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Seah R, Siripongvutikorn S, Wichienchot S, Usawakesmanee W. Functionality and Health-Promoting Properties of Polysaccharide and Plant-Derived Substances from Mesona chinensis. Foods 2024; 13:1134. [PMID: 38611438 PMCID: PMC11011351 DOI: 10.3390/foods13071134] [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: 02/07/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Mesona chinensis, in Thai called Chao Kuay and in Chinese Hsian-tsao, belongs to the Lamiaceae family. This herbal plant grows widely in Southern China, Taiwan (China), Malaysia, the Philippines, Indonesia, Vietnam, and Thailand. The Mesona plant is used to make functional products such as drinks and soft textured sweet treats, and also traditional medicine, to treat heat stroke, high blood pressure, heart attack, high blood sugar, hepatic diseases, colon diseases, inflammatory conditions, and to alleviate myalgia. The proximate composition of M. chinensis is a mixture of protein, fat, fiber, ash, and minerals. The main biological compounds in M. chinensis extracts are polysaccharides, terpenoids, flavonoids, and polyphenols, with wide-ranging pharmacological properties including antioxidant, antidiabetic, antilipidemic, carcinoma-inhibitory, renal-protective, antihypertensive, DNA damage-protective, and anti-inflammatory effects. This review investigated the proximate composition, polysaccharide type, and pharmacological properties of M. chinensis extracts. Phytochemical properties enhance the actions of the gut microbiota and improve health benefits. This review assessed the functional and medicinal activities of M. chinensis extracts. Future studies should further elucidate the in vitro/in vivo mechanisms of this plant extract and its impact on gut health.
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Affiliation(s)
- Romson Seah
- Department of Chemistry, Faculty of Education, Fatoni University, Yarang, Pattani 94160, Thailand;
| | - Sunisa Siripongvutikorn
- Centre of Excellence in Functional Foods and Gastronomy, Faculty of Agro-Industry Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (S.W.); (W.U.)
| | - Santad Wichienchot
- Centre of Excellence in Functional Foods and Gastronomy, Faculty of Agro-Industry Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (S.W.); (W.U.)
| | - Worapong Usawakesmanee
- Centre of Excellence in Functional Foods and Gastronomy, Faculty of Agro-Industry Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; (S.W.); (W.U.)
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Madan K, Sawhney JPS. Exercise and lipids. Indian Heart J 2024; 76 Suppl 1:S73-S74. [PMID: 38599728 PMCID: PMC11019314 DOI: 10.1016/j.ihj.2023.11.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/27/2023] [Indexed: 04/12/2024] Open
Abstract
Evidence from the existing literature suggests that exercise has positive effects for prevention and treatment of cardiovascular diseases by reducing risk factors such as elevated blood lipids. Based on clinical and observational clinical trials, it is well established that increased physical activity and regular exercise has a favourable impact on blood lipids and lipoprotein profiles. Exercise training significantly decreases blood triglycerides concentration and increases high density lipoprotein cholesterol levels. Though the Indian data depicting the effect of exercise on lipids is scarce, exercise directly improves "atherogenic dyslipidaemia" which is frequently present among Indians i.e. HDL-C is increased, TG is reduced and LDL-C particle size is improved. While drug therapy is key to the treatment of dyslipidaemia, lifestyle alterations such as exercise should continue to be actively promoted and encouraged by clinicians. Exercise is a low cost, non pharmacological therapeutic lifestyle change that is of value to lipid metabolism and cardiovascular fitness.
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Affiliation(s)
- Kushal Madan
- Dharma Vira Heart Center Sir Ganga Ram Hospital, New Delhi, 110060, India.
| | - J P S Sawhney
- Dharma Vira Heart Center Sir Ganga Ram Hospital, New Delhi, 110060, India.
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Li C, Spencer G, Husain MJ, Nugent R, Auzenne D, Kostova D, Richter P. Barriers to accessibility of medicines for hyperlipidemia in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002905. [PMID: 38346061 PMCID: PMC10861044 DOI: 10.1371/journal.pgph.0002905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
Despite the high burden of hyperlipidemia and the effectiveness of treatment, evidence suggests that the accessibility of hyperlipidemia medicines can be low in many low- and middle-income countries (LMICs). The aim of this study was to identify common barriers to the accessibility of medicines for hyperlipidemia in LMICs. A multimethod analysis and multiple data sources were used to assess the accessibility and barriers of medicines for hyperlipidemia in selected LMICs. The overall median availability of statins for hyperlipidemia in public facilities was 0% and 5.4%, for originators and generics, respectively. In private facilities, median availability was 13.3% and 35.9%, for originators and generics, respectively. Statin availability was lowest in Africa and South-East Asia. Private facilities generally had higher availability than public facilities. Statins are less affordable in lower-income countries, costing around 6 days' wages per month. Originator statins are less affordable than generics in countries of all income-levels. The median cost for statin medications per month ranges from a low of $1 in Kenya to a high of $62 in Mexico, with most countries having a median monthly cost between $3.6 and $17.0. The key informant interviews suggested that accessibility to hyperlipidemia medicines in LMICs faces barriers in multiple dimensions of health systems. The availability and affordability of statins are generally low in LMICs. Several steps could be implemented to improve the accessibility of hyperlipidemia medicines, including private sector engagement, physician education, investment in technology, and enhancement of health systems.
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Affiliation(s)
- Chaoyang Li
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Muhammad Jami Husain
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Deon Auzenne
- Department of Psychology, Howard University, Washington, District of Columbia, United States of America
| | - Deliana Kostova
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patricia Richter
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Amin N, Devasia T, Kamath SU, Paramasivam G, Shetty PN, Singh A, Prakash GNS. Confounding Factors Responsible for Elevated Lp(a) Levels in Patients with Coronary Artery Disease. Ann Card Anaesth 2024; 27:32-36. [PMID: 38722118 PMCID: PMC10876127 DOI: 10.4103/aca.aca_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are a leading cause of global mortality, motivating research into novel approaches for their management. Lipoprotein(a) (Lp(a)), a unique lipoprotein particle, has been implicated in atherosclerosis and thrombosis, suggesting its potential as a therapeutic target for CVDs. AIM This study aimed to investigate the association of Lp(a) levels with various cardiovascular parameters and events among patients with confirmed cardiovascular disease. METHODOLOGY A prospective study was conducted, enrolling 600 participants, predominantly comprising males (79%), with a mean age of 52.78 ± 0.412 years diagnosed with cardiovascular disease. The follow-up was done for 18 months. Patient demographics, blood investigations, and occurrence of major adverse cardiac events (MACE) were collected. SPSS version 21 was used to statistically analyze the relationships between elevated Lp(a) levels and factors such as age, glycated hemoglobin, mortality, MACE, cardiac death, target vessel revascularization, and stroke. RESULTS The study revealed significant (P < 0.05) associations between elevated Lp(a) levels and advanced age, increased glycated hemoglobin levels, as well as occurrences of all-cause mortality, MACE, cardiac death, target vessel revascularization, and stroke. Notably, a significant (P < 0.05), association between high Lp(a) levels and acute coronary syndrome (ACS) emerged, suggesting Lp(a)'s role in advanced cardiac events. CONCLUSION The findings highlight the potential significance of Lp(a) as a notable risk factor in cardiovascular health. The observed associations between elevated Lp(a) and adverse cardiovascular events, including ACS, underscore its pathogenic role. Consequently, this study supports the rationale for further research into Lp(a)-specific therapeutic interventions, offering substantial promise in refining the management strategies for cardiovascular diseases.
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Affiliation(s)
- Navaneeth Amin
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shobha Ullas Kamath
- Department of Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasad Narayana Shetty
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajit Singh
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesha N. S. Prakash
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kumar S. Profile of type 2 diabetes mellitus patients attending family medicine clinic in a rural tribal locality in India. J Family Med Prim Care 2023; 12:3242-3248. [PMID: 38361905 PMCID: PMC10866235 DOI: 10.4103/jfmpc.jfmpc_2114_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/03/2023] [Accepted: 07/27/2023] [Indexed: 02/17/2024] Open
Abstract
Objective Diabetes prevalence has been predicted to reach 578 million worldwide in 2030 and is estimated to increase by 51% (700 million) in 2045. Type 2 diabetes mellitus (T2DM) is frequently associated with various cardiovascular (CV) risk factors secondary to associated dyslipidemias and good glycemic control is key for the prevention of long-term CV complications; this study was conducted to assess present glycemic status and lipid profile of the population residing in a rural tribal locality of Jharkhand (India). Materials and Methods This cross-sectional study was conducted as a project for Fellowship in diabetes course by the Department of Endocrinology, DEDU, CMC Vellore. Whole blood and sera were analyzed for fasting blood sugar (FBS), glycated-hemoglobin (HbA1c), total cholesterol (CH), triglycerides (TGs), high-density-lipoprotein-cholesterol (HDL-C), low-density-lipoprotein-cholesterol (LDL-C), and very-low-density-lipoprotein-cholesterol (VLDL-C). A correlation test of HbA1c with lipid ratios and individual lipid indexes was done. Results The mean Hb1Ac level was uncontrolled as 7.24 ± 1.80 and, interestingly, was marginally higher [7.31 ± 1.92 Vs 6.92 ± 1.16] in patients with T2DM <5 years as compared to those with T2DM >5 years. Mixed dyslipidemias were common with abnormal TG, LDL, VLDL, HDL, and total CH values. Hb1Ac levels showed a significant positive correlation with serum CH, TG, LDL, and VLDL levels, while a significant negative correlation with HDL levels in the study. Conclusion Apart from being a reliable indicator of long-term glycemic control, HbA1c can also be used as a surrogate marker of dyslipidemia, and thus early diagnosis and treatment of dyslipidemia can prevent life-threatening cardiovascular complications that can be particularly useful in resource-poor rural tribal locality settings.
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Affiliation(s)
- Sumit Kumar
- Department of Physiology, Government Medical College, Datia, Madhya Pradesh, India
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Olujide OP, Olujide ME, Leonardi‐Bee J, Chattopadhyay K. Content and quality of clinical practice guidelines for the management of type 2 diabetes in India: A systematic review. Endocrinol Diabetes Metab 2023; 6:e405. [PMID: 36646655 PMCID: PMC10000656 DOI: 10.1002/edm2.405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/16/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Over the last few decades, India has witnessed an increase in the number of people with type 2 diabetes mellitus (T2DM). Consequently, several clinical practice guidelines (CPGs) have been developed to assist western and traditional Indian medicine practitioners in managing this disease. This systematic review aimed to evaluate and synthesize the content and quality of these CPGs. METHODS Several databases and sources were searched from inception to May 2022, to identify CPGs for managing adults with T2DM in India. The screening of titles and abstracts and full texts, data extraction and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. A data extraction tool from a previous study was adapted to extract the content of the included CPGs, and the Appraisal of Guidelines for Research and Evaluation II tool was used to assess the quality of the included CPGs. A narrative synthesis was conducted. RESULTS Of 3350 records identified, 11 were retrieved for full-text screening and five CPGs were included in this systematic review-three focused on traditional Indian medicine (Ayurveda) and two focused on western medicine. These two western medicine CPGs contained comprehensive recommendations for managing T2DM but only one of these, the Research Society for the Study of Diabetes in India/Endocrine Society of India (RSSDI/ESI) CPG, was of high quality. CONCLUSIONS Only one CPG can be recommended for managing T2DM by western medicine practitioners in India. Future CPGs, especially for traditional Indian medicine practitioners, should be developed and updated using the standard CPG manuals and quality appraisal tools. REGISTRATION PROSPERO (CRD42021279499).
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Affiliation(s)
- Oluwasegun P. Olujide
- Lifespan and Population Health Academic Unit, School of MedicineUniversity of NottinghamNottinghamUK
| | | | - Jo Leonardi‐Bee
- Lifespan and Population Health Academic Unit, School of MedicineUniversity of NottinghamNottinghamUK
- The Nottingham Centre for Evidence‐Based Healthcare: A JBI Centre of ExcellenceNottinghamUK
| | - Kaushik Chattopadhyay
- Lifespan and Population Health Academic Unit, School of MedicineUniversity of NottinghamNottinghamUK
- The Nottingham Centre for Evidence‐Based Healthcare: A JBI Centre of ExcellenceNottinghamUK
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Dhurjati R, Sagar V, Kanukula R, Rehana N, Mohanan PP, Huffman MD, Bhaumik S, Salam A. Quality of the Indian clinical practice guidelines for the management of cardiovascular conditions. JRSM Open 2022; 13:20542704221127178. [PMID: 36506268 PMCID: PMC9730011 DOI: 10.1177/20542704221127178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To assess the quality of Indian clinical practice guidelines (CPG)s for the management of cardiovascular conditions, MEDLINE, Embase, Google Scholar and websites of relevant medical associations and government organisations were searched, from inception until August 2020, to identify Indian CPGs for the management of cardiovascular disease (CVD) conditions, produced in or between 2010 and 2019. Excluded were CPGs that were not specific to India, focused on alternative systems of medicine, of non-CVD conditions (even if they included a component of CVD), and those related to the electronic devices, cardiac biomarkers, or diagnostic procedures. Quality of the each included CPG was assessed using the AGREE II tool by four reviewers in duplicate, independently. Each AGREE II domain score and overall quality score was considered low (≤40%), moderate (40.1%-59.9%), and high (≥60%). Of the 23 CPGs included, six (26%) were reported to be adapted from other CPGs. Fourteen (61%) CPGs were produced by medical associations, six (26%) by individual authors and three (13%) by government agencies. Based on the AGREE II overall quality score, two (9%) CPGs were of high quality, four (17%) and seventeen (74%) CPGs were of moderate and low quality, respectively. Except for scope and purpose, and clarity of presentation all other domains were rated low. The quality of most Indian CPGs for managing CVD conditions assessed using the AGREE II tool was moderate-to-low. Combined efforts from different stakeholders are needed to develop, disseminate and implement high-quality CPGs while identifying and addressing barriers to their uptake to optimize patient care and improve outcomes.
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Affiliation(s)
| | - Vidya Sagar
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Raju Kanukula
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Nusrath Rehana
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Mark D. Huffman
- Washington University in St. Louis, St Louis, MO, USA,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Soumyadeep Bhaumik
- The George Institute for Global Health, New Delhi, Delhi, India,Meta-research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, Delhi, India
| | - Abdul Salam
- The George Institute for Global Health, New Delhi, Delhi, India,Manipal Academy of Higher Education, Manipal, Karnataka, India,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,Abdul Salam.
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Cheng W, Kong F, Chen S. Comparison of the predictive value of four insulin resistance surrogates for the prevalence of hypertension: a population-based study. Diabetol Metab Syndr 2022; 14:137. [PMID: 36163185 PMCID: PMC9511744 DOI: 10.1186/s13098-022-00907-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Several studies have investigated the association of insulin resistance (IR) surrogates and the risk of hypertension. However, it is unclear whether there exist differences between different IR surrogates and hypertension risk. Therefore, this study aimed to explore the association of four IR surrogates (triglyceride-glucose index (TyG index), triglyceride-glucose index with body mass index (TyG-BMI), triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-c), and metabolic score for IR (METS-IR)) with the prevalence of hypertension. METHODS This is a cross-sectional study with a total of 117,056 participants. Data were extracted from a computerized database established by Rich Healthcare Group in China, which included all medical records of participants who received a health check-up from 2010 to 2016. IR surrogates were grouped into quartiles as continuous variables, and multivariate logistic regression was performed to estimate the association between different IR surrogate levels and the prevalence of hypertension. Results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Missing data were accounted by multiple imputation. These analyses were considered as the sensitivity analysis. Meanwhile, the Bayesian network (BN) model was constructed to further evaluate the relationship between baseline characteristics and the four IR surrogates and the prevalence of hypertension, as well as the importance of every single variable for the prevalence of hypertension. RESULTS Multivariate logistic regression analysis revealed that TyG-BMI and METS-IR were independent risk factors for the prevalence of hypertension that increased significantly with increasing TyG-BMI and METS-IR (p for trend < 0.001). The area under the TyG-BMI curve (AUC) was 0.681 [95% CI: 0.677-0.685], and the cut-off value was 199.5, with a sensitivity and specificity of 65.57% and 61.18%, respectively. While the area under the METS-IR curve (AUC) was 0.679 [95% CI: 0.674-0.683], and the cut-off value was 33.61, with a sensitivity and specificity of 69.67% and 56.67%, respectively. The BN model presented that among these four IR surrogates and related variables, TyG-BMI was the most important predictor of hypertension prevalence, with a significance of 34%. The results before and after multiple imputation were similar. CONCLUSION TyG-BMI and METS-IR were independent risk factors for the prevalence of hypertension. TyG-BMI and METS-IR had good predictive value for the prevalence of hypertension, and TyG-BMI was superior to METS-IR.
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Affiliation(s)
- Wenke Cheng
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Fanliang Kong
- Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
| | - Siwei Chen
- Department of Cardiovascular Medicine, The Third Hospital of Nanchang, No.1268, Jiuzhou Street, Chaoyang New District, Nanchang, Jiangxi, China.
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Misra S, Lyngdoh T, Mulchandani R. Guidelines for dyslipidemia management in India: A review of the current scenario and gaps in research. Indian Heart J 2022; 74:341-350. [PMID: 35940234 PMCID: PMC9647649 DOI: 10.1016/j.ihj.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular Diseases (CVD) have a high disease burden in India. Dyslipidemia, a major CVD risk factor, requires effective management. Our review describes the appropriateness of the international dyslipidemia guidelines in the Indian context. A systematic search was performed in PubMed, Google Scholar, Cochrane Library and Science Direct to obtain relevant articles. Dyslipidemia management guidelines by western medical associations are based on their studies, with ethnic minorities underrepresented and biological features of other racial groups inadequately incorporated. The Lipid Association of India (LAI) came up with a consensus statement guided by an expert panel to adapt the western guidelines to Indians. However, absence of Indian guidelines has led to physicians basing treatment on individual preference, contributing to heterogeneity. Our review underscores the need for formulating Indian dyslipidemia management guidelines and CV risk estimation algorithms, highlighting the scope for further research. This could supplement the clinical expertise of LAI and enhance patient experience.
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RSSDI consensus recommendations for dyslipidemia management in diabetes mellitus. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01063-6] [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: 10/18/2022] Open
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Prevalence, clinical profile, and stroke risk of atrial fibrillation in rural Andhra Pradesh, India (the ap-af study). Indian Heart J 2022; 74:86-90. [PMID: 35257736 PMCID: PMC9039683 DOI: 10.1016/j.ihj.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022] Open
Abstract
The burden of atrial fibrillation (AF) is increasing worldwide. It is often asymptomatic, with stroke being the first manifestation in some. AF burden in the community and the practice of stroke prophylaxis has not been studied in India. The problem might be higher in rural regions due to poor health awareness and challenges to healthcare access. This study aimed to estimate the prevalence of AF, clinical profile and stroke risk in rural India. Methods This is a community-based cross-sectional study done in rural Andhra Pradesh (AP). Adults from 40 villages formed the study population. We did a door-to door survey to collect information on demographics, and medical history. Electrocardiogram was recorded using a smart phone based Alivecor device. Participants diagnosed with AF underwent echocardiogram. Study cardiologists assessed the cardiovascular risk profile and collected detailed medical history. Results Fourteen of the 4281 individuals screened had AF (0.3%). The mean age of the sampled population was 44 ± 16.5 years with 56% women. The mean age of participants with AF was 71 ±7.8 years; males were 71%. Except for one, all were non-valvular AF. Majority had a CHA2D2S2Vasc score of ≥2. Three had history of stroke. Two were on anticoagulant therapy but without INR monitoring. Conclusion The prevalence of AF is lower in this study compared to studies from the developed countries. Non-rheumatic cardiovascular risk factors were primary causes for AF. Non-adherence to stroke prophylaxis is a major threat that needs to be addressed.
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Nagarathna R, Kumar S, Anand A, Acharya IN, Singh AK, Patil SS, Latha RH, Datey P, Nagendra HR. Effectiveness of Yoga Lifestyle on Lipid Metabolism in a Vulnerable Population-A Community Based Multicenter Randomized Controlled Trial. MEDICINES 2021; 8:medicines8070037. [PMID: 34357153 PMCID: PMC8303653 DOI: 10.3390/medicines8070037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 01/09/2023]
Abstract
Background: Dyslipidemia poses a high risk for cardiovascular disease and stroke in Type 2 diabetes (T2DM). There are no studies on the impact of a validated integrated yoga lifestyle protocol on lipid profiles in a high-risk diabetes population. Methods: Here, we report the results of lipid profile values of 11,254 (yoga 5932 and control 5322) adults (20–70 years) of both genders with high risk (≥60 on Indian diabetes risk score) for diabetes from a nationwide rural and urban community-based two group (yoga and conventional management) cluster randomized controlled trial. The yoga group practiced a validated integrated yoga lifestyle protocol (DYP) in nine day camps followed by daily one-hour practice. Biochemical profiling included glycated hemoglobin and lipid profiles before and after three months. Results: There was a significant difference between groups (p < 0.001 ANCOVA) with improved serum total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein in the yoga group compared to the control group. Further, the regulatory effect of yoga was noted with a significant decrease or increase in those with high or low values of lipids, respectively, with marginal or no change in those within the normal range. Conclusion: Yoga lifestyle improves and regulates (lowered if high, increased if low) the blood lipid levels in both genders of prediabetic and diabetic individuals in both rural and urban Indian communities.
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Affiliation(s)
- Raghuram Nagarathna
- Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru 560105, India; (A.K.S.); (S.S.P.); (H.R.N.)
- Correspondence: (R.N.); (A.A.)
| | - Saurabh Kumar
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
| | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
- Centre for Mind Body Medicine, PGIMER, Chandigarh 160012, India
- Centre for Cognitive Science and Phenomenology, Panjab University, Chandigarh 160014, India
- Correspondence: (R.N.); (A.A.)
| | - Ishwara N. Acharya
- Central Council for Research in Yoga & Naturopathy (CCRYN), Delhi 110058, India;
| | - Amit Kumar Singh
- Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru 560105, India; (A.K.S.); (S.S.P.); (H.R.N.)
| | - Suchitra S. Patil
- Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru 560105, India; (A.K.S.); (S.S.P.); (H.R.N.)
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Abid H, Abid Z, Abid S. Atherogenic indices in clinical practice and biomedical research: A short review. BAGHDAD JOURNAL OF BIOCHEMISTRY AND APPLIED BIOLOGICAL SCIENCES 2021. [DOI: 10.47419/bjbabs.v2i02.52] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases (CVD) represent a major cause of mortality and morbidity worldwide. To date, many physicians still requesting traditional lipid profile tests (TG, TC, HDL-C, and LDL-C) to confirm the clinical diagnosis related to CVD. However, using these tests may be inadequate for the prediction of CVD risk, especially in intermediate risk. For better clinical practice, laboratory diagnostic alternatives should constantly be evaluated and developed by physicians and laboratory scientists. In this review, we sought to focus on the benefits of lipid ratios (CRI-, CRI-II, AIP, AC, and CHOLindex) in supporting clinical diagnosis and how they can be calculated. To attain this aim, a literature search in reputed databases (PubMed and Scopus) was performed and peer-reviewed research articles were included to conduct this review. Short theoretical and practical notes about each index were accordingly included along with calculation formulas. Thus, the current article can assist new researchers and young physicians to review what supports their knowledge in managing early CVDs.
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Saggu DK, Rangaswamy VV, Yalagudri S, Sundar G, Reddy NK, Shah V, K K, Shankar M, Chennapragada S, Narasimhan C. Prevalence, clinical profile, and stroke risk of atrial fibrillation in rural Andhra Pradesh, India (The AP-AF study) - Rationale and design. Indian Pacing Electrophysiol J 2021; 21:275-280. [PMID: 34010662 PMCID: PMC8414173 DOI: 10.1016/j.ipej.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/25/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The epidemiology of atrial fibrillation (AF) in India has not been studied systematically in large scale population based surveys. Stroke is one of the leading causes of death and disability in India. As AF is a major contributor of stroke, it is important to know the burden of AF and stroke risk in the population. The Andhra Pradesh Atrial Fibrillation (AP-AF) study aims to assess the prevalence, etiology, risk factors and stroke risk among the rural population in Andhra Pradesh, India. METHODS This is a cross-sectional survey done using a two-stage sampling process. Adults (≥18years) from villages in East and West Godavari districts were sampled. Field investigators used a structured questionnaire to collect information on basic demographics, cardiovascular risk factors and medical history. Anthropometric measurements were performed, blood pressure measured and fasting capillary blood glucose was assessed. Electrocardiogram was done using a hand-held mobile ECG device-KardioMobile. ECGs were interpreted by study cardiologists. Participants diagnosed to have AF were invited to participate in a camp conducted by cardiologists where echocardiogram was done and also a focused history related to AF was collected. Along with age and sex stratified prevalence of AF, descriptive statistics will be used to present demographics, clinical profile, and cardiovascular risk factors. Stroke risk will be calculated using CHA 2 DS 2 -Vasc score. CONCLUSION The AP-AF study is expected to provide important information on AF epidemiology in rural India. The information may help improve health care policies in preventing stroke and other complications of AF.
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Affiliation(s)
- Daljeet Kaur Saggu
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | | | - Sachin Yalagudri
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | - Gomathi Sundar
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | - N K Reddy
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | - Vihang Shah
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | - Kotti K
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | - Manjunath Shankar
- CARE Foundation, Road No.1, Banjara Hills, CARE Hospital, Hyderabad, Telangana, 500 034, India
| | | | - Calambur Narasimhan
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad, Telangana, 500 034, India.
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Distribution of Lipids and Prevalence of Dyslipidemia among Indian Expatriates in Qatar. J Lipids 2021; 2021:8866784. [PMID: 33747568 PMCID: PMC7960024 DOI: 10.1155/2021/8866784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/26/2021] [Accepted: 02/06/2021] [Indexed: 01/23/2023] Open
Abstract
Background Dyslipidemia is a significant risk factor for cardiovascular diseases (CVD). If detected and managed in the early stages of life, can reduce morbidity and mortality associated with CVD in a vulnerable population. Out of the 94 expatriate nationalities in Qatar, Indians constitute the most prominent single nationality, accounting for 21.8% of the total population (2,773,885 in 2019). This study aims to determine the status of the lipid profile among Indians in Qatar. Study Design. We conducted an observational retrospective study on lipid profile test data of Indian expatriates visiting a private healthcare facility in Qatar from Oct 17 to Oct 2018 to evaluate the gender and age-specific distribution of lipids and the prevalence of dyslipidemia. Results Among the total 4483 Indian expatriates (3891 men and 592 women), the mean (SD) mg/dL levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) were higher in men TC 196.9 (40.6), TG 168.9 (114.6), and LDL-C 122.9 (37.2) mg/dL compared to women TC 185 (38.1), TG 117.7 (78.2), and LDL-C 114.1 (31.1) mg/dL, p value < 0.0001. Utilizing predefined National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) limits to categorize dyslipidemias; the greater prevalence of elevated TC, TG, and LDL-C was noted in men 44.7%, 45.8%, and 40.9% than women 31.6%, 22%, and 28.7%, respectively. However, women had higher levels of mean high-density lipoprotein cholesterol (HDL-C) as 47.1 (9.8) mg/dL vs. 40.6 (8.3) mg/dL in men, p value < 0.05, the prevalence of dyslipidemia, low HDL-C was also more 65.7% vs. 48.9% in women than men. With age, men showed a declining trend while women showed a rising trend for mean lipid levels as well as for the prevalence of dyslipidemia, high TC, TG, and LDL-C (p value < 0.0001). The mean HDL-C cholesterol increased, and the prevalence of dyslipidemia, low HDL-C decreased with age in both the genders. Conclusion Our results demonstrate the higher mean lipid levels and prevalence of atherogenic dyslipidemia among Indian expatriate men than women counterparts at the younger age group. The screening programs and awareness campaigns must be initiated to prevent the early onset of dyslipidemia induced atherosclerosis leading to CVD. Future controlled studies are needed to estimate the prevalence of dyslipidemias among Indian migrants in Qatar.
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Bansal M, Ranjan S, Kasliwal RR. Cardiovascular Risk Calculators and their Applicability to South Asians. Curr Diabetes Rev 2021; 17:e100120186497. [PMID: 33023452 DOI: 10.2174/1573399816999201001204020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Estimation of absolute cardiovascular disease (CVD) risk and tailoring therapies according to the estimated risk is a fundamental concept in the primary prevention of CVD is assessed in this study. Numerous CVD risk scores are currently available for use in various populations but unfortunately, none exist for South Asians who have much higher CVD risk as compared to their western counterparts. METHODS A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic. RESULTS Various currently available CVD risk scores and their pros and cons are summarized. The studies performed in native as well as migrant South Asians evaluating the accuracy of these risk scores for estimation of CVD risk are also summarized. The findings of these studies have generally been inconsistent, but it appears that the British risk scores (e.g. QRISK versions) may be more accurate because of inclusion of migrant South Asians in the derivation of these risk scores. However, the lack of any prospective study precludes our ability to draw any firm conclusions. Finally, the potential solution to these challenges, including the role of recalibration and subclinical atherosclerosis imaging, is also discussed. CONCLUSION This review highlights the need to develop large, representative, prospectively followed databases of South Asians providing information on various CVD risk factors and their contribution to incident CVD. Such databases will not only allow the development of validated CVD risk scores for South Asians but will also enable application of machine-learning approaches to provide personalized solutions to CVD risk assessment and management in these populations.
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Affiliation(s)
- Manish Bansal
- Clinical and Preventive Cardiology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shraddha Ranjan
- Department of Cardiology, Medanta- The Medicity, Gurgaon, India
| | - Ravi R Kasliwal
- Clinical and Preventive Cardiology, Medanta- The Medicity, Gurgaon, Haryana, India
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Das AK, Saboo B, Unnikrishnan AG. Current Practices and Gaps in Management of Dyslipidemia in Type 2 Diabetes Mellitus (T2DM) in Accordance with American Diabetes Association (ADA) Guidelines: A Subset Analysis from a Real-World, Cross-Sectional Observational Study (LEADD Study). Diabetes Metab Syndr Obes 2021; 14:2693-2700. [PMID: 34163197 PMCID: PMC8214520 DOI: 10.2147/dmso.s294842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/04/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diabetic dyslipidemia is a risk factor for coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). American Diabetes Association (ADA) provides internationally accepted guidelines to manage dyslipidemia in T2DM. OBJECTIVE To assess if ADA guidelines are followed for managing dyslipidemia in patients with T2DM in India. METHODS This was a subset analysis of a prospective, cross sectional, observational study (LEADD Study) conducted at 199 sites across India to evaluate dyslipidemia management practices in T2DM patients (N=4002), in a real-world setting. The data was stratified based on age and atherosclerotic cardiovascular disease (ASCVD) and ASCVD risk factors to record the percentages of T2DM patients achieving LDL-C target and treated optimally with the Guideline directed intensity of statin. Analysis was conducted using descriptive statistics. RESULTS As per ADA 2018 targets: LDL-C levels (<100mg/dL) were seen in 30.6% of participants. High intensity statins were prescribed to 13.4% of the participants with LDL levels ≥100 mg/dL. ASCVD risk assessment details were available for 89.2% of participants. Data was not available for smoking and albuminuria. In participants <40 years of age, 80% and 64.2% with ASCVD and ASCVD risk factors, respectively, did not achieve target LDL-C levels. In this age group, 15.6% and 83.3% of participants with ASCVD risk factors and ASCVD group, respectively, were not receiving statins in the recommended dose. In participants ≥40 years of age, 88.0% and 91.5% with ASCVD and ASCVD risk factors, respectively, did not have LDL-C levels as per ADA 2018 targets. In this age group, 87.2% and 77.9% of participants with ASCVD risk factors and ASCVD, respectively, were not receiving statins in the recommended dose. CONCLUSION The sub-analysis of LEADD study shows sub-optimal adherence to ADA 2018 guidelines for management of diabetic dyslipidemia.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Banshi Saboo
- Department of Endocrinology, Dia Care, Ahmedabad, Gujarat, India
| | - Ambika G Unnikrishnan
- Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
- Correspondence: Ambika G Unnikrishnan Department of Endocrinology, Chellaram Diabetes Institute, Pune, 411021, Maharashtra, IndiaTel +91 8605011934 Email
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Longkumer I, Devi NK, Murry B, Saraswathy KN. Differential risk factors and morbidity/mortality pattern in type 2 diabetes: A study among two Mendelian populations with different ancestry (India). Diabetes Metab Syndr 2020; 14:1769-1776. [PMID: 32942252 DOI: 10.1016/j.dsx.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/29/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Association studies of type 2 diabetes mellitus (T2DM) with risk factors have shown variable results. Moreover, population-specific comparative investigations are negligible. Therefore, the present study aimed to evaluate the association of dyslipidemia and obesity with impaired fasting glucose (IFG) and T2DM among two ethnically, geographically and culturally different populations in India. METHODS This was a cross-sectional study among Jats and Meiteis, each inhabiting a separate geographical region. A total of 2371 individuals, age ≥30 years were recruited through household survey. Obesity variables were captured using anthropometric measurements while fasting blood (2.5 mL) was drawn to measure lipid and glucose levels using enzymatic assay by spectrophotometer. Participants were categorized under normal, IFG and T2DM groups, indicative of diabetes progression stages. Statistical analysis was performed using SPSS 16.0 version. RESULTS Significant differential distribution of lipid and obesity variables among IFG and T2DM in both populations were observed. Odds ratio revealed high TC and all obesity variables except BMI posed significant increased risk for T2DM among Jats. Abnormal TG, VLDL, WC, and WHtR posed significant increased risk for T2DM among Meiteis. Age-cohort wise prevalence of T2DM showed increasing trend at ≥60 years among Jats and decreasing trend at ≥60 years among Meiteis, suggesting a potential higher morbidity in the former and mortality in latter because of T2DM. CONCLUSIONS The present study observed a differential association of risk factors for T2DM among Jats and Meiteis. This study emphasize the need to implement community-specific intervention programs for prevention, treatment and management of T2DM.
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Affiliation(s)
- Imnameren Longkumer
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | | | - Benrithung Murry
- Department of Anthropology, University of Delhi, Delhi, 110007, India
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
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Lin YH, Kang L, Feng WH, Cheng TL, Tsai WC, Huang HT, Lee HC, Chen CH. Effects of Lipids and Lipoproteins on Mesenchymal Stem Cells Used in Cardiac Tissue Regeneration. Int J Mol Sci 2020; 21:ijms21134770. [PMID: 32635662 PMCID: PMC7369828 DOI: 10.3390/ijms21134770] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
Mesenchymal stem cells (MSCs) have two characteristics of interest for this paper: the ability to self-renew, and the potential for multiple-lineage differentiation into various cells. MSCs have been used in cardiac tissue regeneration for over a decade. Adult cardiac tissue regeneration ability is quite low; it cannot repair itself after injury, as the heart cells are replaced by fibroblasts and lose function. It is therefore important to search for a feasible way to repair and restore heart function through stem cell therapy. Stem cells can differentiate and provide a source of progenitor cells for cardiomyocytes, endothelial cells, and supporting cells. Studies have shown that the concentrations of blood lipids and lipoproteins affect cardiovascular diseases, such as atherosclerosis, hypertension, and obesity. Furthermore, the MSC lipid profiles, such as the triglyceride and cholesterol content, have been revealed by lipidomics, as well as their correlation with MSC differentiation. Abnormal blood lipids can cause serious damage to internal organs, especially heart tissue. In the past decade, the accumulated literature has indicated that lipids/lipoproteins affect stem cell behavior and biological functions, including their multiple lineage capability, and in turn affect the outcome of regenerative medicine. This review will focus on the effect of lipids/lipoproteins on MSC cardiac regenerative medicine, as well as the effect of lipid-lowering drugs in promoting cardiomyogenesis-associated MSC differentiation.
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Affiliation(s)
- Yi-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-H.L.); (W.-H.F.); (W.-C.T.)
- Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Lin Kang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Wen-Han Feng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-H.L.); (W.-H.F.); (W.-C.T.)
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Tsung-Lin Cheng
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-L.C.); (H.-T.H.)
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wei-Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-H.L.); (W.-H.F.); (W.-C.T.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsuan-Ti Huang
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-L.C.); (H.-T.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Departments of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 807, Taiwan
| | - Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-H.L.); (W.-H.F.); (W.-C.T.)
- Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Correspondence: (H.-C.L.); (C.-H.C.); Tel.: +886-7-3209209 (C.-H.C.)
| | - Chung-Hwan Chen
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-L.C.); (H.-T.H.)
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Departments of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 807, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Correspondence: (H.-C.L.); (C.-H.C.); Tel.: +886-7-3209209 (C.-H.C.)
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Kar S. Elevated Lipoprotein A in South Asians and the Associated Risk of Cardiovascular Disease: A Systematic Review. Curr Probl Cardiol 2020; 46:100581. [PMID: 32295712 DOI: 10.1016/j.cpcardiol.2020.100581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND South Asians have a premature risk of cardiovascular disease and increased lipoprotein A which enhances their risk. METHODS This systematic review evaluates the role of elevated lipoprotein A in cardiovascular disease risk for South Asians. It discusses the pathophysiology, clinical studies, and treatment of elevated lipoprotein A using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. RESULTS A total of 72 articles was incorporated which consisted of clinical studies, case-control and cohort studies, meta-analysis, reviews, and editorials. Cardiovascular disease and myocardial infarction occurs prematurely in South Asians, which is further enhanced with an elevated lipoprotein A. CONCLUSIONS South Asians with an elevated lipoprotein A have an increased risk of coronary artery disease so they should have early enactment of lifestyle modification and aggressive medical management.
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Abstract
Purpose of Review This review focuses on lipoprotein abnormalities in South Asians (SA) and addresses risk stratification and management strategies to lower atherosclerotic cardiovascular disease (ASCVD) in this high-risk population. Recent Findings South Asians (SAs) are the fastest growing ethnic group in the United States (U.S) and have an increased risk of premature coronary artery disease (CAD). While the etiology may be multifactorial, lipoprotein abnormalities play a key role. SAs have lower low-density lipoprotein cholesterol (LDL-C) compared with Whites and at any given LDL-C level, SA ethnicity poses a higher risk of myocardial infarction (MI) and coronary artery disease (CAD) compared with other non-Asian groups. SAs have lower high-density lipoprotein cholesterol (HDL-C) with smaller particle sizes of HDL-C compared with Whites. SAs also have higher triglycerides than Whites which is strongly related to the high prevalence of metabolic syndrome in SAs. Lipoprotein a (Lp(a)) levels are also higher in SAs compared with many other ethnic groups. This unique lipoprotein profile plays a vital role in the elevated ASCVD risk in SAs. Studies evaluating dietary patterns of SAs in the U.S show high consumption of carbohydrates and saturated fats. Summary SAs have a high-risk lipoprotein profile compared with other ethnicities. Lipid abnormalities play a central role in the pathogenesis of CAD in SAs. More studies are needed to understand the true impact of the various lipoproteins and their contribution to increasing ASCVD in SAs. Aggressive lowering of LDL-C in high-risk groups using medications, such as statins, and lifestyle modification including dietary changes is essential in overall CAD risk reduction.
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Ray S, Sawhney JPS, Das MK, Deb J, Jain P, Natarajan S, Sinha KK. Adaptation of 2016 European Society of Cardiology/European Atherosclerosis Society guideline for lipid management to Indian patients - A consensus document. Indian Heart J 2018; 70:736-744. [PMID: 30392515 PMCID: PMC6204479 DOI: 10.1016/j.ihj.2018.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022] Open
Abstract
In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia.
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Affiliation(s)
- Saumitra Ray
- Ramakrishna Mission Seva Pratishthan and Vivekananda Institute of Medical Sciences, Kolkata, India.
| | - J P S Sawhney
- Dept. of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
| | - M K Das
- Calcutta Medical Research Institute, Kolkata, India.
| | - Jyoti Deb
- Columbia Asia Hospital, Kolkata, India.
| | - Peeyush Jain
- Department of Preventive and Rehabilitative Cardiology, Ambulatory Cardiology, Escorts Heart Institute and Research Centre, New Delhi, India.
| | | | - K K Sinha
- Woodlands Multi-Speciality Hospital, Kolkata, India.
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Gopalan HS, Misra A, Jayawardena R. Nutrition and diabetes in South Asia. Eur J Clin Nutr 2018; 72:1267-1273. [PMID: 30185841 DOI: 10.1038/s41430-018-0219-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Hema S Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India
| | - Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India. .,Diabetes Foundation (India), New Delhi, 110016, India. .,Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B 16, Chirag Enclave, New Delhi, India.
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Geldsetzer P, Manne-Goehler J, Theilmann M, Davies JI, Awasthi A, Danaei G, Gaziano TA, Vollmer S, Jaacks LM, Bärnighausen T, Atun R. Geographic and sociodemographic variation of cardiovascular disease risk in India: A cross-sectional study of 797,540 adults. PLoS Med 2018; 15:e1002581. [PMID: 29920517 PMCID: PMC6007838 DOI: 10.1371/journal.pmed.1002581] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality in India. Yet, evidence on the CVD risk of India's population is limited. To inform health system planning and effective targeting of interventions, this study aimed to determine how CVD risk-and the factors that determine risk-varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. METHODS AND FINDINGS We used 2 large household surveys carried out between 2012 and 2014, which included a sample of 797,540 adults aged 30 to 74 years across India. The main outcome variable was the predicted 10-year risk of a CVD event as calculated with the Framingham risk score. The Harvard-NHANES, Globorisk, and WHO-ISH scores were used in secondary analyses. CVD risk and the prevalence of CVD risk factors were examined by state, rural-urban residence, age, sex, household wealth, and education. Mean CVD risk varied from 13.2% (95% CI: 12.7%-13.6%) in Jharkhand to 19.5% (95% CI: 19.1%-19.9%) in Kerala. CVD risk tended to be highest in North, Northeast, and South India. District-level wealth quintile (based on median household wealth in a district) and urbanization were both positively associated with CVD risk. Similarly, household wealth quintile and living in an urban area were positively associated with CVD risk among both sexes, but the associations were stronger among women than men. Smoking was more prevalent in poorer household wealth quintiles and in rural areas, whereas body mass index, high blood glucose, and systolic blood pressure were positively associated with household wealth and urban location. Men had a substantially higher (age-standardized) smoking prevalence (26.2% [95% CI: 25.7%-26.7%] versus 1.8% [95% CI: 1.7%-1.9%]) and mean systolic blood pressure (126.9 mm Hg [95% CI: 126.7-127.1] versus 124.3 mm Hg [95% CI: 124.1-124.5]) than women. Important limitations of this analysis are the high proportion of missing values (27.1%) in the main outcome variable, assessment of diabetes through a 1-time capillary blood glucose measurement, and the inability to exclude participants with a current or previous CVD event. CONCLUSIONS This study identified substantial variation in CVD risk among states and sociodemographic groups in India-findings that can facilitate effective targeting of CVD programs to those most at risk and most in need. While the CVD risk scores used have not been validated in South Asian populations, the patterns of variation in CVD risk among the Indian population were similar across all 4 risk scoring systems.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michaela Theilmann
- Department of Economics, University of Goettingen, Göttingen, Germany.,Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health, King's College London, London, United Kingdom
| | - Ashish Awasthi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India.,Public Health Foundation of India, Delhi, National Capital Region, India
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Thomas A Gaziano
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sebastian Vollmer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Economics, University of Goettingen, Göttingen, Germany.,Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Public Health Foundation of India, Delhi, National Capital Region, India
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Institute of Public Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, Mtubatuba, South Africa
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
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Volgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, Lichtman JH, Mehta LS, Patel HN, Shah KS, Shah SH, Watson KE. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e1-e34. [PMID: 29794080 DOI: 10.1161/cir.0000000000000580] [Citation(s) in RCA: 268] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the world's population and are one of the fastest-growing ethnic groups in the United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD). South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Literature relevant to South Asian populations regarding demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies, is summarized. The evidence to date is that the biology of ASCVD is complex but is no different in South Asians than in any other racial/ethnic group. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially those related to insulin resistance, and no unique risk factors in this population have been found. This scientific statement focuses on how ASCVD risk factors affect the South Asian population in order to make recommendations for clinical strategies to reduce disease and for directions for future research to reduce ASCVD in this population.
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Saraswathy KN, Joshi S, Yadav S, Garg PR. Metabolic distress in lipid & one carbon metabolic pathway through low vitamin B-12: a population based study from North India. Lipids Health Dis 2018; 17:96. [PMID: 29695256 PMCID: PMC5918761 DOI: 10.1186/s12944-018-0748-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022] Open
Abstract
Background Dyslipidemia and hyper-homocysteinemia are the major independent risk factors of cardio vascular disease. Deficiency of folate and vitamin B-12 are associated with both hyper-homocysteinemia and dyslipidemia. The aim of the study is to evaluate the relationship of homocysteine and its associated dietary determinant levels (Folate and Vitamin B-12) with lipids and obesity parameters (WC, BMI, WHR) in North Indian population. Methods The participants were recruited under a major government funded project through household survey covering 15 villages of Haryana, India. Participants were both males and females, between age group 30–65 years, from a north Indian community. Initially 1634 individuals were recruited, of which 1374 were considered for analysis as they were not found to be on any kind of medication for high blood pressure, CAD, diabetes or any other disorder, and had no missing data. 5 mL of intravenous blood sample was collected after obtaining written informed consent from the participants. Homocysteine, folate and vitamin B12 levels were estimated through Immulite 1000 by chemi-luminescence technique. Triglyceride, total cholesterol and HDL-C were estimated by spectrophotometry technique using commercial kits. The values for LDL and VLDL were calculated using Friedwald’s equation. Height, weight, waist circumference (WC), hip circumference (HC) was measured over light clothing. Statistical analysis for data was performed using SPSS 16.0 version. Results All the lipid indices, except HDL, showed a trend of negative correlation with homocysteine after controlling for confounders, though not significant. No association was found between obesity (WC, BMI, WHR) and homocysteine in the present study. Vitamin B-12 deficiency was significantly associated with both hyper-homocysteinemia and low HDL. Folate was found to have significantly reduced risk for high TC & LDL. Conclusions The “hcy-lipid” hypothesis does not seem to be complementing in the present studied population. The population is vulnerable to severe under-nutrition due to the association of vitamin B-12 with HDL, leading to metabolic disturbance in both the pathways; lipid and one carbon metabolic pathway. Co-factors such as ethnicity, cultural practices, and lifestyle & dietary habits must be considered while making public health policies to control diseases. Electronic supplementary material The online version of this article (10.1186/s12944-018-0748-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Shipra Joshi
- Department of Anthropology, University of Delhi, 110007, Delhi, India
| | - Suniti Yadav
- Department of Anthropology, University of Delhi, 110007, Delhi, India
| | - Priyanka Rani Garg
- Public health foundation of India, plot no. 47, sector 44, Delhi, NCR, 122002, India
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Sairam SG, Sola S, Barooah A, Javvaji SK, Jaipuria J, Venkateshan V, Chelli J, Sanjeevi CB. The role of Lp-PLA 2 and biochemistry parameters as potential biomarkers of coronary artery disease in Asian South-Indians: a case-control study. Cardiovasc Diagn Ther 2017; 7:589-597. [PMID: 29302464 DOI: 10.21037/cdt.2017.08.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Lipoprotein associated phospholipase A2 (Lp-PLA2) is an emerging biomarker for inflammation that has shown association with CAD. Its significance in the Asian Indian population is not clearly known. We sought to compare the possible association of various biomarkers of atherosclerosis along with Lp-PLA2, in symptomatic individuals with CAD vs. healthy controls in Asian South-Indians. Methods We conducted a cross-sectional case control study at three centers in a South Indian population. A total of 100 CAD patients with acute coronary syndrome (ACS), 100 age and gender matched healthy controls participated, of which, 166 subjects or 83 case-control pairs with complete data for both participants were identified for the statistical analysis. Lp-PLA2 concentration and activity were measured using PLAC test and PLAC activity assay respectively (diaDexus Inc., San Francisco, CA, USA), while all other parameters were measured using standard commercially available kits. Results We enrolled a total of 200 subjects (mean age 50.7±9.6 years, 87.5% males). A total of 83 subjects completed the study in the CAD group (mean age 51 ±8.9 years, 85% males) and 83 subjects in the control group (mean age 50±8.9 years, 86.5% males). In the CAD group, Lp-PLA2 concentration positively correlated with TC (ρ=0.19, P=0.02), non-HDL-C (ρ=0.20, P=0.02), Lp-PLA2 activity (ρ=0.27, P=0.001) and Lp(a) (r=0.25, P=0.02). Lp-PLA2 activity correlated positively with TC (ρ=0.28, P=0.001), LDL-C (ρ=0.30, P<0.001), non-HDL-C (ρ=0.35, P<0.001), ApoB (ρ=0.35, P<0.001) and negatively correlated to HDL-C (ρ=-0.24, P=0.004). Cox proportionality hazards model revealed Lp-PLA2 concentration (β=0.006, SE =0.002, P=0.009) to have positive association with the event of CAD, while negative association was observed for ApoA1 (β=-0.06, SE =0.02, P=0.001). ROC analysis revealed that the highest quartile of Lp-PLA2 concentration to have area under curve (AUC) of 0.80 (95% CI, 0.65-0.9; P<0.001) with cut off value of >427 ng/mL and ApoA1 with AUC of 0.78 (95% CI, 0.70-0.85; P<0.001) with cut off value of ≤129.6 mg/dL with the optimum balance of sensitivity and specificity. Conclusions In this study population, circulating plasma Lp-PLA2 was found to be elevated in CAD group. ApoA1 showed negative association and Lp-PLA2 concentration showed positive association with risk for CAD. In the highest quartile, Lp-PLA2 concentration had the best diagnostic utility. Our results support the hypothesis that Lp-PLA2 may be a potential risk marker for CAD in Asian Indians.
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Affiliation(s)
- Sai Giridhar Sairam
- Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, India
| | - Srikanth Sola
- Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Asha Barooah
- Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Sai Kiran Javvaji
- Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Jiten Jaipuria
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthi Gram, India
| | | | - Janardhana Chelli
- Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, India
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Wander GS, Jadhav UM, Chemburkar A, Lopez M, Gogtay J. Lipid management in India: a nationwide, cross-sectional physician survey. Lipids Health Dis 2017; 16:130. [PMID: 28673294 PMCID: PMC5496264 DOI: 10.1186/s12944-017-0519-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/15/2017] [Indexed: 12/22/2022] Open
Abstract
Background Current international guidelines on dyslipidemia are not concordant on various aspects of management. Also, there are no uniformly accepted Indian guidelines. We, therefore, performed a physician survey to understand lipid management practices in India. Methods An anonymous survey questionnaire was administered to gauge physicians’ self-reported behavior regarding lipid management aspects. Results were expressed in terms of percentages based on the number of responses obtained. Results A total of 404 physicians participated in the survey. Eighty-eight percent respondents ordered a lipid profile before starting statin therapy, and 80% preferred to set lipid targets, though the tools used for calculating cardiovascular risk varied. Atorvastatin was preferred over rosuvastatin in primary prevention (72.9 vs. 32.4%), secondary prevention (54.6 vs. 46.7%), diabetic patients (56.3 vs. 40.3%) and post-ACS (78.3 vs. 34%). High-intensity statins were preferred by 73.7% of respondents in post-ACS cases. Fifty percent doctors chose not to use a statin in diabetic patients, irrespective of their LDL-C levels. The most preferred drug option for managing atherogenic dyslipidemia and moderate hypertriglyceridemia was statin-fibrate combination (55.1%) and fibrates (35.4%), respectively. Sixty-three percent doctors preferred to prescribe statins in patients with moderately high LDL-C and normal triglycerides, without CHD or CHD risk equivalents. Around 28% of doctors preferred not to use pharmacotherapy for managing isolated low HDL. Of the participants, 73% used fibrates in ≤20% of their dyslipidemic patients, with fenofibrate being the most preferred (90.5%). Ezetimibe was mainly used in patients with uncontrolled LDL-C despite statin therapy (52.4% respondents). Most preferred approaches to manage statin intolerance included reducing statin dose (39%) and stopping and restarting statins at a lower dose (34.5%). Fifty-two percent of doctors chose not to alter pre-existing therapy in patients who had LDL-C levels at goal but elevated non-HDL-C levels. Conclusion This is the first survey in India that provides useful insights into Indian physicians’ self-reported perspectives on managing dyslipidemia in routine clinical practice. Despite concordance with the currently available guidelines in certain aspects, there is incongruence in managing specific dyslipidemia problems. Further continuing medical education and the development of evidence-based, India-specific lipid guidelines can help reduce some of these differences. Electronic supplementary material The online version of this article (doi:10.1186/s12944-017-0519-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gurpreet S Wander
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Uday M Jadhav
- Department of Cardiology, MGM New Bombay Hospital, New Mumbai, 400703, India
| | | | - Meena Lopez
- Cipla Ltd, Lower Parel, Mumbai, 400013, India.
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Gulati S, Misra A, Pandey RM. Effects of 3 g of soluble fiber from oats on lipid levels of Asian Indians - a randomized controlled, parallel arm study. Lipids Health Dis 2017; 16:71. [PMID: 28376899 PMCID: PMC5381086 DOI: 10.1186/s12944-017-0460-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cardiovascular diseases are more prevalent and severe in Asian Indians. Simple diet-based strategies are important for prevention of cardiovascular diseases.The aim of the present study was to evaluate the effects of oats consumption on lipid parameters in mildly hypercholesterolemic Asian Indians living in India. Methods A short-term, prospective, open-labeled, randomized controlled, parallel group study was conducted. Mildly hypercholesterolemic (total cholesterol >200 mg/dL and <240 mg/dL) subjects (n = 80) were randomized into two groups: intervention (n = 40) and usual diet (n = 40). Sample size was calculated for a two-group parallel superiority randomized control trial. Out of 80 enrolled subjects 69 subjects completed the study; 33 in the control group and 36 in the intervention group. In the intervention group, patients were served 70 g of oats twice a day in the form of porridge and upma (A thick porridge from oats with seasonings and vegetables) under observation at the study site. Lipid parameters were assessed at baseline and after 4 weeks of intervention. Results There was a reduction of 3.1% in total cholesterol levels in the control group as against 8.1% reduction in the intervention group (p < 0.02). Greater reductions were also seen in low-density lipoprotein cholesterol in the intervention group (11.6%) as compared to control group (4.1%, p < 0.04) over a period of 28 days. Conclusion Daily consumption of 3 g of soluble fiber from 70 g of oats leads to beneficial effects on the lipid parameters, specifically total cholesterol and low-density lipoprotein cholesterol in hypercholesterolemic Asian Indians. Large scale studies over a longer period of intervention are required to further establish the cholesterol-lowering effect of oat fiber. Trial registration The study was retrospectively registered at clinicaltrials.gov (dated: 25th Februrary.2015) with registration number NCT02376660.
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Affiliation(s)
- Seema Gulati
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi, India.,National Diabetes, Obesity, and Cholesterol Foundation (N-DOC), Safdarjung Development Area, New Delhi, India.,Center of Nutrition & Metabolic Research (C-NET), SDA, New Delhi, India
| | - Anoop Misra
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi, India. .,National Diabetes, Obesity, and Cholesterol Foundation (N-DOC), Safdarjung Development Area, New Delhi, India. .,Center of Nutrition & Metabolic Research (C-NET), SDA, New Delhi, India. .,Fortis C-DOC Center for Excellence for Diabetes, Metabolic Diseases and Endocrinology, B-16, Chirag Enclave, New Delhi, -110048, India. .,Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, India.
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Abstract
Dyslipidemia is the most important atherosclerotic risk factor. Review of population based studies in India shows increasing mean total cholesterol levels. Recent studies have reported that high cholesterol is present in 25–30% of urban and 15–20% rural subjects. This prevalence is lower than high-income countries. The most common dyslipidemia in India are borderline high LDL cholesterol, low HDL cholesterol and high triglycerides. Studies have reported that over a 20-year period total cholesterol, LDL cholesterol and triglyceride levels have increased among urban populations. Case-control studies have reported that there is significant association of coronary events with raised apolipoproteinB, total cholesterol, LDL cholesterol and non-HDL cholesterol and inverse association with high apolipoproteinA and HDL cholesterol. Prevalence of suspected familial hypercholesterolemia in urban subjects varies from 1:125 to 1:450. Only limited studies exist regarding lipid abnormalities in children. There is low awareness, treatment and control of hypercholesterolemia in India.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Ravinder S Rao
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Anoop Misra
- Department of Metabolic Diseases, Fortis C-DOC Centre, Chiragh Enclave, New Delhi, India
| | - Samin K Sharma
- Department of Cardiology, Mount Sinai Hospital and Icahn School of Medicine, New York, USA
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Stanley A, Ponde CK, Rajani RM, Ashavaid TF. Association between genetic loci linked to HDL-C levels and Indian patients with CAD: a pilot study. HEART ASIA 2017; 9:9-13. [PMID: 28123455 DOI: 10.1136/heartasia-2016-010822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/28/2016] [Accepted: 12/02/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association between loci linked to high-density lipoprotein cholesterol (HDL-C) levels and coronary artery disease (CAD). METHODS A pilot study consisting of age-matched and gender-matched angiographically confirmed CAD cases (n=150) and non-CAD controls (n=150) was performed to test an association. Illumina's Human Cardio-Metabo BeadChip containing 3112 variants associated with HDL-C levels was used for genotyping. RESULTS A preliminary analysis identified 36 variants from 16 genes that were statistically significant (p<0.05) between cases and controls. However, none of the variants remained statistically significant after correction for multiple testing. Besides, variants rs11039159 (MADD), rs749067 (MADD), rs367070 (LILRA3) and rs330921 (PPP1R3B) showed modest association with HDL-C levels. CONCLUSIONS None of the HDL-C associated loci included in this study were found to be a significant risk factor for CAD. However, the study could replicate the findings of four variants influencing HDL-C levels.
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Affiliation(s)
- Ashley Stanley
- Research Laboratories , P. D. Hinduja Hospital & Medical Research Centre , Mumbai , India
| | - C K Ponde
- Department of Cardiology , P. D. Hinduja Hospital & Medical Research Centre , Mumbai , India
| | - R M Rajani
- Department of Cardiology , P. D. Hinduja Hospital & Medical Research Centre , Mumbai , India
| | - T F Ashavaid
- Research Laboratories, P. D. Hinduja Hospital & Medical Research Centre, Mumbai, India; Department of Laboratory Medicine, P. D. Hinduja Hospital & Medical Research Centre, Mumbai, India
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Ama Moor VJ, Ndongo Amougou S, Ombotto S, Ntone F, Wouamba DE, Ngo Nonga B. Dyslipidemia in Patients with a Cardiovascular Risk and Disease at the University Teaching Hospital of Yaoundé, Cameroon. Int J Vasc Med 2017; 2017:6061306. [PMID: 28163932 PMCID: PMC5253480 DOI: 10.1155/2017/6061306] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/04/2016] [Accepted: 12/15/2016] [Indexed: 12/25/2022] Open
Abstract
Objective. To determine the frequency of lipid abnormalities in patients with a cardiovascular risk and disease at the University Teaching Hospital (UTH) of Yaoundé. Materials and Methods. We conducted a cross-sectional study from 1 March to 31 May 2015 at the UTH of Yaoundé. We included all patients seen in the outpatient department with a diagnosis of a cardiovascular disease or a risk factor for cardiovascular disease. Patients who accepted to participate in the study were asked to answer a questionnaire; after that a blood sample was taken for lipid profile. An informed consent was signed by all the participants and the study has received approval from the national ethic committee. Results. We recruited 264 patients of which 119 were men and 145 were women with a sex ratio of 0.82. Mean age was 61.36 years. The frequency of lipid profiles abnormalities was as follows: low HDL cholesterol (44.3%), hypertriglyceridemia (18.9%), high LDL cholesterol (3.8%), and high total cholesterol 3.4%). Hypertriglyceridemia was strongly associated with type 2 diabetes mellitus. Conclusion. Low levels of HDL cholesterol and hypertriglyceridemia are more prevalent in our study population. More studies are needed to confirm this finding in our environment.
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Affiliation(s)
- Vicky Jocelyne Ama Moor
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Sylvie Ndongo Amougou
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Felicien Ntone
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Bernadette Ngo Nonga
- Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Pranav Chand R, Kumar AS, Anuj K, Vishnupriya S, Mohan Reddy B. Distinct Patterns of Association of Variants at 11q23.3 Chromosomal Region with Coronary Artery Disease and Dyslipidemia in the Population of Andhra Pradesh, India. PLoS One 2016; 11:e0153720. [PMID: 27257688 PMCID: PMC4892567 DOI: 10.1371/journal.pone.0153720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/01/2016] [Indexed: 12/20/2022] Open
Abstract
In our attempt to comprehensively understand the nature of association of variants at 11q23.3 apolipoprotein gene cluster region, we genotyped a prioritized set of 96 informative SNPs using Fluidigm customized SNP genotyping platform in a sample of 508 coronary artery disease (CAD) cases and 516 controls. We found 12 SNPs as significantly associated with CAD at P <0.05, albeit only four (rs2849165, rs17440396, rs6589566 and rs633389) of these remained significant after Benjamin Hochberg correction. Of the four, while rs6589566 confers risk to CAD, the other three SNPs reduce risk for the disease. Interaction of variants that belong to regulatory genes BUD13 and ZPR1 with APOA5-APOA4 intergenic variants is also observed to significantly increase the risk towards CAD. Further, ROC analysis of the risk scores of the 12 significant SNPs suggests that our study has substantial power to confer these genetic variants as predictors of risk for CAD, as illustrated by AUC (0.763; 95% CI: 0.729-0.798, p = <0.0001). On the other hand, the protective SNPs of CAD are associated with elevated Low Density Lipoprotein Cholesterol and Total Cholesterol levels, hence with dyslipidemia, in our sample of controls, which may suggest distinct effects of the variants at 11q23.3 chromosomal region towards CAD and dyslipidemia. It may be necessary to replicate these findings in the independent and ethnically heterogeneous Indian samples in order to establish this as an Indian pattern. However, only functional analysis of the significant variants identified in our study can provide more precise understanding of the mechanisms involved in the contrasting nature of their effects in manifesting dyslipidemia and CAD.
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Affiliation(s)
| | | | - Kapadia Anuj
- Department of Cardiology, Care Hospitals, Hyderabad, India
| | | | - Battini Mohan Reddy
- Molecular Anthropology Group, Indian Statistical Institute, Hyderabad, India
- * E-mail:
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Maternal and infant correlates of maternal feeding beliefs and practices in a multi-ethnic Asian population: the GUSTO (Growing Up in Singapore Towards healthy Outcomes) study. Public Health Nutr 2016; 19:2789-98. [PMID: 27121890 DOI: 10.1017/s1368980016000744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Little is known about the influences of maternal and infant correlates on maternal feeding beliefs and practices in the first 2 years of life, despite its important role in early obesogenic eating behaviours and weight gain. DESIGN Cross-sectional study using demographic data of mothers and infants obtained at 26-28 weeks of gestation, and postnatally from birth to 15 months, respectively. The Infant Feeding Questionnaire was administered at 15 months postpartum. The associations between maternal and infant characteristics with seven maternal feeding beliefs and practices subscales were evaluated using multivariate linear regression analysis. SETTING Data obtained from the Singapore GUSTO (Growing Up in Singapore Towards healthy Outcomes) mother-offspring birth cohort. SUBJECTS Mothers and infants (n 1237). RESULTS Among other maternal correlates such as age, education, BMI, income and milk feeding practices, ethnicity was a consistent factor associated with six subscales, including concern about infant overeating/undereating and weight status, concern and awareness about infants' hunger and satiety cues, social interaction during feeding and feeding an infant on schedule. Similarly, among infant correlates such as gender and birth order, infant body size gain (reflected by BMI Z-score change from 0 to 15 months) was significantly associated with all subscales except feeding an infant on schedule. Overall, maternal correlates had greater influence on all subscales compared with infant correlates except for the maternal concern about infant undereating or becoming underweight subscale. CONCLUSIONS The present study highlights that maternal feeding beliefs and practices can be influenced by both maternal correlates and infant correlates at 15 months of age.
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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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Dwivedi S. History of cardiology in India. Indian Heart J 2016; 68:237-8. [DOI: 10.1016/j.ihj.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/17/2022] Open
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Bansal M, Sarat Chandra K, Nair T, Iyengar SS, Gupta R, Manchanda SC, Mohanan PP, Dayasagar Rao V, Manjunath CN, Sawhney JPS, Sinha N, Pancholia AK, Mishra S, Kasliwal RR, Kumar S, Krishnan U, Kalra S, Misra A, Shrivastava U, Gulati S. Consensus statement on the management of dyslipidemia in Indian subjects: Our perspective. Indian Heart J 2016; 68:238-41. [PMID: 27133351 PMCID: PMC4867022 DOI: 10.1016/j.ihj.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Manish Bansal
- Senior Consultant Cardiology, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001, India
| | - K Sarat Chandra
- Sr. Cardiologist, Indo US Superspecialty Hospital, Ameerpet, Hyderabad 500016, India.
| | - Tiny Nair
- Head, Department of Cardiology, PRS Hospital, Trivandrum, Akashdeep, TC 17/881, Poojapura, Trivandrum, Kerala 695012, India
| | - S S Iyengar
- Sr. Consultant & HOD, Manipal Hospital, 133, JalaVayu Towers, NGEF Layout, Indira Nagar, Bangalore 560038, India
| | - Rajeev Gupta
- Head of Medicine and Director Research, Fortis Escorts Hospital, JLN Marg, Malviya Nagar, Jaipur 302017, India
| | | | - P P Mohanan
- Westfort H. Hospital, Poonkunnanm, Thrissur 680002, India
| | - V Dayasagar Rao
- Sr. Cardiologist, Krishna Institute of Medical Science, Minister Road, Secunderabad, India
| | - C N Manjunath
- Director, Prof & HOD, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bannerghatta Road, Bangalore 560069, India
| | - J P S Sawhney
- Chairman, Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Nakul Sinha
- Sr. Consultant & Chief Interventional Cardiologist, Sahara India Medical Institute, VirajKhand, Gomti Nagar, Lucknow, Uttar Pradesh 226010, India
| | - A K Pancholia
- Head, Department of Clinical and Preventive Cardiology and Research Centre, Arihant Hospital, Indore, MP, India
| | - Sundeep Mishra
- Prof. Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ravi R Kasliwal
- Chairman, Clinical and Preventive Cardiology, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001, India
| | - Soumitra Kumar
- Professor, Vivekanada Institute of Medical Sciences, Kolkata, India; Chief Co-ordinator, Academic Services (Cardiology), Narayana Hrudayalay, RTIICS, Kolkata, India; Consultant Cardiologist, Fortis Hospital, Kolkata, India
| | - Unni Krishnan
- Chief Endocrinologist & CEO, Chellaram Diabetes Institute, Pune 411021, India
| | - Sanjay Kalra
- Consultant Endocrinology, Bharti Hospital & BRIDE, Karnal, Haryana, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, New Delhi, India
| | - Usha Shrivastava
- Head, Public Health, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India), New Delhi, India
| | - Seema Gulati
- Head, Nutrition Research Group, Centre for Nutrition & Metabolic Research (C-NET) & National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Chief Project Officer, Diabetes Foundation (India), C-6/57, Safdarjung Development Area, New Delhi 110016, India
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Gupta S. LDL cholesterol, statins and PCSK 9 inhibitors. Indian Heart J 2015; 67:419-24. [PMID: 26432726 PMCID: PMC4593843 DOI: 10.1016/j.ihj.2015.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/11/2015] [Accepted: 05/27/2015] [Indexed: 01/14/2023] Open
Abstract
Reduction of low density lipoprotein cholesterol (LDLc) is of vital importance for the prevention of atherosclerotic cardiovascular disease (ASCVD). Statin is the most effective therapy today to lower LDLc by inhibiting HMG-CoA-reductase. However despite intensive statin therapy, there remains a residual risk of recurrent myocardial infarction in about 20-30% cases. Moreover a few patients develop statin intolerance. For severe hypercholesterolemia, statins alone or in combination of ezetimibe, niacin and fenofibrate have been advocated. For homozygous familial hypercholesterolemia (HOFH), a microsomal triglyceride transfer protein MTP inhibitor (Lopitamide) and antisense oligonucleotide (ASO) (Mipomersen) have recently been approved by FDA, USA through 'Risk evaluation and Mitigation Strategy (REMS)'. Possible future therapies include PCSK-9 inhibitors which have excellent lipid lowering properties. Three monoclonal antibodies (PCSK 9 Inhibitors) alirocumab, evolocumab and Bococizumab are under advanced clinical stage IV trials and awaiting approval by FDA and European Medicines Agency.
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Affiliation(s)
- Sanjiv Gupta
- Consultant Interventional Cardiologist, SDM Hospital, Jaipur, India.
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Dwivedi S. Time to sensitize medical graduates to the Indian systems of medicine and homeopathy. Indian J Pharmacol 2015; 47:338-9. [PMID: 26069379 PMCID: PMC4450567 DOI: 10.4103/0253-7613.157139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shridhar Dwivedi
- Department of Medicine / Preventive Cardiology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Are western guidelines good enough for Indians? My name is Borat. Indian Heart J 2015; 67:85-9. [PMID: 26071282 DOI: 10.1016/j.ihj.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022] Open
Abstract
Physicians in an attempt to give their patients the best possible care need to be updated on the evolving body of scientific research, trials, case reports, and combine this evidence with their own clinical experience keeping in mind each individual patient's circumstances and preferences. To address this felt need, guidelines are systematically developed statements designed to help clinicians make management decisions. While a multitude of guidelines are available from developed world they might not exactly fit into developing world context. Thus a host of fresh guidelines might be required to fill this void or the existing guidelines modified (supplemented, altered or deleted) to be relevant to this part of the world.
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Gupta R, Sharma KK, Gupta BK, Gupta A, Saboo B, Maheshwari A, Mahanta T, Deedwania PC. Geographic epidemiology of cardiometabolic risk factors in middle class urban residents in India: cross-sectional study. J Glob Health 2015; 5:010411. [PMID: 25969733 PMCID: PMC4416330 DOI: 10.7189/jogh.05.010411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To determine epidemiology of cardiovascular risk factors according to geographic distribution and macrolevel social development index among urban middle class subjects in India. Methods We performed cross-sectional surveys in 11 cities in India during years 2005–2009. 6198 subjects aged 20–75 years (men 3426, women 2772, response 62%) were evaluated for cardiovascular risk factors. Cities were grouped according to geographic distribution into northern (3 cities, n = 1321), western (2 cities, n = 1814), southern (3 cities, n = 1237) and eastern (3 cities, n = 1826). They were also grouped according to human social development index into low (3 cities, n = 1794), middle (5 cities, n = 2634) and high (3 cities, n = 1825). Standard definitions were used to determine risk factors. Differences in risk factors were evaluated using χ2 test. Trends were examined by least squares regression. Findings Age–adjusted prevalence (95% confidence intervals) of various risk factors was: low physical activity 42.1% (40.9–43.3), high dietary fat 49.9% (47.8–52.0), low fruit/vegetables 26.9% (25.8–28.0), smoking 10.1% (9.1–11.1), smokeless tobacco use 9.8% (9.1–10.5), overweight 42.9% (41.7–44.1), obesity 11.6% (10.8–12.4), high waist circumference 45.5% (44.3–46.7), high waist–hip ratio 75.7% (74.7–76.8), hypertension 31.6% (30.4–32.8), hypercholesterolemia 25.0% (23.9–26.9), low HDL cholesterol 42.5% (41.3–43.7), hypertriglyceridemia 36.9% (35.7–38.1), diabetes 15.7% (14.8–16.6), and metabolic syndrome 35.7% (34.5–36.9). Compared with national average, prevalence of most risk factors was not significantly different in various geographic regions, however, cities in eastern region had significantly lower prevalence of overweight, hypertension, hypercholesterolemia, diabetes and metabolic syndrome compared with other regions (P < 0.05 for various comparisons). It was also observed that cities with low human social development index had lowest prevalence of these risk factors in both sexes (P < 0.05). Conclusions Urban middle–class men and women in eastern region of India have significantly lower cardiometabolic risk factors compared to northern, western and southern regions. Low human social development index cities have lower risk factor prevalence.
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Affiliation(s)
| | | | - Bal Kishan Gupta
- SP Medical College and Associated Group of Hospitals, Bikaner, India
| | | | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, India
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Enas EA, Dharmarajan TS, Varkey B. Consensus statement on the management of dyslipidemia in Indian subjects: A different perspective. Indian Heart J 2015; 67:95-102. [PMID: 26071285 PMCID: PMC4475838 DOI: 10.1016/j.ihj.2015.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Enas A Enas
- Executive Director, Coronary Artery Disease among Asian Indians (CADI) Research Foundation, USA.
| | - T S Dharmarajan
- Professor of Clinical Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Basil Varkey
- Professor Emeritus of Medicine, Medical College of Wisconsin, USA
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