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Molina CR, Mathur A, Soykan C, Sathe A, Kunhiraman L. Risk Factor Interactions, Non-High-Density Lipoprotein Cholesterol to Apolipoprotein B Ratio, and Severity of Coronary Arteriosclerosis in South Asian Individuals: An Observational Cohort Study. J Am Heart Assoc 2023; 12:e027697. [PMID: 37183833 DOI: 10.1161/jaha.122.027697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background South Asian individuals are at higher risk for arteriosclerotic cardiovascular disease and diabetes. The factors associated with arteriosclerotic cardiovascular disease severity and their interactions are unknown. Methods and Results This is a retrospective cohort study of the first 1162 South Asian participants enrolled in the South Asian Heart Center's AIM to Prevent Program who completed noncontrast coronary computed tomography scans. Using machine-learning algorithms, we identified and modeled the interaction of predictor variables with coronary artery calcification (CAC) severity in South Asian individuals. Anthropometric, laboratory, demographic, and lifestyle predictor variables were analyzed using continuous boosted regression trees to model the relationship with and in between predictor variables and CAC. Participants with CAC were older, predominately men, had smoking history, had personal histories of diabetes, hypertension, and hypercholesterolemia, and had family histories of coronary artery disease. Insulin, body mass index, blood pressure, fasting blood sugar, hemoglobin A1c, and waist-to-height ratio were associated with CAC but not low-density lipoprotein cholesterol or lipoprotein (a). The arteriosclerotic cardiovascular disease score failed to classify individuals. Only age, body mass index, non-high-density lipoprotein cholesterol/apolipoprotein B ratio, smoking risk, fasting blood sugar, and diastolic blood pressure were predictive, explaining 30.3% of CAC severity. A non-high-density lipoprotein cholesterol/apolipoprotein B ratio of 1.4 or less markedly increased coronary calcification. Conclusions Our findings highlight factors associated with dysmetabolism and cholesterol-depleted non-high-density lipoprotein cholesterol particles with coronary arteriosclerosis, possibly explaining the dual epidemics of diabetes and arteriosclerotic cardiovascular disease in this population. Markers of glucose dysmetabolism and the non-high-density lipoprotein cholesterol to apolipoprotein B ratio should become the focus of assessment for cardiovascular risk in South Asian individuals, with prevention strategies directed at improving glucose metabolic health.
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Affiliation(s)
- César R Molina
- South Asian Heart Center, El Camino Health Mountain View CA
| | - Ashish Mathur
- South Asian Heart Center, El Camino Health Mountain View CA
| | - Candan Soykan
- South Asian Heart Center, El Camino Health Mountain View CA
| | - Anita Sathe
- South Asian Heart Center, El Camino Health Mountain View CA
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Sarkar S, Dey SK, Datta G, Bandyopadhyay A. Vitamin C and E supplementation and high intensity interval training induced changes in lipid profile and haematological variables of young males. SPORTS MEDICINE AND HEALTH SCIENCE 2023. [DOI: 10.1016/j.smhs.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Vijayalakshmi IB, Nemani L, Kher M, Kumar A. The Gamut of Coronary Artery Disease in Indian Women. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/mm_ijcdw_404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Coronary artery disease is the leading cause of death among women. Majority of women suffering from CAD have one or more risk factors for CAD in their parents. Women are at higher risk for cardiac events with respect to traditional risk factors including dyslipidemia, hypertension, diabetes, and smoking. Menopause, pregnancy complications, inflammation, anemia, migraines, and depression are important sex-specific novel risk factors for CVD, and it is important that clinicians should be aware of these risks to design strategies for prevention. Education, self-awareness in women, and timely recognition of CAD in women with lifestyle modifications and timely intervention result in better outcomes.
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Affiliation(s)
- I. B. Vijayalakshmi
- Department of Pediatric Cardiology, Super Specialty Hospital (Pradhana Mantri Swasthya Suraksha Yojana), Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India,
| | - Lalita Nemani
- Department of Cardiology, Nizams Institute of Medical Sciences, Punjagutta, Hyderabad, India,
| | - Monica Kher
- Department of Cardiology, Aster Hospital, Doha, Qatar,
| | - Achukatla Kumar
- Department of Health Research, ICMR, Port Blair, Andaman and Nicobar Islands, India,
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4
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The Morphology of Coronary Artery Disease in South Asians versus White Caucasians and its Implications. Can J Cardiol 2022; 38:1570-1579. [PMID: 35568268 DOI: 10.1016/j.cjca.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes relative to White Caucasians (WCs) following invasive revascularization procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and discuss their potential impact on the development of coronary disease, acute coronary syndrome and revascularization outcomes. SAs have a more diffuse pattern with multi-vessel involvement compared to WCs. However, less is known about other morphological characteristics such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher non-calcified plaque composition, elevated thrombosis and inflammatory markers likely contribute to the disease pattern. While the current evidence on the role of coronary vessel size remains inconsistent, smaller coronary diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularization outcomes. In conclusion, SAs have a unique CAD risk profile comprised of traditional and novel risk factors. Our findings highlight the need for additional awareness of healthcare professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.
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Enas EA, Varkey B. Letter by Enas and Varkey Regarding Article, "Quantifying and Understanding the Higher Risk of Atherosclerotic Cardiovascular Disease Among South Asian Individuals: Results From the UK Biobank Prospective Cohort Study". Circulation 2022; 145:e146. [PMID: 35100018 DOI: 10.1161/circulationaha.121.056750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Enas A Enas
- Coronary Artery Disease Among Asian Indians (CADI) Research Foundation, Lisle, IL
| | - Basil Varkey
- Coronary Artery Disease Among Asian Indians (CADI) Research Foundation, Lisle, IL
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Prasad GVR, Bhamidi V. Managing cardiovascular disease risk in South Asian kidney transplant recipients. World J Transplant 2021; 11:147-160. [PMID: 34164291 PMCID: PMC8218347 DOI: 10.5500/wjt.v11.i6.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.
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Affiliation(s)
- G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
| | - Vaishnavi Bhamidi
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
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Rauniyar BK, Kadel A, Thakur K, Adhikari RB, Limbu D, Acharya K, Rajbhandari S, Kansakar S, Malla R, Adhikari CM, Maskey A, Rajbhandari R. Spectrum of coronary angiographic findings in patients with ST Elevation Myocardial Infarction (STEMI) undergoing primary PCI in a tertiary care center of Nepal. Ann Cardiol Angeiol (Paris) 2021; 71:32-35. [PMID: 33637314 DOI: 10.1016/j.ancard.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention. RESULTS During the period of 1 year (January 2019 to December 2019), 816 patients presented to our ER with acute STEMI, among them 437 (53.6%) patients underwent primary PCI strategy and among them 22 (5.3%) patients were died. Thirty-six (4.4%) patients received thrombolysis, among them 5 (13.9%) patients were died while remaining 343 (42.0%) patients were managed conservatively and among them 20 (5.8%) were died. The mean age of patient who underwent primary PCI was 58.5±12.7 years range from 25 years to 99 years. Among them 55-75 years old 217 (49.6%) were highest in number followed by<55 years old 180 (41.2%). Males 318 (72.8%) were predominant. Among those who underwent primary PCI, hypertension 214 (49%) was the most common risk factor, followed by smoking 198 (45.3%), diabetes mellitus 123 (28.1%), dyslipidemia 53 (12.1%) and family history of premature coronary artery disease 18 (4.1%). Among those patients, 292 patients (66.8%) had single vessel disease, 99 patients (22.7%) had double vessel disease, 41 patients (9.3%) had triple vessel disease and 5 patients (1.1%) had non-significant coronary artery stenosis. Left anterior descending (53.3%) was the most frequently found culprit artery, followed by right coronary artery, left circumflex, ramus intermedius and left main artery. CONCLUSION Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55-75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.
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Affiliation(s)
- B K Rauniyar
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - A Kadel
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - K Thakur
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R B Adhikari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - D Limbu
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - K Acharya
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - S Rajbhandari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - S Kansakar
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R Malla
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - C M Adhikari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - A Maskey
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R Rajbhandari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
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Alenaini W, Parkinson JRC, McCarthy JP, Goldstone AP, Wilman HR, Banerjee R, Yaghootkar H, Bell JD, Thomas EL. Ethnic Differences in Body Fat Deposition and Liver Fat Content in Two UK-Based Cohorts. Obesity (Silver Spring) 2020; 28:2142-2152. [PMID: 32939982 DOI: 10.1002/oby.22948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Differences in the content and distribution of body fat and ectopic lipids may be responsible for ethnic variations in metabolic disease susceptibility. The aim of this study was to examine the ethnic distribution of body fat in two separate UK-based populations. METHODS Anthropometry and body composition were assessed in two separate UK cohorts: the Hammersmith cohort and the UK Biobank, both comprising individuals of South Asian descent (SA), individuals of Afro-Caribbean descent (AC), and individuals of European descent (EUR). Regional adipose tissue stores and liver fat were measured by magnetic resonance techniques. RESULTS The Hammersmith cohort (n = 747) had a mean (SD) age of 41.1 (14.5) years (EUR: 374 men, 240 women; SA: 68 men, 22 women; AC: 14 men, 29 women), and the UK Biobank (n = 9,533) had a mean (SD) age of 55.5 (7.5) years (EUR: 4,483 men, 4,873 women; SA: 80 men, 43 women, AC: 31 men, 25 women). Following adjustment for age and BMI, no significant differences in visceral adipose tissue or liver fat were observed between SA and EUR individuals in the either cohort. CONCLUSIONS Our data, consistent across two independent UK-based cohorts, present a limited number of ethnic differences in the distribution of body fat depots associated with metabolic disease. These results suggest that the ethnic variation in susceptibility to features of the metabolic syndrome may not arise from differences in body fat.
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Affiliation(s)
- Wareed Alenaini
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - James R C Parkinson
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - John P McCarthy
- School of Healthcare Practice, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Neuro-psychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London-Hammersmith Hospital, London, UK
| | - Henry R Wilman
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
- Perspectum Diagnostics, Oxford, UK
| | | | - Hanieh Yaghootkar
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
- Genetics of Complex Traits, Medical School, University of Exeter-Royal Devon & Exeter Hospital, Exeter, UK
- Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Jimmy D Bell
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - E Louise Thomas
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
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NDSP 05: Prevalence and pattern of dyslipidemia in urban and rural areas of Pakistan; a sub analysis from second National Diabetes Survey of Pakistan (NDSP) 2016-2017. J Diabetes Metab Disord 2020; 19:1215-1225. [PMID: 33520835 DOI: 10.1007/s40200-020-00631-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Abstract
Objectives Dyslipidemia is a major risk issue for the development of cardiovascular disease. The aim of our study was to observe the pattern and prevalence of dyslipidemia in Pakistani population. Methodology This is a sub analysis of a population based second National Diabetes Survey of Pakistan (NDSP) 2016-2017 in adults aged 20 years or above, carried out from February 2016 to August 2017 across Pakistan. Multi stage sampling technique was used for the stratification of population, based on rural and urban domains. District wise clusters and sub clusters were selected i.e. 27 and 46 in number. Subjects, consented to participate were requested to come after an overnight fast for anthropometric measurements, oral glucose tolerance test and fasting lipid profile (except for subjects with self-reported diabetes). Dyslipidemia was identified using Adult Treatment Panel III guidelines. Results A total of 10,834 subjects (43.8% male and 56.2% female) having mean age of 43.8 ± 14.0 years, participated in the survey. Of the subjects studied, 39.3% had hypercholesterolemia, 48.9% had hypertriglyceridemia, 39.7% had high LDL-C levels while 83.9% men and 90% women had low HDL levels. High cholesterol and triglyceride levels were highest in 50-59 years age group, while high LDL and low HDL was most common in 40-49 years age group. Diabetes, obesity and hypertension were found to be the significant determinants for dyslipidemia. Conclusion Prevalence of dyslipidemia seems to be very high in Pakistan, necessitating an urgent call for early screening and effective management through lifestyle intervention and appropriate lipid lowering drugs to prevent this important cardiovascular risk factor.
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Sathiyamoorthi S, Anand DP, Muthunarayanan L. Is Master Health Checkup the Answer to Tackle the Rising Non-Communicable Disease Burden in India? - A Cross-Sectional Study. J Lifestyle Med 2019; 9:111-118. [PMID: 31828029 PMCID: PMC6894444 DOI: 10.15280/jlm.2019.9.2.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
Background Master Health Checkup (MHC) is a battery of tests done to detect and identify Non Communicable Diseases (NCDs) early. But it should also be noted that some tests in MHC have no known benefits for otherwise healthy adults. This study was conducted to evaluate the usefulness of MHC in a hospital based setting. Methods A cross-sectional study was conducted among 337 subjects aged 18 years and above who attended the MHC Clinic during the study period. They were subjected to interview and various biochemical investigations to estimate the number of newly diagnosed, clinically relevant abnormalities among apparently normal adults using standard guidelines. Categorical data summarized as frequencies with percentages. Chi-square test was used to compare proportions. Results Among the 337 participants, 244 were apparently normal with a gender distribution as 109 (44.7%) males and 135 (55.3%) females. The study was able to newly detect 12.3% with Type 2 diabetes, 37.7% in pre-diabetic stage, 54.1% with anaemia, 42.2% with dyslipidemia, 11.5% with hypothyroidism, 27% with liver disorders and 6.5% with renal disorders, about which the participants were unaware of. Females also had statistically significant association with dyslipidaemia and hypothyroidism compared to males with a p-value of 0.004, 0.026 respectively. Apparently normal participants aged > 35 years had strong statistical association with diabetic status and dyslipidemia compared to those aged between 18 – 35 years (p-value 0.001). Conclusion Based on the results from the study it is evident that a significant number of NCDs were newly identified by Master Health checkup (MHC).
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Affiliation(s)
- Sathiyanarayanan Sathiyamoorthi
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Vijayawada, Andhra Pradesh, India
| | - Dharshana Prem Anand
- Department of Community Medicine, SRM Medical College & Research Centre, SRM IST, Chennai, India
| | - Logaraj Muthunarayanan
- Department of Community Medicine, SRM Medical College & Research Centre, SRM IST, Chennai, India
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Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An underrecognized genetic risk factor for malignant coronary artery disease in young Indians. Indian Heart J 2019; 71:184-198. [PMID: 31543191 PMCID: PMC6796644 DOI: 10.1016/j.ihj.2019.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/14/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023] Open
Abstract
Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD-a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.
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Affiliation(s)
- Enas A Enas
- Coronary Artery Disease in Indians (CADI) Research Foundation, Lisle, IL, USA.
| | - Basil Varkey
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Vinay K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Patel M, Boutin-Foster C, Phillips E. Understanding of cardiovascular disease risk factors among Bangladeshi immigrants in New York City. ETHNICITY & HEALTH 2019; 24:432-442. [PMID: 28669239 DOI: 10.1080/13557858.2017.1346191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/17/2017] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Among all South Asians, Bangladeshis have the highest prevalence of cardiovascular disease (CVD). The purpose of our study was to compare the understanding of CVD risk factors among Bangladeshi immigrants to the general Caucasian population in the U.S. DESIGN We surveyed Bangladeshi immigrants in Queens, New York using a CVD risk factor knowledge instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study to assess awareness of risk factors. Using multivariate regression modeling, we compared scores on the knowledge instrument between Bangladeshis we surveyed and Caucasians from the CARDIA study, controlling for potential confounders. We subsequently examined the frequency of mentioning each risk factor to understand what was driving the difference in the overall score. RESULTS The proportion of Bangladeshis scoring low on the knowledge assessment was 0.53, where as the proportion of whites scoring low in the CARDIA study was 0.32 (p value < .001). Whites were 34% more likely to score high than Bangladeshis (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.19-1.52). Bangladeshis were more likely to mention diet and cholesterol as risk factors and less likely to mention lack of exercise, being overweight, and smoking as risk factors. CONCLUSION Understanding of cardiovascular disease risk factors was lower among Bangladeshis than whites. This was driven by Bangladeshis having less awareness regarding how exercise and being overweight contribute to CVD. Community based interventions and community health partnerships should target these behavioral risk factors in the Bangladeshi population.
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Affiliation(s)
- Mihir Patel
- a Division of General Internal Medicine, Department of Medicine , George Washington University , Washington , DC , USA
| | - Carla Boutin-Foster
- b Office of Diversity Education & Research , SUNY Downstate Medical Center , Brooklyn , NY , USA
| | - Erica Phillips
- c Division of General Internal Medicine , Weill Cornell Medicine , New York , NY , USA
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Palaniappan L, Garg A, Enas E, Lewis H, Bari S, Gulati M, Flores C, Mathur A, Molina C, Narula J, Rahman S, Leng J, Gany F. South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. J Community Health 2018; 43:1100-1114. [PMID: 29948525 PMCID: PMC6777562 DOI: 10.1007/s10900-018-0527-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
South Asians (SAs) are at heightened risk for cardiovascular disease as compared to other ethnic groups, facing premature and more severe coronary artery disease, and decreased insulin sensitivity. This disease burden can only be partially explained by conventional risk factors, suggesting the need for a specific cardiovascular risk profile for SAs. Current research, as explored through a comprehensive literature review, suggests the existence of population specific genetic risk factors such as lipoprotein(a), as well as population specific gene modulating factors. This review catalogues the available research on cardiovascular disease and genetics, anthropometry, and pathophysiology, and cancer genetics among SAs, with a geographical focus on the U.S. A tailored risk profile will hinge upon population customized classification and treatment guidelines, informed by continued research.
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Affiliation(s)
| | - Arun Garg
- Laboratory Medicine and Pathology, Fraser Health Authority, New Westminster, BC, Canada
| | - Enas Enas
- Coronary Artery Disease among Asian Indians (CADI) Research Foundation, Lisle, IL, USA
| | - Henrietta Lewis
- Rollins School of Public Health, Global Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Cristina Flores
- The Warren Alpert Medical School, The Brown Human Rights Asylum Clinic (BHRAC), Brown University, Providence, RI, USA
| | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | - Cesar Molina
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | | | - Shahid Rahman
- I-Say, Bangladeshi American Youth Association, Teach & Travel, New York, NY, USA
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Zaid M, Hasnain S. Plasma lipid abnormalities in Pakistani population: trends, associated factors, and clinical implications. ACTA ACUST UNITED AC 2018; 51:e7239. [PMID: 30043855 PMCID: PMC6065832 DOI: 10.1590/1414-431x20187239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/29/2018] [Indexed: 12/21/2022]
Abstract
Previous studies have reported increased prevalence of coronary heart disease (CHD) in Indians and South Asian settlers in North America. This increased burden of CHD among South Asians is mainly caused by dyslipidemia. To the best of our knowledge, none of the previous works has studied the patterns and prevalence of dyslipidemia in the Pakistani population. The present work aimed to study the plasma lipid trends and abnormalities in a population-based sample of urban and rural Pakistanis. The study included 238 participants (108 males,130 females). Plasma lipid profiles of the participants were determined using standard protocols. We observed that 63% of the study population displayed irregularities in at least one major lipid-fraction including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides (TG). The most common form of isolated-dyslipidemia was low HDL-C (17.3%) followed by high TG (11.2%). Several overlaps between high TC, LDL-C, TG and low HDL-C were also noted. Gender, urbanization, and occupational class were all observed to have an impact on lipid profiles. Briefly, male, urban, and blue-collar participants displayed higher prevalence of dyslipidemia compared to female, rural, and white-collar participants, respectively. In comparison to normal subjects, dyslipidemic subjects displayed significantly higher values for different anthropometric variables including body mass index (BMI), body fat percentage, and waist circumference. The present work provides a comprehensive estimation of the prevalence of dyslipidemia and CHD risk in the Pakistani population. This information will be helpful for better healthcare planning and resource allocation in Pakistan.
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Affiliation(s)
- M Zaid
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan.,Department of Life Sciences, University of Management and Technology, Lahore, Pakistan
| | - S Hasnain
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
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15
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Agrawal D, Manchanda SC, Sawhney JPS, Kandpal B, Jain R, Mehta A, Mohanty A, Passey R, Makhija A, Sharma MK. To study the effect of high dose Atorvastatin 40mg versus 80mg in patients with dyslipidemia. Indian Heart J 2018; 70 Suppl 3:S8-S12. [PMID: 30595326 PMCID: PMC6310693 DOI: 10.1016/j.ihj.2018.01.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/12/2017] [Accepted: 01/25/2018] [Indexed: 01/09/2023] Open
Abstract
Objective Primary objective was to compare the effects of atorvastatin 40 mg vs 80 mg on LDL-C in Indian patients with atherosclerotic dyslipidemia. Secondary objectives were to compare the effects of atorvastatin 40 mg vs 80 mg on HDL-C and triglycerides and also comparing of side effects (myopathy, hepatotoxicity and new onset diabetes mellitus) of both doses. Method This Study is A Prospective, randomized, open-label, comparative study. This study was conducted on 240 patients of dyslipidemia (as per ACC/AHA 2013 lipid guidelines) attending the OPD/wards/CCU of department of cardiology, Sir Ganga Ram Hospital. They were randomly divided into 2 groups of 120 each. Group A consisted patients who received Atorvastatin 40 mg daily and Group B Atorvastatin 80 mg daily. The follow up period was 6 months. Results At 3 and 6 month follow up, Atorvastatin 40 mg leads to mean LDL cholesterol reduction of 47.18 ± 20.81 & 50.03 ± 18.06 respectively. While Atorvastatin 80 mg results in LDL reduction as 50.11 ± 15.85 & 52.30 ± 13.72. The comparison between two doses revealed a non-significant difference (p = .118 & p = .149 respectively). At 6 months of follow up, few patients reported myalgia (2 in group A and 7 in Group B). The difference between groups was significant (p = .045). Although none of our patient had significant elevation of CPK. Conclusion This study concluded that both doses of atorvastatin (40 & 80 mg) are equally efficacious in improving dyslipidemia but higher dose leads to more incidence of myalgia.
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Affiliation(s)
- Deepak Agrawal
- Department of Cardiology, Sir Ganga Ram hospital, 13/4, Upper ground floor, West Patel Nagar, New Delhi, 110008, India.
| | - S C Manchanda
- Department of Cardiology, Sir Ganga Ram hospital, R-721, New Rajinder Nagar, New Delhi, 110 060, India.
| | - J P S Sawhney
- Department of Cardiology, Sir Ganga Ram hospital, House No.10, Road No.4 West Punjabi Bagh Extension, New Delhi, 110 026, India.
| | - Bhuwanesh Kandpal
- Department of Cardiology, Sir Ganga Ram hospital, 535, DDA Flats, Sector - 22, Dwarka, New Delhi, 110075, India.
| | - Rajneesh Jain
- Department of cardiology, Sir Ganga Ram hospital, S-455, Ground Floor Greater Kailash - 1, New Delhi, 110048, India.
| | - Ashwani Mehta
- Department of cardiology, Sir Ganga Ram hospital, 20/1 Old Rajinder Nagar, New Delhi, 110 060, India.
| | - Arun Mohanty
- Department of Cardiology, Sir Ganga Ram hospital, B-101, Shivam Appt., Plot-14, Sec-12, Dwarka, New Delhi, 110078, India.
| | - Rajiv Passey
- Department of Cardiology, Sir Ganga Ram hospital, C-111 Preet Vihar, New Delhi, 110 092, India.
| | - Aman Makhija
- Department of Cardiology, Sir Ganga Ram hospital, 56-B, Pocket-1, Mayur Vihar, Phase-I, New Delhi, 110091, India.
| | - Manish Kr Sharma
- Department of Cardiology, Sir Ganga Ram hospital, 8A/15, Old Rajinder Nagar, New Delhi, 110060, India.
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Prevalence of Selected Intermediate Risk Factors for Non-communicable Diseases in an Apparently Healthy Indian Community in KwaZulu-Natal, South Africa. J Community Health 2018; 42:122-128. [PMID: 27544682 DOI: 10.1007/s10900-016-0238-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
South Africa, burdened with the emerging chronic diseases, is home to one of the largest migrant Indian population, however, little data exists on the risk factors for non-communicable diseases in this population. The aim of this study was to determine the prevalence of yet undiagnosed selected intermediate risk factors for non-communicable diseases among the Indian population in KwaZulu-Natal. We randomly selected 250 apparently healthy Indians, aged 35-55 years, living in KwaDukuza to participate in this study. Clinical and anthropometric measurements were taken under prescribed clinical conditions using Asian cut-off points. Pearson correlations was used to detect associations between anthropometric and clinical risk markers. A large percentage of participants' systolic blood pressure fell within the normal range. Diastolic blood pressure was >85 mmHg for 61 % of the participants and triglyceride levels were >1.69 mmol/L for 89 % of the participants'; 94 % of the women and 87 % of the men were classified as centrally obese. Raised fasting blood glucose was seen in 39 % of participants'. Waist circumference and body mass index showed statistically significant associations with all clinical risk markers except for diastolic blood pressure. Our findings suggest that the use of ethno specific strategies in the management of the disease profile of South African Indians, will enable the South African health system to respond more positively towards the current trend of increased metabolic and physiological risk factors in this community. Moreover, key modifiable behaviours such as increased physical activity and weight reduction may improve most of these metabolic abnormalities.
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Krishnamurthy A, Keeble C, Burton-Wood N, Somers K, Anderson M, Harland C, Baxter PD, McLenachan JM, Blaxill JM, Blackman DJ, Malkin CJ, Wheatcroft SB, Greenwood JP. Clinical outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction according to sex and race. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:264-272. [DOI: 10.1177/2048872617735803] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Female sex and South Asian race have been associated with poor clinical outcomes following primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) but remain understudied in large real-world series. We therefore investigated the association of sex and race with clinical outcomes following PPCI. Methods: We conducted a prospective study of all patients undergoing PPCI for STEMI between January 2009 and December 2011 at a large UK cardiac centre. Clinical characteristics and outcomes were compared according to sex and race using Chi-square test, independent samples Student’s t-test and Mann–Whitney U-test. Primary and secondary outcomes were 12-month major adverse cardiovascular events (MACEs) – defined as all-cause mortality, myocardial infarction and unplanned revascularization, analysed using Cox proportional hazard models adjusting for cardiovascular risk factors. Results: Three thousand and forty-nine patients were included. Women ( n=826) were older than men ( n=2223) (median age 69 vs. 60 years, p <0.01). Mortality (hazard ratio 1.48 (1.15–1.90)) and MACE (hazard ratio 1.40 (1.14–1.72)) were higher in women in univariable analysis. However, there were no significant sex-differences in mortality or MACE after age-stratification alone. Multivariable analysis also showed no significant differences in outcomes between sexes. South Asians ( n=297) were younger but had a higher prevalence of most risk factors than White patients ( n=2570). Mortality and MACE did not differ significantly between South Asian and White patients in univariable or multivariable analysis. Conclusion: MACE and mortality was not greater in women, or in South Asian patients following PPCI after adjustment for cardiovascular risk factors including age, which was most strongly associated with both outcomes.
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Affiliation(s)
- Arvindra Krishnamurthy
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds General Infirmary, UK
| | - Claire Keeble
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | | | | | | | | | - Paul D Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | | | | | | | | | - Stephen B Wheatcroft
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds General Infirmary, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds General Infirmary, UK
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18
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Makaryus AN, Jauhar R, Tortez LM, Pekmezaris R. Comparison of the Diameters of the Major Epicardial Coronary Arteries by Angiogram in Asian-Indians Versus European Americans <40 Years of Age Undergoing Percutaneous Coronary Artery Intervention. Am J Cardiol 2017; 120:924-926. [PMID: 28756957 DOI: 10.1016/j.amjcard.2017.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/19/2017] [Accepted: 06/08/2017] [Indexed: 12/16/2022]
Abstract
Coronary artery disease (CAD) rates are higher in Asian-Indians than in Caucasians. CAD occurs at an earlier age in this group, with about a quarter of all myocardial infarctions occurring under the age of 40. Previous reports have suggested smaller coronary artery size in Asian-Indians as a major cause for increased CAD in this population. This study sought to evaluate the size of normal "atheroma-free" segments of the epicardial coronary arteries in Asian-Indians and Caucasians aged ≤40 years undergoing coronary artery intervention in other diseased segments. A total of 69 consecutive patients (41 whites, 28 Asian-Indians) aged ≤40 years were evaluated. Angiograms were analyzed using standard quality control analysis software with digital acquisition. The arteries measured were the left main, left anterior descending, left circumflex, and the right coronary artery. Conventional risk factors, including hypertension, smoking, and diabetes, that could influence coronary size were also assessed. The coronary arteries of Asian-Indian patients showed significantly smaller values in the mean diameters of the left main (2.96 mm vs 4.04 mm, p = 0.0004), left anterior descending (2.48 mm vs 3.24 mm, p = 0.0005), left circumflex (2.52 mm vs 3.06 mm, p = 0.00002), and right coronary artery (2.71 mm vs 3.65 mm, p = 0.0008) as compared with Caucasians. Even after correction for body surface area, a statistically significant difference remained in coronary artery diameters. In conclusion, statistically significant difference in the mean diameter size even after correction for body surface area in Asian-Indians has implications for predisposition to atherosclerosis, and more challenging performance of procedures such as coronary artery bypass grafting, stent implantation, or atherectomy.
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Pathak LA, Shirodkar S, Ruparelia R, Rajebahadur J. Coronary artery disease in women. Indian Heart J 2017; 69:532-538. [PMID: 28822527 PMCID: PMC5560902 DOI: 10.1016/j.ihj.2017.05.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 05/04/2017] [Accepted: 05/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the importance of CAD for women, there is persistent perception that CAD is a man's disease. Contributing to this notion is the observation of differences in incidence rates according to age; the incidence of CAD in women is lower than men, but rises steadily after fifth decade. The distribution of CAD risk factors varies between men and women across age ranges and failure to consider these differences may have contributed to the belief that women are at lower risk of CAD compared with men. In addition, women are more likely to have symptoms considered atypical compared with men. There is an urgent need to better understand the presentation of cardiac symptoms in women, in order to facilitate diagnosis and treatment, to initiate aggressive risk factor intervention and to improve the quality of life. METHODS We studied clinical and angiographic profile of women undergoing coronary angiogram over a period of 6 years at Nanavati Hospital, Mumbai. The objectives were to examine the distribution of risk factor and coronary angiographic patterns of CAD in women. RESULTS It was observed that coronary artery disease is most commonly involving females between the age 60 to 80 years. Raised LDL-C was found to be most common risk factor involved in development of coronary artery disease in females. Most common presentation of CAD in women is unstable angina or non-ST segment elevation MI. Most common coronary angiography finding was single vessel disease. CONCLUSION Though coronary artery disease is late to present in women it significantly hamper quality of life. The clinical presentation of coronary artery disease in women varies from asymptomatic to severe unstable angina to myocardial infarction. Stress testing and 2D-ECHO helps to some extent for prediction of coronary artery disease but false positive as well as false negative test results are not negligible. Coronary angiography is the conclusive test to determine spectrum and characterization of coronary artery anatomy in women. As this study is based on experience at single center, various biases may be possible. Widespread data collection involving multiple center and multiple operators will be helpful.
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Affiliation(s)
- Lekha Adik Pathak
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India.
| | - Salil Shirodkar
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India
| | - Ronak Ruparelia
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India
| | - Jaideep Rajebahadur
- Nanavati Heart Institute, Nanavati Hospital, S.V. Road, Vile Parle West, Mumbai, Maharastra, India
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20
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Yusuf S, Joseph P. The epidemic of cardiovascular disease in South Asians: Time for action. Am Heart J 2017; 185:150-153. [PMID: 28267468 DOI: 10.1016/j.ahj.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
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Das A, Ambale-Venkatesh B, Lima JAC, Freedman JE, Spahillari A, Das R, Das S, Shah RV, Murthy VL. Cardiometabolic disease in South Asians: A global health concern in an expanding population. Nutr Metab Cardiovasc Dis 2017; 27:32-40. [PMID: 27612985 DOI: 10.1016/j.numecd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.
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Affiliation(s)
- A Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - B Ambale-Venkatesh
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J A C Lima
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J E Freedman
- Department of Cardiology, UMass Memorial Health Care, MA, USA
| | - A Spahillari
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R Das
- The John Hopkins University, Baltimore, USA
| | - S Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R V Shah
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - V L Murthy
- Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, USA.
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Bhatta MP, Shakya S, Assad L, Zullo MD. Chronic Disease Burden Among Bhutanese Refugee Women Aged 18-65 Years Resettled in Northeast Ohio, United States, 2008-2011. J Immigr Minor Health 2016; 17:1169-76. [PMID: 24849870 DOI: 10.1007/s10903-014-0040-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this community-based study was to assess the prevalence of chronic diseases among 18-65 year old Bhutanese refugee women resettled in Northeast Ohio, United States (US). A Nepali-language questionnaire was administered in a face-to-face mode. Anthropometric measurements included height, weight, and hip and waist circumferences. The overall prevalence (95 % confidence interval) of self-reported hypertension, diabetes, asthma, heart disease, and cancer were 15.3 % (9.2-23.4), 6.4 % (2.3-10.9), 5.5 % (2.0-11.5), 2.7 % (0.6-7.8), and 1.8 % (0.2-6.4), respectively. Overweight/obesity was observed in 64.8 % of the women; 69.5 and 74.1 % had waist circumference >80 cm and waist-to-hip ratio ≥85, respectively. Length of time in the US was not associated with the prevalence of the chronic conditions. This study suggests chronic conditions may be significant health issues among US resettled Bhutanese refugees and a larger population-based study to confirm the findings is warranted.
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Affiliation(s)
- Madhav P Bhatta
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, College of Public Health, Kent State University, P. O. Box 5190, Kent, OH, 44242, USA,
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Dalal J, Hiremath MS, Das MK, Desai DM, Chopra VK, Biswas AD. Vascular Disease in Young Indians (20-40 years): Role of Ischemic Heart Disease. J Clin Diagn Res 2016; 10:OE08-OE12. [PMID: 27790504 DOI: 10.7860/jcdr/2016/20206.8517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/16/2016] [Indexed: 12/23/2022]
Abstract
Coronary Artery Disease (CAD) occurs at a younger age in Indians with over 50% of Cardiovascular Disease (CVD) mortality occurring in individuals aged less than 50 years. Although several risk factors have been suggested; smoking, dyslipidemia and hypertension are major risk factors in the young. In this review, we have pooled the current evidence on Ischemic Heart Disease (IHD) in young (20-40 years) and provided an opinion for the effective management of IHD in young Indians.
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Affiliation(s)
- Jamshed Dalal
- Director, Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital , Mumbai, Maharashtra, India
| | | | - Mrinal Kanti Das
- Consultant Cardiologist, Birla Heart Research Centre , Kolkata, West Bengal, India
| | - Devangkumar M Desai
- Technical Director, Department of Cardiology, B. D. Mehta Mahavir Heart Institute , Surat, Gujarat, India
| | - Vijay Kumar Chopra
- Director, Heart Failure Program, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Arup Das Biswas
- Ex-Professor and Head, Department of Cardiology, NRS Medical College , Kolkata, West Bengal, India
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Ghosh A, Bose K, Chakravarti S, Chaudhuri AB, Chattopadhyay J, Dasgupta G, Sengupta S. Central obesity and coronary risk factors. ACTA ACUST UNITED AC 2016; 124:86-90. [PMID: 15067981 DOI: 10.1177/146642400412400213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cross-sectional study of 130 Bengalee Hindu men (mean age=50.3 years; SD=10.5 years) was undertaken to investigate the relationship of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) with total cholesterol (TC), high density (HDL-C), low density (LDL-C) and very low-density (VLDL-C) lipoprotein cholesterol, fasting plasma glucose (FPG) and triglycerides (FTG). Correlation studies revealed that WHR was significantly correlated (r=0.245, p<0.01) with TC. WC and WHR had significant correlations with VLDL-C, FPG and FTG. All subjects were further divided into two groups based on WHR<0.95 (centrally non-obese, CNO) and WHR>0.95 (centrally obese, CO) following the US Joint National Committee (JNC) guidelines. Students’ t-test revealed that CO subjects (n=83) had a significantly higher mean TC (p<0.05), VLDL (p<0.05), FPG (p<0.01) and FTG (p<0.05) compared with CNO individuals (n=47). Results of analysis of variance (ANOVA) of central obesity status (CNO=no, CO=yes) and BMI (BMI tertiles used as a categorical variable) with these metabolic variables revealed that CO status had a significant effect (p<0.05) on TC, VLDL-C, FPG and FTG. BMI tertiles did not a have significant effect on any of these metabolic variables. There was no significant BMI tertile-central obesity status interaction. It can therefore be concluded that the JNC guidelines of WHR>0.95 to define central obesity can be used, irrespective of BMI, among this population, to identify individuals who have enhanced metabolic risk factors of coronary heart disease (CHD). Furthermore, it can be routinely used for health promotion purposes among Bengalee men.
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Affiliation(s)
- Amab Ghosh
- Department of Anthropology, University of Calcutta, Kolkata, India
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Bora K, Pathak MS, Borah P, Das D. Association of Decreased High-Density Lipoprotein Cholesterol (HDL-C) With Obesity and Risk Estimates for Decreased HDL-C Attributable to Obesity: Preliminary Findings From a Hospital-Based Study in a City From Northeast India. J Prim Care Community Health 2016; 8:26-30. [PMID: 27531078 DOI: 10.1177/2150131916664706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Obesity is an important risk factor for decrease in high-density lipoprotein cholesterol (HDL-C) levels, which predisposes to cardiovascular diseases. But, the relative contribution of obesity toward decreased HDL-C and the risk estimates of decreased HDL-C attributable to obesity are unavailable. Such measures will help in understanding the extent by which the burden of decreased HDL-C can be reduced by tackling obesity. OBJECTIVES The objectives of this study were to ( a) determine the association between decreased HDL-C and obesity and ( b) estimate the attributable risk proportion (ARP) and population attributable risk proportion (PARP) for decreased HDL-C due to obesity. METHODS Body mass index (BMI) and waist circumference (WC) were measured as indices of overweight (or generalized obesity) and central obesity, respectively in 190 subjects (95 cases with low HDL-C and 95 healthy controls with normal HDL-C) from Guwahati city. Crude odds ratio (OR) and adjusted OR with 95% confidence interval (CI) were calculated along with the risk estimates (ARP and PARP). RESULTS People with overweight or generlized obesity (adjusted OR = 4.90, 95% CI = 3.59-6.68), and people with central obesity (adjusted OR = 3.33, 95% CI = 2.39-4.64) had significantly greater odds of developing decreased HDL-C. Among the exposed, 79.8% of the decreased HDL-C cases could be attributed to overweight (or generalized obesity), while 72.8% cases could be attributed to central obesity. In the overall population, the corresponding figures were 57.1% and 36%, respectively. CONCLUSION Decreased HDL-C is strongly associated with and largely attributable to obesity.
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Affiliation(s)
- Kaustubh Bora
- 1 Gauhati Medical College and Hospital, Guwahati, Assam, India.,2 North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | | | - Probodh Borah
- 3 State Biotech Hub and Bioinformatics Infrastructure Facility, College of Veterinary Science, Guwahati, Assam, India
| | - Dulmoni Das
- 4 Regional College of Nursing, Guwahati, Assam, India.,5 Army Institute of Nursing, Guwahati, Assam, India
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Sadanandam R, Al Khaja N, Aziz MA, Turner MA. Profile of Coronary Artery Bypass Surgery in United Arab Emirates: Dubai Hospital Experience. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239800600210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although coronary artery bypass surgery has become a common procedure, there were no data available regarding this type of surgery in the United Arab Emirates. Therefore, we undertook this retrospective study of the first 522 consecutive patients undergoing coronary artery bypass graft surgery between October 1992 and July 1997. The mean age was 49.1 years at operation with a 97.1% male predominance. Patients of Asian origin accounted for 75.8%, Arabs 22.4%, and Europeans 1.7%. Chronic stable angina was the most frequent presenting symptom (70.4%) and 62.1% patients had at least one prior myocardial infarction. There was a 44.6% incidence of hypertension and 32.9% of patients were diabetic. Other prominent risk factors were smoking (55.7%), hyperlipidemia (53.9%), and family history of ischemic heart disease (10.7%). Left main coronary artery obstruction was evident in 6.5% of patients. An average of 3.4 grafts per patient were performed using reverse saphenous vein and endarterectomies were needed in 2.2%. The early mortality rate in elective cases was 2.4%. This study suggests that in spite of a high incidence of multiple risk factors, our patients tolerated coronary artery bypass surgery well. Our findings highlight the trend towards more urgent operations and the decreasing age of patients with severe coronary artery disease.
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Affiliation(s)
- Rajan Sadanandam
- Department of Cardiothoracic Surgery Dubai Hospital Dubai, United Arab Emirates
| | - Najib Al Khaja
- Department of Cardiothoracic Surgery Dubai Hospital Dubai, United Arab Emirates
| | - Mohd A Aziz
- Department of Cardiothoracic Surgery Dubai Hospital Dubai, United Arab Emirates
| | - Murdo A Turner
- Department of Cardiothoracic Surgery Dubai Hospital Dubai, United Arab Emirates
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Das SK, Sankar NM, Satyaprasad V, Bashi VV, Cherian KM. Experience with Bilateral Internal Mammary Artery Grafts for Myocardial Revascularization in Asian Patients. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239500300407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bilateral internal mammary artery grafts were used for direct myocardial revascularisation in 72 patients from August 1988 to January 1994. Twenty-five of them had diffuse coronary artery disease. The coronary arteries were small in the majority of patients and 10 patients needed endarterectomy. Two patients died in the hospital. Fifty-nine patients were followed up and the mean time of follow-up was 25 months. One patient died during the follow-up period and another patient developed inferior wall myocardial infarction. Three patients are on antianginal medications and the rest are doing well.
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Affiliation(s)
- Sarajit Kumar Das
- Department of Cardiac Surgery Institute of Cardio-Vascular Diseases Madras, India
| | - Nainar Madhu Sankar
- Department of Cardiac Surgery Institute of Cardio-Vascular Diseases Madras, India
| | - Velivela Satyaprasad
- Department of Cardiac Surgery Institute of Cardio-Vascular Diseases Madras, India
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Tayal D, Goswami B, Tyagi S, Chaudhary M, Mallika V. Interaction between dyslipidaemia, oxidative stress and inflammatory response in patients with angiographically proven coronary artery disease. Cardiovasc J Afr 2016; 23:23-7. [PMID: 22331247 PMCID: PMC3721930 DOI: 10.5830/cvja-2010-092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 09/07/2010] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is emerging as the biggest killer of the 21st century. A number of theories have been postulated to explain the aetiology of atherosclerosis. The present study attempts to elucidate the interaction, if any, between inflammation, oxidative stress and dyslipidaemia in CAD. METHODS A total of 753 patients undergoing angiography were evaluated and 476 were included in the study. The parameters studied included complete lipid profile, and apolipoprotein B, ferritin and nitric oxide (NO) levels. Statistical analysis was carried out to determine the interrelationship between these parameters and the best predictor of CAD risk. Cut-off points were determined from the receiver operating characteristics curves, and the specificity, sensitivity, positive predictive value, negative predictive value, odds ratio and confidence intervals were calculated. RESULTS The levels of the parameters studied increased with the stenotic state and a positive correlation was observed between ferritin, NO and apolipoprotein B. NO emerged as the most reliable predictor of CAD, with an area under the curve of 0.992 and sensitivity and specificity of 97 and 98%, respectively. CONCLUSION Environmental and genetic risk factors for CAD interact in a highly complex manner to initiate the atherosclerotic process. These risk factors should be considered mutually inclusive, not exclusive when devising pharmacological interventions, as multi-factorial risk management is the cornerstone of CAD management.
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Affiliation(s)
- D Tayal
- Department of Biochemistry, GB Pant Hospital, New Delhi, India
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Bilen O, Kamal A, Virani SS. Lipoprotein abnormalities in South Asians and its association with cardiovascular disease: Current state and future directions. World J Cardiol 2016; 8:247-57. [PMID: 27022456 PMCID: PMC4807313 DOI: 10.4330/wjc.v8.i3.247] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/16/2015] [Accepted: 12/09/2015] [Indexed: 02/06/2023] Open
Abstract
South Asians have a high prevalence of coronary heart disease (CHD) and suffer from early-onset CHD compared to other ethnic groups. Conventional risk factors may not fully explain this increased CHD risk in this population. Indeed, South Asians have a unique lipid profile which may predispose them to premature CHD. Dyslipidemia in this patient population seems to be an important contributor to the high incidence of coronary atherosclerosis. The dyslipidemia in South Asians is characterized by elevated levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, elevated lipoprotein(a) levels, and a higher atherogenic particle burden despite comparable low-density lipoprotein cholesterol levels compared with other ethnic subgroups. HDL particles also appear to be smaller, dysfunctional, and proatherogenic in South Asians. Despite the rapid expansion of the current literature with better understanding of the specific lipid abnormalities in this patient population, studies with adequate sample sizes are needed to assess the significance and contribution of a given lipid parameter on overall cardiovascular risk in this population. Specific management goals and treatment thresholds do not exist for South Asians because of paucity of data. Current treatment recommendations are mostly extrapolated from Western guidelines. Lastly, large, prospective studies with outcomes data are needed to assess cardiovascular benefit associated with various lipid-lowering therapies (including combination therapy) in this patient population.
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Affiliation(s)
- Ozlem Bilen
- Ozlem Bilen, Salim S Virani, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Ayeesha Kamal
- Ozlem Bilen, Salim S Virani, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Salim S Virani
- Ozlem Bilen, Salim S Virani, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
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Flowers E, Molina C, Mathur A, Reaven GM. Use of plasma triglyceride/high-density lipoprotein cholesterol ratio to identify increased cardio-metabolic risk in young, healthy South Asians. Indian J Med Res 2016; 141:68-74. [PMID: 25857497 PMCID: PMC4405943 DOI: 10.4103/0971-5916.154506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background & objectives: Prevalence of insulin resistance and associated dyslipidaemia [high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations] are increased in South Asian individuals; likely contributing to their increased risk of type-2 diabetes and cardiovascular disease. The plasma concentration ratio of TG/HDL-C has been proposed as a simple way to identify apparently healthy individuals at high cardio-metabolic risk. This study was carried out to compare the cardio-metabolic risk profiles of high-risk South Asian individuals identified by an elevated TG/HDL-C ratio versus those with a diagnosis of the metabolic syndrome. Methods: Body mass index, waist circumference, blood pressure, and fasting plasma glucose, insulin, TG, and HDL-C concentrations were determined in apparently healthy men (n=498) and women (n=526). The cardio-metabolic risk profile of “high risk” individuals identified by TG/HDL-C ratios in men (≥ 3.5) and women (≥2.5) was compared to those identified by a diagnosis of the metabolic syndrome. Results: More concentrations of all cardio-metabolic risk factors were significantly higher in “high risk” groups, identified by either the TG/HDL-C ratio or a diagnosis of the metabolic syndrome. TG, HDL-C, and insulin concentrations were not significantly different in “high risk” groups identified by either criterion, whereas plasma glucose and blood pressure were higher in those with the metabolic syndrome. Interpretation & conclusions: Apparently healthy South Asian individuals at high cardio-metabolic risk can be identified using either the TG/HDL-C ratio or the metabolic syndrome criteria. The TG/HDL-C ratio may be used as a simple marker to identify such individuals.
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Affiliation(s)
- Elena Flowers
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
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31
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Baruah S, Chaliha MS, Borah PK, Rajkakati R, Borua PK, Mahanta J. Insertion/Insertion Genotype of Angiotensin I-Converting-Enzyme Gene Predicts Risk of Myocardial Infarction in North East India. Biochem Genet 2015; 54:134-46. [PMID: 26687160 DOI: 10.1007/s10528-015-9706-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
Myocardial infarction (MI) is common in India and the disease occurs at a relatively younger age. We wanted to look for association of Angiotensin I-converting enzyme (ACE) gene with MI in North East India. We also wanted to examine possible environmental interaction of ACE gene with established cardiovascular risk factors in causation of MI. In the study carried out in Assam Medical College, 200 consecutive confirmed cases of MI were recruited. Equal numbers of age- and sex-matched control subjects from hospital workers and patients attending the hospital for diseases unrelated to cardiovascular disease were enrolled. Structured questionnaires were used to note demographic and clinical factors. Cardiovascular risk factors were determined from history, physical examination and biochemical investigations. ACE insertion/deletion (I/D) polymorphism was determined by PCR method. Interaction of ACE gene with other risk factors was noted. The study identified ACE II genotype (odds ratio = 3.02; 95% CI 1.40-6.51), smoking, hypertension, diabetes and serum triglyceride > 150 mg/dl as independent risk factors for MI. ACE II genotype showed greater risk in non-smokers, non-hypertensives, non-diabetics and in subjects with LDL-C < 130 mg/dl. Low HDL cholesterol enhanced the genetic risk. Subjects with ACE II genotype have an independent risk of developing MI, specially in low cardiovascular risk subjects.
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Affiliation(s)
- Sukanya Baruah
- Regional Medical Research Centre-NE-Region (Indian Council of Medical Research), Post Box No-105, Dibrugarh, Assam, 786001, India
| | | | - Prasanta K Borah
- Regional Medical Research Centre-NE-Region (Indian Council of Medical Research), Post Box No-105, Dibrugarh, Assam, 786001, India
| | | | | | - Jagadish Mahanta
- Regional Medical Research Centre-NE-Region (Indian Council of Medical Research), Post Box No-105, Dibrugarh, Assam, 786001, India.
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Bora K, Pathak MS, Borah P, Das D. Variation in Lipid Profile Across Different Patterns of Obesity - Observations from Guwahati, Assam. J Clin Diagn Res 2015; 9:OC17-21. [PMID: 26672627 PMCID: PMC4668450 DOI: 10.7860/jcdr/2015/15334.6787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/14/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obesity adversely affects cardiovascular health is known. But, data is few in this regard from Assam, northeast India. The serum lipid profile is performed for cardio-metabolic status assessment. AIM The aim of the study was to investigate variation in serum lipids across different obesity patterns in an urban population from Assam. MATERIALS AND METHODS Two hundred subjects were classified by WC (waist circumference) and BMI (body mass index) values into four groups as follows: Group I (normal WC, normal BMI), Group II (normal WC, increased BMI), Group III (increased WC, normal BMI) and Group IV (increased WC, increased BMI). WC and BMI served as measures of central and generalized obesity respectively. Lipid profile was measured using VITROS 5600 Autoanalyser, and compared across these groups. Multivariate analyses were performed separately for males and females to confirm the results of univariate analyses. RESULTS WC and BMI exhibited significant correlations with different lipid parameters. Group IV individuals had the most abnormal lipid profile values, while, Group I individuals had the most normal values. Group II and Group III individuals had intermediate values. BMI was independently associated with serum triglycerides in both males and females. WC was independently associated with high density lipoprotein cholesterol in females. CONCLUSION The lipid values varied significantly across different obesity patterns. Serum lipid concentrations were strongly influenced by anthropometric indices of obesity in both sexes. Presence of both central and generalized obesity led to greater abnormalities in lipid profile than presence of central or generalized obesity alone.
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Affiliation(s)
- Kaustubh Bora
- Senior Resident, Department of Biochemistry, NEIGRIHMS, Shillong, Meghalaya, India
| | - Mauchumi Saikia Pathak
- Professor, Department of Biochemistry, Gauhati Medical College & Hospital, Guwahati, Assam, India
| | - Probodh Borah
- Professor and Principal Co-ordinator, State Biotech Hub, College of Veterinary Science, Guwahati, Assam, India
| | - Dulmoni Das
- Clinical Instructor, Army Institute of Nursing, Guwahati, Assam, India
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Alagona P, Ahmad TA. Cardiovascular disease risk assessment and prevention: current guidelines and limitations. Med Clin North Am 2015; 99:711-31. [PMID: 26042878 DOI: 10.1016/j.mcna.2015.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Even after decades of progress in understanding atherosclerotic cardiovascular disease (ASCVD) and improved cardiovascular event prevention, the incidence, consequences and cost of cardiovascular disease (CVD) remain a significant public health issue. Observational studies have identified major ASCVD risk factors and lead to the development of a number of risk assessment systems/scores now in use. However many patients who will develop clinically important CVD are not identified by current systems or approaches and significant numbers of recurrent cardiovascular events continue to occur even after aggressive secondary prevention treatment strategies are utilized. Some now term this residual risk. The statin era revolutionized clinical practice with effective outcome-driven risk reduction. As a result there are now numerous clinical recommendations or guidelines for ASCVD risk stratification and treatment. Further disease and event prevention may rely on improved patient-centered risk stratification using novel biomarkers, imaging techniques, and new treatment approaches including emerging pharmacologic therapies.
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Affiliation(s)
- Peter Alagona
- Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, University Drive, Rm C5833, P.O.Box 850, Hershey, PA 17033-0850, USA.
| | - Tariq Ali Ahmad
- Division of General Internal Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
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Fernando E, Razak F, Lear SA, Anand SS. Cardiovascular Disease in South Asian Migrants. Can J Cardiol 2015; 31:1139-50. [PMID: 26321436 DOI: 10.1016/j.cjca.2015.06.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/09/2023] Open
Abstract
Cardiovascular disease (CVD) represents a significant cause of global mortality and morbidity. South Asians (SAs) have a particularly high burden of coronary artery disease (CAD). This review describes current literature regarding the prevalence, incidence, etiology, and prognosis of CVD in SA migrants to high-income nations. We conducted a narrative review of CVD in the SA diaspora through a search of MEDLINE and PubMed. We included observational studies, randomized clinical trials, nonsystematic reviews, systematic reviews, and meta-analyses written in English. Of 15,231 articles identified, 827 articles were screened and 124 formed the basis for review. SA migrants have a 1.5-2 times greater prevalence of CAD than age- and sex-adjusted Europids. Increased abdominal obesity and body fat and increased burden of type 2 diabetes mellitus and dyslipidemia appear to be primary drivers of the excess CAD burden in SAs. Sedentary lifestyle and changes in diet after immigration are important contributors to weight gain and adiposity. Early life factors, physical activity patterns and, in some cases, reduced adherence to medical therapy may contribute to increased CVD risks in SAs. Novel biomarkers like leptin and adipokines may show distinct patterns in SAs and provide insights into cardiometabolic risk determinants. In conclusion, SAs have distinct CVD risk predispositions, with a complex relationship to cultural, innate, and acquired factors. Although CVD risk factor management and treatment among SAs is improving, opportunities exist for further advances.
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Affiliation(s)
- Eshan Fernando
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Harvard Center for Population and Development Studies, Boston, Massachusetts, USA
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Epidemiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada.
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Chatterjee B, Mehta M, Shah T, Mahant H, Katwa V, Gosai K. Association of Lipoprotein(a) and hsCRP Levels with Metabolic Syndrome and its Components. Indian J Clin Biochem 2015. [DOI: 10.1007/s12291-014-0473-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ahmed E, Gehani A, El-Menyar A, AlBinAli HA, Singh R, Al Suwaidi J. Acute coronary syndrome and ethnicity: observations from the Middle East. Future Cardiol 2014; 10:337-48. [PMID: 24976471 DOI: 10.2217/fca.14.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS To evaluate the presentation and outcome of South Asian (SAP) to Middle Eastern Arabs (MEAP) patients presenting with acute coronary syndrome. METHODS Data were collected retrospectively in Qatar between 1991 and 2010, and were analyzed according to patient ethnicity. RESULTS Of 14,593 acute coronary syndrome patients, 49% were MEAP and 51% were SAP. When compared with MEAP, SAP were younger, males and smokers (p < 0.01). Other cardiovascular risk factors were less common in SAP when compared with MEAP. ST-elevation myocardial infarction and the use of evidence-based medications were more prevalent among SAP (all p < 0.001). Compared to MEAP, SAP had better in-hospital outcomes; however, ethnicity was not an independent predictor of in-hospital mortality. CONCLUSION In contrary to data from Western countries, SAP living in the Middle East are younger with lower cardiovascular risk profile and better outcomes when compared with Arab patients. However, further studies are warranted.
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Affiliation(s)
- Emad Ahmed
- Department of Adult Cardiology & Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
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Study of metabolic syndrome and its risk components in patients attending tertiary care center of uttarakhand. Indian J Clin Biochem 2014; 29:362-6. [PMID: 24966487 DOI: 10.1007/s12291-013-0366-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/11/2013] [Indexed: 01/02/2023]
Abstract
Metabolic syndrome is a complex of metabolic factors which includes central obesity, insulin-resistance, dyslipidemia and hypertension. Metabolic syndrome is associated with increased risk of cardiovascular disease. This study aimed to know the rate of metabolic syndrome in outpatients presenting to medicine department of our hospital and their profile. The metabolic syndrome was diagnosed using International Diabetes Federation criteria. The parameters analyzed included age, sex, blood pressure, BMI, fasting plasma glucose, HDL and triglycerides. The rate of metabolic syndrome was 21.1 % in our study. The younger population was most susceptible to metabolic derangements. Further, females were found to be affected more than males. The extremely significant parameters were deranged fasting plasma glucose, HDL, triglycerides while hypertension was found to be insignificant. Being overweight maybe a strong predictor for presence of metabolic syndrome in our region of study, and all overweight persons should be assessed and appropriately treated to prevent future cardiovascular events.
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Prevalence of dyslipidemia in urban and rural India: the ICMR-INDIAB study. PLoS One 2014; 9:e96808. [PMID: 24817067 PMCID: PMC4016101 DOI: 10.1371/journal.pone.0096808] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/11/2014] [Indexed: 12/18/2022] Open
Abstract
Aim To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India. Methods Phase I of the Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India [Tamil Nadu, Maharashtra and Jharkhand] and one Union Territory [Chandigarh], and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines. Results Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia. Conclusion The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor.
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Singh S, Aulakh R, Kawasaki T. Kawasaki disease and the emerging coronary artery disease epidemic in India: is there a correlation? Indian J Pediatr 2014; 81:328-32. [PMID: 24072580 DOI: 10.1007/s12098-013-1229-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 08/14/2013] [Indexed: 12/15/2022]
Abstract
Although Kawasaki disease (KD) is now being increasingly reported from India, the vast majority of children with KD are still not being diagnosed and treated. A recent study from Chandigarh has shown that the incidence of KD is at least 4.54/100,000 children below 15 y of age. Extrapolations of this figure suggest that a minimum of 17,417 new cases of KD would be occurring every year in our country. A significant proportion of these children may develop coronary artery abnormalities. These children would then be at risk of developing myocardial ischemia as young adults. It is authors' contention that (undiagnosed) KD in childhood may be contributing to the growing pool of coronary artery disease (CAD) in India. Similarly, a missed diagnosis of KD in childhood should be considered as a possibility while evaluating adults with CAD, especially when there are no overt risk factors and no family history of the disease.
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Affiliation(s)
- Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India,
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Kaur K, Rai J, Sharma G, Bal BS. An open-label comparison of the effects of simvastatin and niacin alone and combined on the lipid profile and lipoprotein (a) level in an Indian population with dyslipidemia. Curr Ther Res Clin Exp 2014; 65:455-69. [PMID: 24672098 DOI: 10.1016/j.curtheres.2005.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2004] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Abstract. BACKGROUND Patients with dyslipidemia often require the use of >1 lipid-altering agent to achieve the target levels recommended by the National Cholesterol Education Program Adult Treatment Panel III. OBJECTIVE The aim of this study was to compare the effects of simvastatin and niacin alone and combined on the lipid profile and lipoprotein (a) (Lp[a]) level in an Indian population with dyslipidemia. METHODS This 12-week, open-label, nonrandomized study was conducted at the Departments of Pharmacology and Medicine, Government Medical College, Amritsar (Punjab), India. Patients aged 30 to 70 years with dyslipidemia were eligible. Patients were assigned to 1 of 3 treatment groups. Group 1 received simvastatin 20 mg/d for 12 weeks. Group 2 received niacin at doses of 375 mg/d for 1 week, 500 mg/d for 1 week, and 500 mg BID for 10 weeks. Group 3 received simvastatin 10 mg/d plus niacin (375 mg for 1 week and 500 mg for 11 weeks). The lipid profile (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol [TC], and triglycerides [TG]) and Lp(a) were measured before the start of therapy and at 6 and 12 weeks of treatment. Percentage changes from baseline were calculated. Adverse effects (AEs) were recorded at weeks 6 and 12 and through spontaneous reporting. RESULTS Ninety patients were enrolled (50 men, 40 women; 30 patients per treatment group). In group 1, the mean (SD) percentage decrease in LDL-C level at 12 weeks was 42.79% (16.29%) (P < 0.05), but no significant change was seen in group 2 or 3. The mean (SD) percentage increases in HDL-C level were 18.43% (13.28%) and 20.82% (17.57%) in groups 2 and 3, respectively (both, P < 0.05), but no significant change was seen in group 1. TC levels decreased by a mean (SD) of 32.97% (13.66%) in group 1 (P < 0.05), but no significant change was seen in group 2 or 3. TG and Lp(a) levels did not change significantly in any of the 3 treatment groups. Flushing, myalgia, and dyspepsia were the most common AEs in patients receiving niacin. CONCLUSIONS In this study in Indian patients with dyslipidemia, simvastatin-niacin combination therapy was associated with greater changes in lipid profile compared with either agent used alone. Niacin was also associated with greater changes in Lp(a) levels. AEs were less prevalent with combination therapy than with niacin alone.
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Affiliation(s)
- Kirandeep Kaur
- Departments of Pharmacology and Medicine, Government Medical College, Amritsar (Punjab), India
| | - Jaswant Rai
- Departments of Pharmacology and Medicine, Government Medical College, Amritsar (Punjab), India
| | - Geeta Sharma
- Departments of Pharmacology and Medicine, Government Medical College, Amritsar (Punjab), India
| | - Baljinder Singh Bal
- Departments of Pharmacology and Medicine, Government Medical College, Amritsar (Punjab), India
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Bhanvadia VM, Desai NJ, Agarwal NM. Study of coronary atherosclerosis by modified american heart association classification of atherosclerosis-an autopsy study. J Clin Diagn Res 2013; 7:2494-7. [PMID: 24392381 DOI: 10.7860/jcdr/2013/6828.3588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/18/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The study was designed to assess the atherosclerotic lesions in coronary arteries in cases subjected to autopsy to grade by applying Modified American Heart Association (AHA) classification, evaluate the atheromatous & vulnerable plaques to find out the to age and sex related prevalence of atherosclerosis in the semi-urban & urban population of Jamnagar, a district in Western India. MATERIAL & METHODS Autopsy was conducted on 264 cases whose age ranged from 8-79 years, by the conventional technique; heart was removed & dissected along the direction of blood flow. Microscopic assessment of the three main coronary arteries was done. RESULT According to Modified AHA classification of atherosclerosis, maximum number of cases were in the 40-49 years age group. Intimal xanthoma was the most common type in all three coronary arteries. The number of males was 168(64%) and females was 96(36%). 59% males & 52% female were affected from atherosclerosis. An intermediate lesion was noted commonly in young individuals (10-39 years) and older individuals (40-79 years) were 46% & 41% respectively. Pathological Intimal thickening was more common in left anterior descending coronary artery compared to others. Thin fibrous cap atheroma was more common in Left circumflex artery than compared to Left anterior descending artery & Right coronary artery. CONCLUSION The study highlights the impact of atherosclerotic lesions in the population of Jamnagar, a district in Gujarat state of Western India. The increased amount of intermediate atherosclerotic lesions found in the young population gives an indication that anti-atherogenic preventive measures and drastic dietary & life style modification need to be implemented in young individuals, this will help to prevent coronary artery disease from causing premature death that lead to huge financial burden on the economy and health sector of India.
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Affiliation(s)
- Viral M Bhanvadia
- Assistant Professor, Department of Pathology, MP. Shah Medical College, Jamnagar, Gujarat, India
| | - Nandini J Desai
- Professor, Department of Pathology, MP. Shah Medical College, Jamnagar, Gujarat, India
| | - Neeru M Agarwal
- Associate Professor, Department of Pathology, MP. Shah Medical College, Jamnagar, Gujarat, India
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Patel M, Phillips-Caesar E, Boutin-Foster C. Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US. J Immigr Minor Health 2013; 16:994-1000. [PMID: 23861069 DOI: 10.1007/s10903-013-9868-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance.
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Affiliation(s)
- Mihir Patel
- Divison of General Internal Medicine, Department of Medicine, St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY, 10025, USA,
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Abstract
The purpose of this literature review is to describe and assess the cultural barriers to behavior change in migrant South Asians, given the high morbidity and mortality associated with cardiovascular disease in this population. We reviewed studies that explored the relationship between South Asian culture in the Diaspora and lifestyle behaviors. Our review produced 91 studies, of which 25 discussed the relationship between various aspects of South Asians' belief system and their approach to modifying lifestyle habits. We identify 6 specific categories of beliefs which play the largest role in the difficulties South Asians describe with behavior change: gender roles, body image, physical activity misconceptions, cultural priorities, cultural identity, and explanatory model of disease. Future research and interventions should account for these cultural factors to successfully improve dietary habits and physical activity levels in migrant South Asian populations.
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Anand SS, Vasudevan A, Gupta M, Morrison K, Kurpad A, Teo KK, Srinivasan K. Rationale and design of South Asian Birth Cohort (START): a Canada-India collaborative study. BMC Public Health 2013; 13:79. [PMID: 23356884 PMCID: PMC3585827 DOI: 10.1186/1471-2458-13-79] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/18/2012] [Indexed: 12/31/2022] Open
Abstract
Background People who originate from the Indian subcontinent (South Asians) suffer among the highest rates of type 2 diabetes in the world. Prior evidence suggests that metabolic risk factors develop early in life and are influenced by maternal and paternal behaviors, the intrauterine environment, and genetic factors. The South Asian Birth Cohort Study (START) will investigate the environmental and genetic basis of adiposity among 750 South Asian offspring recruited from highly divergent environments, namely, rural and urban India and urban Canada. Methods Detailed information on health behaviors including diet and physical activity, and blood samples for metabolic parameters and DNA are collected from pregnant women of South Asian ancestry who are free of significant chronic disease. They also undergo a provocative test to diagnose impaired glucose tolerance and gestational diabetes. At delivery, cord blood and newborn anthropometric indices (i.e. birth weight, length, head circumference and skin fold thickness) are collected. The mother and growing offspring are followed prospectively and information on the growth trajectory, adiposity and health behaviors will be collected annually up to age 3 years. Our aim is to recruit a minimum of 750 mother-infant pairs equally divided between three divergent environments: rural India, urban India, and Canada. Summary The START cohort will increase our understanding of the environmental and genetic determinants of adiposity and related metabolic abnormalities among South Asians living in India and Canada.
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Affiliation(s)
- Sonia S Anand
- McMaster University, 1280 Main St West MDCL 3200, L8S 4K1, Hamilton, ON, Canada.
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Rajasekhar D, Saibaba KSS, Srinivasa Rao PVLN, Latheef SAA, Subramanyam G. Lipoprotein (A): Better assessor of coronary heart disease risk in south Indian population. Indian J Clin Biochem 2012; 19:53-9. [PMID: 23105457 DOI: 10.1007/bf02894258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In an attempt to search for risk factors which can explain the increasing prevalence of coronary heart disease (CHD) in Indian population, we conducted a case-control study to assess the association of Lipoprotein (a)(Lp(a)) with CHD. One hundred and fifty one consecutive patients with clinical and angiographic evidence of CHD and forty-nine healthy controls were drawn for the study. Triglycerides, very low density cholesterol (VLDL-C), total cholesterol (total-C)/high density cholesterol (HDL-C) ratio, low density cholesterol (LDL-C)/HDL cholesterol ratio and Lp(a) were found to be higher in patients than controls. In female sex and in those with family history of CHD, higher total and LDL cholesterol levels were observed to be associated with higher Lp(a) levels. Lp(a) levels were also found to be higher in triple vessel disease than other vessel disease patients. Significant difference in Lp(a) levels were observed between normal coronaries vs. single and triple vessel disease(P<0.05) and also between single vs. double and triple vessel disease (P<0.01).Lp(a) levels correlated positively with vessel severity(P<0.005). Lp(a) levels >25 mg/dl were associated with coronary heart disease (Odds ratio 1.98 P<0.05 95% CI 0.007-1.18). Our findings suggest a cut-off level of 25mg/dl for determination of risk of CHD. Studies from different areas involving larger sample size are needed to confirm the findings of the present study.
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Affiliation(s)
- D Rajasekhar
- Department of Cardiology, Sri Venkatesware Institute of Medical Sciences, 517507 Tirupati, India
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Abstract
This article reviews issues relating to the prevalence, health implications, and prevention and treatment perspectives of obesity in U.S racial and ethnic minority groups. The growing interest in obesity in minority populations reflects an awareness of the high prevalence of obesity among black, Hispanic, Asian and Pacific Islander and Native Americans as well as a generally increased interest in minority health. In addition, the fact that some aspects of obesity among minorities differ from those in whites suggests that new insights may be gained from studying obesity in diverse populations. However, there are many methodological problems to be overcome, including some that arise from the way minority groups are defined. Under the assumption that all obesity results from a period of sustained positive energy balance at the individual level, an epidemiologic explanation for the excess of obesity in minorities at the population level seems readily apparent. A surplus of obesity-promoting forces and a deficit of obesity-inhibiting forces, caused by secular changes in food availability and physical activity, accompany the early phases of modernization and economic advancement. The high prevalence of obesity in minority populations can be viewed as a function of the slope and timing of these secular changes. Genetic predisposition, cultural attitudes, and exposure to maternal obesity and diabetes in utero may be potentiating factors. In this context, interventions targeting individuals would seem inevitably to put racial and ethnic minority groups on the path toward the same weight control crisis now observed in the majority white population. This suggests that the underlying causes of the societal energy balance problem must be addressed at the population level in order for effective clinical approaches to be developed for minority populations with a high obesity prevalence.
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Affiliation(s)
- S K Kumanyika
- Center for Biostatistics and Epidemiology, College of Medicine, Pennsylvania State University, P.O. Box 850, Hershey, PA 17033, USA
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Krishnan MN. Coronary heart disease and risk factors in India - on the brink of an epidemic? Indian Heart J 2012; 64:364-7. [PMID: 22929818 DOI: 10.1016/j.ihj.2012.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Meenakshisundaram R, Devidutta S, Michaels AD, Senthilkumaran S, Rajendiran C, Thirumalaikolundusubramanian P. Significance of the intima-media thickness of carotid and thoracic aorta in coronary artery disease in the South Indian population. Heart Views 2012; 12:150-6. [PMID: 22574240 PMCID: PMC3345149 DOI: 10.4103/1995-705x.90901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Ultrasound detected intima-media thickness (IMT) of the carotid artery and thoracic aorta are possible screening tests to assess the risk of coronary artery disease (CAD) in asymptomatic individuals. Objective: Aim of the study was to assess the utility of carotid and aortic IMT as a predictor of CAD and to assess the extent of IMT with severity of CAD in a South Indian population. Patients and Methods: A cross-sectional and analytical study was carried out among 40 cases, who had angiographic evidence of CAD against 30 healthy control subjects with a normal treadmill test. At plaque-free regions, the carotid IMT was evaluated by B-mode ultrasonography and thoracic aorta IMT was evaluated by trans-esophageal echocardiography (TEE). The significance of difference in means between two groups was analyzed using one-way ANOVA F-test and the significance of difference in proportions by Chi-square test. Multiple comparisons were done by Bonferroni t test. The correlation between IMT and severity of CAD was assessed by Spearman's method. Results: There were 38 males and 2 females among cases with age 51.7 ± 8.3 years, and 28 males and 2 females among control subjects with age 52.2 ± 7.1 years. Increased carotid IMT was noted among 24 cases and 2 control subjects, and the association was significant for CAD [P < 0.001, Chi-square = 20.89, odds ratio (OR) = 21.00, and 95% confidence interval (CI) = 4.78-89.59]. Similarly, 19 cases and one control subject had abnormal IMT with positive correlation for CAD (P < 0.001, Chi-square = 16.39, OR = 28.24, and 95% CI = 4.06-163.21). There was no association between IMT and diabetes, hypertension, or smoking; however, IMT was significantly associated with age and dyslipidemia. Also, there was no correlation between extent of IMT and severity of CAD. Conclusions: IMT of the carotid and thoracic aorta is strongly associated with risk of CAD in a South Indian population, and may be used as a non-invasive screening tool for coronary atherosclerosis in resource-limited settings. The presence of dyslipidemia influenced IMT and may be used as a tool to follow patients on hypolipidemic drugs.
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