL, Mansournia MA, Mantovani LG, Mapoma CC, Marami D, Maravilla JC, Marcenes W, Marina S, Martinez-Raga J, Martins SCO, Martins-Melo FR, März W, Marzan MB, Mashamba-Thompson TP, Masiye F, Massenburg BB, Maulik PK, Mazidi M, McGrath JJ, McKee M, Mehata S, Mehendale SM, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mekonen T, Mekonnen TC, Meles HG, Meles KG, Melese A, Melku M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezgebe HB, Miangotar Y, Miazgowski B, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Misganaw AT, Moazen B, Moges NA, Mohammad KA, Mohammadi M, Mohammadifard N, Mohammadi-Khanaposhtani M, Mohammadnia-Afrouzi M, Mohammed S, Mohammed MA, Mohan V, Mokdad AH, Molokhia M, Monasta L, Moradi G, Moradi M, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosapour A, Moschos MM, Mousavi SM, Muche AA, Muchie KF, Mueller UO, Mukhopadhyay S, Mullany EC, Muller K, Murhekar M, Murphy TB, Murthy GVS, Murthy S, Musa J, Musa KI, Mustafa G, Muthupandian S, Nachega JB, Nagel G, Naghavi M, Naheed A, Nahvijou A, Naik G, Nair S, Najafi F, Nangia V, Nansseu JR, Nascimento BR, Nawaz H, Ncama BP, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngalesoni FN, Ngunjiri JW, Nguyen HT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen TH, Ningrum DNA, Nirayo YL, Nisar MI, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Ofori-Asenso R, Ogah OS, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olusanya BO, Olusanya JO, Ong SK, Opio JN, Oren E, Ortiz JR, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, Oyekale AS, P A M, Pacella R, Pakhale S, Pakhare AP, Pana A, Panda BK, Panda-Jonas S, Pandey AR, Pandian JD, Parisi A, Park EK, Parry CDH, Parsian H, Patel S, Patle A, Patten SB, Patton GC, Paudel D, Pearce N, Peprah EK, Pereira A, Pereira DM, Perez KM, Perico N, Pervaiz A, Pesudovs K, Petri WA, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pirsaheb M, Pishgar F, Plass D, Polinder S, Pond CD, Popova S, Postma MJ, Pourmalek F, Pourshams A, Poustchi H, Prabhakaran D, Prakash V, Prakash S, Prasad N, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rahman SU, Rai RK, Rajati F, Rajsic S, Raju SB, Ram U, Ranabhat CL, Ranjan P, Ranta A, Rasella D, Rawaf DL, Rawaf S, Ray SE, Razo-García C, Rego MAS, Rehm J, Reiner RC, Reinig N, Reis C, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezaeian S, Rezai MS, Riahi SM, Ribeiro ALP, Riojas H, Rios-Blancas MJ, Roba KT, Robinson SR, Roever L, Ronfani L, Roshandel G, Roshchin DO, Rostami A, Rothenbacher D, Rubagotti E, Ruhago GM, Saadat S, Sabde YD, Sachdev PS, Saddik B, Sadeghi E, Moghaddam SS, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salahshoor MR, Salam N, Salama JS, Salamati P, Saldanha RDF, Salimi Y, Salimzadeh H, Salz I, Sambala EZ, Samy AM, Sanabria J, Sanchez-Niño MD, Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Savic M, Sawant AR, Sawhney M, Saxena S, Sayyah M, Scaria V, Schaeffner E, Schelonka K, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Shabaninejad H, Shackelford KA, Shafieesabet A, Shaheen AA, Shaikh MA, Shakir RA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma M, Sharma J, Sharma R, She J, Sheikh A, Sheth KN, Shi P, Shibuya K, Shifa GT, Shiferaw MS, Shigematsu M, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shrime MG, Shukla SR, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silpakit N, Silva DAS, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh V, Sinha AP, Sinha DN, Sitas F, Skirbekk V, Sliwa K, Soares Filho AM, Sobaih BH, Sobhani S, Soofi M, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Srivastava RK, Starodubov VI, Stathopoulou V, Steel N, Stein DJ, Steiner C, Stewart LG, Stokes MA, Sudaryanto A, Sufiyan MB, Sulo G, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylaja PN, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Takahashi K, Tandon N, Tassew AA, Tassew SG, Tavakkoli M, Taveira N, Tawye NY, Tehrani-Banihashemi A, Tekalign TG, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teshale MY, Tessema B, Teweldemedhin M, Thakur JS, Thankappan KR, Thirunavukkarasu S, Thomas LA, Thomas N, Thrift AG, Tilahun B, To QG, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Tripathi S, Tripathy SP, Truelsen TC, Truong NT, Tsadik AG, Tsilimparis N, Tudor Car L, Tuzcu EM, Tyrovolas S, Ukwaja KN, Ullah I, Usman MS, Uthman OA, Uzun SB, Vaduganathan M, Vaezi A, Vaidya G, Valdez PR, Varavikova E, Varughese S, Vasankari TJ, Vasconcelos AMN, Venketasubramanian N, Vidavalur R, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Vosoughi K, Vujcic IS, Wagner GR, Wagnew FWS, Waheed Y, Wang Y, Wang YP, Wassie MM, Weiderpass E, Weintraub RG, Weiss DJ, Weiss J, Weldegebreal F, Weldegwergs KG, Werdecker A, Westerman R, Whiteford HA, Widecka J, Widecka K, Wijeratne T, Winkler AS, Wiysonge CS, Wolfe CDA, Wondemagegn SA, Wu S, Wyper GMA, Xu G, Yadav R, Yakob B, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Ye P, Yearwood JA, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, York HW, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zachariah G, Zadnik V, Zafar S, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeeb H, Zeleke MM, Zenebe ZM, Zerfu TA, Zhang K, Zhang X, Zhou M, Zhu J, Zodpey S, Zucker I, Zuhlke LJJ, Lopez AD, Gakidou E, Murray CJL. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1684-1735. [PMID: 30496102 PMCID: PMC6227504 DOI: 10.1016/s0140-6736(18)31891-9] [Citation(s) in RCA: 575] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. FUNDING Bill & Melinda Gates Foundation.
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Harikrishnan S, Sarma S, Sanjay G, Jeemon P, Krishnan MN, Venugopal K, Mohanan PP, Jeyaseelan L, Thankappan KR, Zachariah G. Prevalence of metabolic syndrome and its risk factors in Kerala, South India: Analysis of a community based cross-sectional study. PLoS One 2018; 13:e0192372. [PMID: 29584725 PMCID: PMC5870937 DOI: 10.1371/journal.pone.0192372] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Coronary Artery Disease (CAD) is a leading cause of death and disability in Kerala, India. Metabolic syndrome (MS) is a constellation of established risk factors for CAD. We aimed to estimate the prevalence of MS and evaluate the association between MS and CAD using a community-based sample population. METHODS A cross-sectional community based survey was conducted in urban and rural areas of Kerala in 2011. We included 5063 individuals for analysis. Age standardized prevalence of MS, associated diagnoses (hypertension, diabetes and hypercholesterolemia) and other potential risk factors were assessed for men and women in both urban and rural locations. Univariate and multivariate logistic regression models were developed to identify participant characteristics that are associated with MS. RESULTS After standardization for age and adjustment for sex and urban-rural distribution, the prevalence of metabolic syndrome in Kerala was 24%, 29% and 33% for the NCEP ATP III, IDF and AHA/NHLBI Harmonization definitions, respectively. The mean (SD) age of the participants was 51 (14) years, and 60% were women. Women had a higher prevalence of MS than men (28% versus 20% for ATP III, p<0.001). Similarly, participants living in urban areas had higher prevalence of MS than their rural counterparts (26% versus 22%, p<0.001). Elevated body mass index, older age, and female sex were associated with MS in an adjusted multivariate model. The propensity for definite CAD was 1.7 times higher in individuals with MS defined based on ATP III criteria compared to those without MS (Adjusted OR = 1.69; 95% CI: 1.3-2.2, p<0.001). CONCLUSIONS One of four to one of three adult individuals in Kerala have MS based on different criteria. Higher propensity for CAD in individuals with MS in Kerala calls for urgent steps to prevent and control the burden of metabolic conditions.
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Affiliation(s)
- S. Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Smitha Sarma
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - G. Sanjay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - P. Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - M. N. Krishnan
- Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - K. Venugopal
- Department of Cardiology, Pushpagiri Hospital, Tiruvalla, Kottayam, Kerala, India
| | - P. P. Mohanan
- Department of Cardiology, Westfort High-tech Hospital, Thrissur, Kerala, India
| | - L. Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - K. R. Thankappan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - G. Zachariah
- Department of Cardiology, Mother Hospital, Thrissur, Kerala, India
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Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, Ramakrishnan S, Yadav R, Chaudhary G, Kapoor A, Mahajan A, Sinha AK, Mullasari A, Pradhan A, Banerjee AK, Singh BP, Balachander J, Pinto B, Manjunath CN, Makhale C, Roy D, Kahali D, Zachariah G, Wander GS, Kalita HC, Chopra HK, Jabir A, Tharakan J, Paul J, Venogopal K, Baksi KB, Ganguly K, Goswami KC, Somasundaram M, Chhetri MK, Hiremath MS, Ravi MS, Das MK, Khanna NN, Jayagopal PB, Asokan PK, Deb PK, Mohanan PP, Chandra P, Girish CR, Rabindra Nath O, Gupta R, Raghu C, Dani S, Bansal S, Tyagi S, Routray S, Tewari S, Chandra S, Mishra SS, Datta S, Chaterjee SS, Kumar S, Mookerjee S, Victor SM, Mishra S, Alexander T, Samal UC, Trehan V. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J 2017; 69 Suppl 1:S63-S97. [PMID: 28400042 PMCID: PMC5388060 DOI: 10.1016/j.ihj.2017.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Rishi Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Vinay K Bahl
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Prafula Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Aditya Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Mahajan
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, West Bengal, India
| | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - J Balachander
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Brian Pinto
- Holy family Hospital, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jaydeva Institute of Cardiovascular Sciences & Research, Bangaluru, Karnataka, India
| | | | | | - Dhiman Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - H C Kalita
- Assam Medical College, Dibrugarh, Assam, India
| | | | - A Jabir
- Lisie Hospital, Kochi, Kerala, India
| | - JagMohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Justin Paul
- Madras Medical College, Chennai, Tamil Nadu, India
| | - K Venogopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - K B Baksi
- Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Kewal C Goswami
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - M K Chhetri
- IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | | | - M S Ravi
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | | | - P K Asokan
- The Fatima Hospital, Calicut, Kerala, India
| | - P K Deb
- ESI Hospital, Manicktala, Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - Col R Girish
- Command Hospital, Central Command, Lucknow, India
| | - O Rabindra Nath
- Apollo Gleneagles Heart Institute, Kolkata, West Bengal, India
| | | | - C Raghu
- Prime Hospitals, Hyderabad, India
| | | | | | - Sanjay Tyagi
- GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - S S Chaterjee
- Indra Gandhi Institute of Cardiology, Patna, Bihar, India
| | - Soumitra Kumar
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - Sundeep Mishra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Vijay Trehan
- Indo-US Super Speciality Hospital, Hyderabad, India
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Zachariah G, Padinharepurayil M, Narayanan KM. A Kerala model for cardiovascular research? Indian Heart J 2016; 68:862-865. [PMID: 27931560 PMCID: PMC5143809 DOI: 10.1016/j.ihj.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/22/2016] [Accepted: 06/07/2016] [Indexed: 11/18/2022] Open
Abstract
India's contribution to cardiovascular research has been dismal with a share of only 1% of total number of papers published in the world during the period 1999–2008. Based on two recent studies published from Kerala, the Kerala ACS Registry and the CSI Kerala CRP Study and four other studies being undertaken in Kerala, we think that a Kerala model for cardiovascular research can be conceptualized. This model which consists of funding by professional organization of cardiologists with wide participation of cardiologists, physicians, health workers, nurses, and in some situations general public, logistics looked after by a central coordinator and study design by panel of experts or institutions of repute in the region and carried out at low cost can be considered for implementation in rest of India. Studies based on such a model may change practice pattern of cardiovascular diseases in India.
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Krishnan MN, Zachariah G, Venugopal K, Mohanan PP, Harikrishnan S, Sanjay G, Jeyaseelan L, Thankappan KR. Prevalence of coronary artery disease and its risk factors in Kerala, South India: a community-based cross-sectional study. BMC Cardiovasc Disord 2016; 16:12. [PMID: 26769341 PMCID: PMC4712491 DOI: 10.1186/s12872-016-0189-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no recent data on prevalence of coronary artery disease (CAD) in Indians. The last community based study from Kerala, the most advanced Indian state in epidemiological transition, was in 1993 that reported 1.4% definite CAD prevalence. We studied the prevalence of CAD and its risk factors among adults in Kerala. METHODS In a community-based cross sectional study, we selected 5167 adults (mean age 51 years, men 40.1%) using a multistage cluster sampling method. Information on socio-demographics, smoking, alcohol use, physical activity, dietary habits and personal history of hypertension, diabetes, and CAD was collected using a structured interview schedule. Anthropometry, blood pressure, electrocardiogram, and biochemical investigations were done using standard protocols. CAD and its risk factors were defined using standard criteria. Comparisons of age adjusted prevalence were done using two tailed proportion tests. RESULTS The overall age-adjusted prevalence of definite CAD was 3.5%: men 4.8%, women 2.6% (p < 0.001). Prevalence of any CAD was 12.5%: men 9.8%, women 14.3% (p < 0.001). There was no difference in definite CAD between urban and rural population. Physical inactivity was reported by 17.5 and 18% reported family history of CAD. Other CAD risk factors detected in the study were: overweight or obese 59%, abdominal obesity 57%, hypertension 28%, diabetes 15%, high total cholesterol 52% and low level of high density lipoprotein cholesterol 39%. Current smoking was reported only be men (28%). CONCLUSION The prevalence of definite CAD in Kerala increased nearly three times since 1993 without any difference in urban and rural areas. Most risk factors of CAD were highly prevalent in the state. Both population and individual level approaches are warranted to address the high level of CAD risk factors to reduce the increasing prevalence of CAD in this population.
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Affiliation(s)
- M N Krishnan
- Govt. Medical College, Kozhikode, Kerala, India.
| | | | - K Venugopal
- Pushpagiri Hospital, Tiruvalla, Kottayam, Kerala, India.
| | - P P Mohanan
- Westfort High-tech Hospital, Thrissur, Kerala, India.
| | - S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - G Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College, P.O. 695011, Thiruvananthapuram, Kerala, India.
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Sivaraman SK, Zachariah G, Annamala P. Effect of Smoking on Metalloproteinases (MMPs) Activity in Patients with Acute Myocardial Infarction (AMI). J Clin Diagn Res 2014; 8:27-30. [PMID: 24701473 DOI: 10.7860/jcdr/2014/7052.3998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 12/19/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Many risk factors are involved in the course and pathogenesis of Acute Myocardial Infarction (AMI). Smoking can significantly increase the AMI mortality and morbidity. Matrix metalloproteinases (MMPs), a class of Zn containing enzymes, are involved in the erosion of the fibrous cap and rupture of the plaque which leads to AMI. AIM To evaluate the activity of MMP2 and MMP9 in AMI patients, with or without the habit of smoking. MATERIALS AND METHODS The study group consists of 300 AMI patients and 100 sex and age matched control subjects with and without the habit of smoking. MMP2 and MMP9 activities were measured in the blood samples of these patients and controls by sandwich enzyme immunoassay and the values were noted and compared. RESULTS Both MMP2 and MMP9 were found to be significantly elevated in all the AMI patients when compared to the normal controls subjects irrespective of the habit of smoking. However MMP9 showed a significant elevation when compared to MMP2 in patients with the habit of smoking. CONCLUSION The results of the present study shows increased concentration of both MMPs in AMI patients. However, concentration of MMP9 was found to be more in patients with the habit of smoking when compared to MMP2, indicating that smoking can increase the activity of MMP9 in these patients. Hence apart from producing the free radicals, the smoke can increase the activities of matrix degrading enzymes which in turn contribute to the vulnerability of plaque.
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Affiliation(s)
- Sreekanth K Sivaraman
- Professor, Department of Biochemistry, Sree Gokulam Medical College & Research Foundation , Venjaramoodu P.O., Thiruvananthapuram, Kerala, India
| | - Geevar Zachariah
- Consultant Cardiologist, Mother Hospital , Pullazhi P.O., Olari, Thrissur, Kerala, India
| | - Pt Annamala
- Professor, Department of Biochemistry, Jubilee Mission Medical College & Research Institute , P.B. No: 737, Thrissur, Kerala, India
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Zachariah G, Harikrishnan S, Krishnan MN, Mohanan PP, Sanjay G, Venugopal K, Thankappan KR. Prevalence of coronary artery disease and coronary risk factors in Kerala, South India: a population survey - design and methods. Indian Heart J 2013; 65:243-9. [PMID: 23809375 DOI: 10.1016/j.ihj.2013.04.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/18/2013] [Accepted: 04/03/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is paucity of reliable contemporary data on prevalence of coronary artery disease (CAD) and risk factors in Indians. Only a few studies on prevalence of CAD have been conducted in Kerala, a Southern Indian state. The main objective of the Cardiological Society of India Kerala Chapter Coronary Artery Disease and Its Risk Factors Prevalence Study (CSI Kerala CRP Study) was to determine the prevalence of CAD and risk factors of CAD in men and women aged 20-79 years in urban and rural settings of three geographical areas of Kerala. METHODS The design of the study was cross-sectional population survey. We estimated the sample size based on an anticipated prevalence of 7.4% of CAD for rural and 11% for urban Kerala. The derived sample sizes for rural and urban areas were 3000 and 2400, respectively. The urban areas for sampling constituted one ward each from three municipal corporations at different parts of the state. The rural sample was drawn from two panchayats each in the same districts as the urban sample. One adult from each household in the age group of 20-59 years was selected using Kish method. All subjects between 60 and 79 years were included from each household. A detailed questionnaire was administered to assess the risk factors, history of CAD, family history, educational status, socioeconomic status, dietary habits, physical activity and treatment for CAD; anthropometric measurements, blood pressure, electrocardiogram and fasting blood levels of glucose and lipids were recorded.
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Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, Eapen K, Abraham M, Menon J, Thomas M, Jacob S, Huffman MD, Prabhakaran D. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J 2012; 34:121-9. [PMID: 22961945 DOI: 10.1093/eurheartj/ehs219] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India. METHODS AND RESULTS We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal (<80%). In-hospital mortality and MACE rates were highest for STEMI (8.2 and 10.3%, respectively). After adjustment, STEMI diagnosis (vs. unstable angina) [odds ratio (OR) (95% confidence interval = 4.06 (2.36, 7.00)], symptom-to-door time >6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE. CONCLUSION These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care.
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Affiliation(s)
- Padinhare Purayil Mohanan
- Department of Cardiology, Westfort Hi-Tech Hospital, Ltd, P.B. No. 930, Punkunnam, Thrissur 680 002, Kerala, India.
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Vadhan-Raj S, Trent J, Burgess MA, Patel S, Collard ML, Zachariah G, Hangoc G, Johnson M, Broxmeyer HE, Benjamin RS. Once per cycle combination of long-acting hematopoietic growth factors (HGFs) pegfilgrastim and darbepoetin alfa (Peg-G + DPO) to reduce multi-lineage hematopoietic toxicity of chemotherapy with doxorubicin and ifosfamide (AI) in patients with sarcoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Vadhan-Raj
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - J. Trent
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - M. A. Burgess
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - S. Patel
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - M. L. Collard
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - G. Zachariah
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - G. Hangoc
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - M. Johnson
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - H. E. Broxmeyer
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
| | - R. S. Benjamin
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; Walther Oncology Ctr. IN Univ. Sch of Medicine, Indianapolis, IN
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