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Gupta MD, Batra V, Muduli S, Mp G, Kunal S, Bansal A, Gautam A, Malhotra RK, Goyal D, Qamar A, Yusuf J. Epidemiological profile and clinical outcomes of very young (<35 years) and young (35-50 years) patients with STEMI: Insights from the NORIN STEMI registry. Indian Heart J 2024; 76:128-132. [PMID: 38574813 PMCID: PMC11143511 DOI: 10.1016/j.ihj.2024.04.002] [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: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Despite significant progress in primary prevention, rates of myocardial infarction (MI) in South Asian population is alarmingly high. OBJECTIVES We sought to compare risk factor profiles and outcomes between individuals with ST-Segment Elevation Myocardial Infarction (STEMI) in young (<50 years) and old (≥50 years) age groups. METHODS North India STEMI Registry (NORIN-STEMI) is a prospective observational registry of patients hospitalised with STEMI. We conducted a study of young patients (<50 years) regarding their risk factors for coronary artery disease (CAD), in-hospital and 30-day mortality and compared with their older counterpart. RESULTS Among 5335 patients enrolled, 1752 (32.8%) were young and were 19 years younger than the older cohort. Major risk factors in young patients were physical inactivity (75.1%) and alcohol intake (67.8%). Higher prevalence of tobacco use (66.6% vs 52.4%), but lower prevalence of diabetes (16% vs 26.3%) and hypertension (18.5% vs 29.9%) were seen in young STEMI. Young patients were less likely to die both in-hospital (5.9% vs 10.0%) and at 30-days (11.1% vs 16.2%). Left ventricular ejection fraction (LVEF) < 30% at admission [OR: 8.00, 95% confidence interval (CI): 4.60-13.90, P < 0.001 in-hospital, OR: 3.92, 95% CI: 2.69-5.73 at 30-days] and female sex were strongest predictors of mortality. CONCLUSIONS Young STEMI patients constituted one-third of total cohort. Most of them were tobacco consumers with lesser prevalence of diabetes and hypertension. They were less likely to die both in-hospital and at 30 days because of earlier presentation to a health care facility and hence a relatively preserved LVEF.
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Affiliation(s)
- Mohit D Gupta
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
| | - Vishal Batra
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Subrat Muduli
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Girish Mp
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Shekhar Kunal
- Department of Cardiology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Ankit Bansal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Ankur Gautam
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Rajeev Kumar Malhotra
- Delhi Cancer Registry, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Dixit Goyal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Arman Qamar
- Section of Interventional Cardiology, Northshore University Health System, Evanston, IL, USA
| | - Jamal Yusuf
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
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V J, M S, Wani A, Ahmad SF, Nadeem A, Sharma A, Ahmed SSSJ. Pharmacoscreening, molecular dynamics, and quantum mechanics of inermin from Panax ginseng: a crucial molecule inhibiting exosomal protein target associated with coronary artery disease progression. PeerJ 2023; 11:e16481. [PMID: 38077444 PMCID: PMC10710165 DOI: 10.7717/peerj.16481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Background Exosomes, microvesicles, carry and release several vital molecules across cells, tissues, and organs. Epicardial adipose tissue exosomes are critical in the development and progression of coronary artery disease (CAD). It is hypothesized that exosomes may transport causative molecules from inflamed tissue and deliver to the target tissue and progress CAD. Thus, identifying and inhibiting the CAD-associated proteins that are being transported to other cells via exosomes will help slow the progression of CAD. Methods This study uses a systems biological approach that integrates differential gene expression in the CAD, exosomal cargo assessment, protein network construction, and functional enrichment to identify the crucial exosomal cargo protein target. Meanwhile, absorption, distribution, metabolism, and excretion (ADME) screening of Panax ginseng-derived compounds was conducted and then docked against the protein target to identify potential inhibitors and then subjected to molecular dynamics simulation (MDS) to understand the behavior of the protein-ligand complex till 100 nanoseconds. Finally, density functional theory (DFT) calculation was performed on the ligand with the highest affinity with the target. Results Through the systems biological approach, Mothers against decapentaplegic homolog 2 protein (SMAD2) was determined as a potential target that linked with PI3K-Akt signaling, Ubiquitin mediated proteolysis, and the focal adhesion pathway. Further, screening of 190 Panax ginseng compounds, 27 showed drug-likeness properties. Inermin, a phytochemical showed good docking with -5.02 kcal/mol and achieved stability confirmation with SMAD2 based on MDS when compared to the known CAD drugs. Additionally, DFT analysis of inermin showed high chemical activity that significantly contributes to effective target binding. Overall, our computational study suggests that inermin could act against SMAD2 and may aid in the management of CAD.
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Affiliation(s)
- Janakiraman V
- Muti-omics and Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettnad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Sudhan M
- Muti-omics and Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettnad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Abubakar Wani
- Department of Immunology, St. Jude Children’s Research Hospital Memphis, TN, USA
| | - Sheikh F. Ahmad
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Nadeem
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ashutosh Sharma
- Centre of Bioengineering, NatProLab, Plant Innovation Lab, School of Engineering and Sciences, Tecnologico de Monterrey, Queretaro, Mexico
| | - Shiek S. S. J. Ahmed
- Muti-omics and Drug Discovery Lab, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettnad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
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Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. J Endocr Soc 2023; 8:bvad167. [PMID: 38178904 PMCID: PMC10765382 DOI: 10.1210/jendso/bvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/06/2024] Open
Abstract
South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Satish Babu K Narayanappa
- Department of Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, Karnataka 562101, India
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Pinxterhuis TH, Ploumen EH, Zocca P, Doggen CJM, Schotborgh CE, Anthonio RL, Roguin A, Danse PW, Benit E, Aminian A, Hartmann M, Linssen GCM, von Birgelen C. Impact of premature coronary artery disease on adverse event risk following first percutaneous coronary intervention. Front Cardiovasc Med 2023; 10:1160201. [PMID: 37745109 PMCID: PMC10512829 DOI: 10.3389/fcvm.2023.1160201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/05/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives We assessed differences in risk profile and 3-year outcome between patients undergoing percutaneous coronary intervention (PCI) for premature and non-premature coronary artery disease (CAD). Background The prevalence of CAD increases with age, yet some individuals develop obstructive CAD at younger age. Methods Among participants in four randomized all-comers PCI trials, without previous coronary revascularization or myocardial infarction (MI), we compared patients with premature (men <50 years; women <55 years) and non-premature CAD. Various clinical endpoints were assessed, including multivariate analyses. Results Of 6,171 patients, 887 (14.4%) suffered from premature CAD. These patients had fewer risk factors than patients with non-premature CAD, but were more often smokers (60.7% vs. 26.4%) and overweight (76.2% vs. 69.8%). In addition, premature CAD patients presented more often with ST-segment elevation MI and underwent less often treatment of multiple vessels, and calcified or bifurcated lesions. Furthermore, premature CAD patients had a lower all-cause mortality risk (adj.HR: 0.23, 95%-CI: 0.10-0.52; p < 0.001), but target vessel revascularization (adj.HR: 1.63, 95%-CI: 1.18-2.26; p = 0.003) and definite stent thrombosis risks (adj.HR: 2.24, 95%-CI: 1.06-4.72; p = 0.034) were higher. MACE rates showed no statistically significant difference (6.6% vs. 9.4%; adj.HR: 0.86, 95%-CI: 0.65-1.16; p = 0.33). Conclusions About one out of seven PCI patients was treated for premature CAD. These patients had less complex risk profiles than patients with non-premature CAD; yet, their risk of repeated revascularization and stent thrombosis was higher. As lifetime event risk of patients with premature CAD is known to be particularly high, further efforts should be made to improve modifiable risk factors such as smoking and overweight. TWENTE trials (TWENTE I, clinicaltrials.gov: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).
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Affiliation(s)
- Tineke H. Pinxterhuis
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Eline H. Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | | | - Rutger L. Anthonio
- Department of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, Netherlands
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and B. Rappaport-Faculty of Medicine, Israel, Institute of Technology, Haifa, Israel
| | - Peter W. Danse
- Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Marc Hartmann
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
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Khoja A, Andraweera PH, Lassi ZS, Ali A, Zheng M, Pathirana MM, Aldridge E, Wittwer MR, Chaudhuri DD, Tavella R, Arstall MA. Risk Factors for Premature Coronary Heart Disease in Women Compared to Men: Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2023; 32:908-920. [PMID: 37184900 DOI: 10.1089/jwh.2022.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background: We aimed to systematically examine literature on the prevalence of known modifiable and nonmodifiable risk factors for premature coronary heart disease (PCHD) in women compared with men. Materials and Methods: PubMed, CINAHL, Embase, and Web of Science databases were searched. Review protocol is registered in PROSPERO (CRD42020173216). Quality was assessed using the National Heart, Lung, and Blood Institute tool. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences/standardized mean differences (SMD) with 95% confidence intervals (CIs) for categorical and continuous variables. Results: In this PCHD cohort (age <65 years), the mean age of presentation in women was 3 years older than men. Women had higher total cholesterol (SMD 0.11; 95% CI 0.00 to 0.23) and higher high-density lipoprotein cholesterol (SMD 0.49; 95% CI 0.29 to 0.69). Women were more likely to have hypertension (OR 1.51, 95% CI 1.42 to 1.60), diabetes mellitus (OR 1.78, 95% CI 1.55 to 2.04), obesity (OR 1.33, 95% CI 1.24 to 1.42), metabolic syndrome (OR 3.73, 95% CI 1.60 to 8.69), stroke (OR 1.63, 95% CI 1.51 to 1.77), peripheral vascular disorder (OR 1.67, 95% CI 1.43 to 1.96), and depression (OR 2.29, 95% CI 1.96 to 2.67). Women were less likely to be smokers (OR 0.60, 95% CI 0.55 to 0.66), have reported alcohol intake (OR 0.36, 95% CI 0.33 to 0.40), and reported use of illicit drug (OR 0.32, 95% CI 0.16 to 0.62). Conclusions: Risk factor profile in PCHD has a clear sex difference that supports early, aggressive, holistic, but sex-specific, approach to prevention.
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Affiliation(s)
- Adeel Khoja
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Prabha H Andraweera
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Zohra S Lassi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Ali
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mingyue Zheng
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Maleesa M Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Emily Aldridge
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Melanie R Wittwer
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Debajyoti D Chaudhuri
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Rosanna Tavella
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Margaret A Arstall
- Cardiology Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Medical Specialties, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Gupta R. Genetics-based risk scores for prediction of premature coronary artery disease. Indian Heart J 2023; 75:327-334. [PMID: 37633460 PMCID: PMC10568063 DOI: 10.1016/j.ihj.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023] Open
Abstract
Premature coronary artery disease (CAD) is endemic in India. Global Burden of Diseases study has reported that it led to 286,000 deaths in 2019 in India. Many of these patients have standard risk factors but a third have none. Clinical risk algorithms and imaging provide limited risk information in premature CAD. CAD is multifactorial and studies have now focused on the predictive capability of clusters of genes and single nucleotide polymorphisms (SNPs) using gene risk score (GRS). Older studies combined data from 10 to 12 genes and 100-500 SNPs to calculate GRS, however, following the advent of genome-wide association studies (GWAS), millions of SNPs have been incorporated. Studies have reported that GWAS-based GRS may be more discriminative than conventional tools. Recent studies, especially among South Asians, have reported that GRS improves net reclassification by 15% (12-19%) for younger individuals. Aggressive lifestyle interventions and lipid-lowering therapies can ameliorate risk in high-GRS individuals and potentially prevent premature CAD.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology & Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India.
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Agrawal A, Lamichhane P, Eghbali M, Xavier R, Cook DE, Elsherbiny RM, Jhajj LK, Khanal R. Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review. J Int Med Res 2023; 51:3000605231187806. [PMID: 37555333 PMCID: PMC10413899 DOI: 10.1177/03000605231187806] [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: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023] Open
Abstract
This systematic review provides a qualitative summary of the risk factors, angiographic characteristics, treatment, and complications of young South Asians with coronary artery disease (CAD). PubMed, Embase, and Google Scholar were searched to identify research articles published between 1 January 2010 and 13 November 2022. Studies in patients aged 18 to 45 years that were conducted in South Asian countries, were published in the English language, and included information on patients' clinical profiles and at least two risk factors for young CAD were included in the review. Smoking, dyslipidemia, high body mass index, increased high-sensitivity C-reactive protein, and hyperhomocysteinemia were observed in high proportions in young patients with CAD. Single-vessel disease was more common than multi-vessel disease in young CAD. The complications of CAD such as arrhythmias, cardiogenic shock, and heart failure were also commonly observed in young patients. Large-scale health promotion activities that curb modifiable risk factors such as smoking, obesity, and a sedentary lifestyle should be conducted in South Asian countries.
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Affiliation(s)
- Anushka Agrawal
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | | | - Mason Eghbali
- California University of Science and Medicine, School of Medicine, Colton, California, USA
| | | | | | | | | | - Rajaram Khanal
- Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
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Fan W, Guo C, Zhao Q, Ma H. A comprehensive review of the components of nurse-coordinated care which are most effective in preventing coronary heart diseases. Afr Health Sci 2023; 23:528-534. [PMID: 37545913 PMCID: PMC10398472 DOI: 10.4314/ahs.v23i1.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Coronary artery disease occurs when there is inadequate blood flow to the heart muscle as a consequence of coronary artery blockage, resulting in heart muscle failure. During normal heart action, cardiac muscles will always need an adequate supply of blood to fulfill their oxygen requirements. Coronary heart disease is the most common kind of cardiovascular disease in adults and the leading cause of mortality in the United States. Growing understanding of the possible significance of environmental and lifestyle variables in disease development has enhanced the job of the nurse coordinator, whether at a lower or higher level of responsibility, to keep current ondiagnostic procedures, clinical symptoms, and innovative treatment choices. According to the national cardiovascular control program, secondary prevention of cardiovascular disease has increased, including measures such as cholesterol management, blood pressure monitoring, and smoking cessation. If you know more about NCC, it might be easier to figure out what roles it could play and what effects its use might have.
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Affiliation(s)
- Wenna Fan
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Chao Guo
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Qi Zhao
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Hongbo Ma
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
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Menezes Fernandes R, Mota T, Costa H, Bispo J, Azevedo P, Bento D, Guedes J, Carvalho D, Marques N, Santos W, Mimoso J, de Jesus I. Premature acute coronary syndrome: understanding the early onset. Coron Artery Dis 2022; 33:456-464. [PMID: 35190516 DOI: 10.1097/mca.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Acute coronary syndrome (ACS) is less frequent in young adults, but it has become a significant health problem, associated with the increasing prevalence of modifiable risk factors. OBJECTIVES To characterize patients admitted with premature ACS, comparing with those with nonpremature ACS. METHODS We performed a retrospective study encompassing patients of the Portuguese Registry (ProACS), comparing two groups: one composed of men less than 55 and women less than 65 years old; and other with men ≥55 and women ≥65 years old at the ACS admission. The primary endpoint was the composite of in-hospital mortality, stroke and myocardial reinfarction (re-MI). RESULTS A total of 29 870 patients were enrolled and 25% had premature ACS, with a mean age of 50 ± 7 years old. They had a larger prevalence of smoking habits, obesity and dyslipidemia. ST-segment elevation MI (STEMI) was the main admission diagnosis in young patients and coronary angiogram mainly revealed one vessel disease in this subgroup. They had a lower Killip-Kimball (KK) class and mostly preserved left ventricular ejection fraction (LVEF). Composite endpoint was more frequent in nonpremature ACS patients. Nonpremature age, presentation with syncope or cardiac arrest, KK class >1, multivessel disease and LVEF <40% were independent predictors of the primary endpoint ( P < 0.001). Younger patients had lower rates of in-hospital all-cause mortality, re-MI and stroke. One-year all-cause mortality and 1-year cardiovascular and non-cardiovascular readmissions were also lower. CONCLUSIONS Premature ACS affects 25% of the ACS population, mostly presenting with STEMI, but generally associated with better clinical evolution. Nevertheless, prevention measures are essential to correct modifiable cardiovascular risk factors and reduce coronary events.
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Affiliation(s)
| | - Teresa Mota
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Hugo Costa
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - João Bispo
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Pedro Azevedo
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Dina Bento
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
- Medical and Biomedical Department, University of Algarve, Portugal
| | - João Guedes
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Daniela Carvalho
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Nuno Marques
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
- Medical and Biomedical Department, University of Algarve, Portugal
| | - Walter Santos
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Jorge Mimoso
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Ilídio de Jesus
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
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Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry. Indian Heart J 2022; 74:391-397. [PMID: 35995321 DOI: 10.1016/j.ihj.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/19/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND & AIMS Premature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. METHODS Successive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. RESULTS 4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol ≥200 mg/dl [women 1.52(1.03-2.25) and 1.59(0.79-3.20); men 1.73(1.38-2.17) and 1.92(1.22-3.03)], non-HDL cholesterol ≥130 mg/dl [women 1.84(1.35-2.52) and 1.32(0.72-2.42); men 1.69(1.43-1.90) and 1.67(1.17-2.34)], LDL cholesterol [men 1.10(0.95-1.25) and 1.04(0.77-1.41)], and tobacco [women 1.40(0.84-2.35) and 2.14(0.95-4.82); men 1.63(1.34-1.98) and 1.27(0.81-1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85-1.51)] and very premature [1.29(0.75-2.22)] CAD and was significantly higher in men [1.35(1.16-1.56) and 1.79(1.29-2.49)]. Location and extent of CAD were not different. CONCLUSIONS In India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.
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Rao BH, N S RR, C S SR, Patel PR, Korabathina R, Raj JP, Azam MS, Rao BA, Yerra SK, Abdullakutty J, Raju PK. Metabolic Risk Factors In First Acute Coronary Syndrome (MERIFACS). Indian Heart J 2022; 74:275-281. [PMID: 35931204 PMCID: PMC9453050 DOI: 10.1016/j.ihj.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. METHODS This is a prospective case-control observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n=2153) were compared with matched controls (n=1210). RESULTS Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (P<0.0001), diabetes - 42.6% vs 12.7% (P<0.0001), smoking - 28.3% vs 9.3% (P<0.0001) and elevated LDL-C - 70.2% vs 57.9% (P<0.0001). MRF: BMI - 54.7% vs55.1% (P=0.84), waist: hip ratio 79.5% vs 63.6% (P<0.0001), high HbA1C - 37.8% vs 14.9% (P<0.0001), low HDL-C - 56.2% vs 42.8% (P<0.0001) and elevated triglycerides - 49.7% vs 44.2%. (P=0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (P<0.001), diabetes - 4.7 (P<0.001), high LDL-C - 3.3 (P<0.001) and smoking- 6.3 (P<0.001). MRF: waist: hip ratio - 2.4 (P<0.001) high HbA1c - 3.2 (P<0.001), low HDL-C 2.2 (P<0.001) and elevated triglycerides - 0.878 P=0.17. CONCLUSION In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF.
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Affiliation(s)
- B Hygriv Rao
- Department of Cardiology, KIMS Hospitals, Hyderabad, India; KIMS Foundation and Research Centre (KFRC), Hyderabad, India; Arrhythmia Research & Training Society, Hyderabad, India.
| | - Rama Raju N S
- Department of Cardiology, KIMS Hospitals, Rajahmundry, India
| | | | | | | | | | - Md Sadiq Azam
- Department of Cardiology, KIMS Hospitals, Hyderabad, India
| | - B Annaji Rao
- Department of Cardiology, KIMS Hospitals, Srikakulam, India
| | - Shiv Kumar Yerra
- Department of Cardiology, KIMS Hospitals, Hyderabad, India; Department of Cardiology, Mahavir Hospital, Hyderabad
| | | | - P Krishnam Raju
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
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Jariwala P, Padmavathi A, Patil R, Chawla KD, Jadhav K. The prevalence of risk factors and pattern of obstructive coronary artery disease in young Indians (< 45 years) undergoing percutaneous coronary intervention: A gender-based multi-center study. Indian Heart J 2022; 74:282-288. [PMID: 35843268 PMCID: PMC9453019 DOI: 10.1016/j.ihj.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females <45 years of age compared to males of the same age group who underwent percutaneous coronary intervention (PCI). Materials and Methods This was a retrospective, observational, multi-centre study of young Indian females and males (<45 years) who underwent PCI as per the guidelines at three high-volume centres in India. Results In a group of 3656 patients under the age of 45 who had PCI, 3.1% of those with obstructive CAD were young women (n = 113), while 6.9% were young men (n = 254). Traditional risk factors such as hypertension (p = 0.73), diabetes (p = 0.61), and family history of premature CAD (p = 0.63) were equally common in both genders, whereas dyslipidaemia (p < 0.001), overweight (p < 0.006), smoking (p = 0.004) and, alcoholism (p < 0.001) were more common in young males. Acute coronary syndrome was the most common clinical presentation. Single-vessel disease was common, with the involvement of the left anterior descending artery as the most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males, while the in-hospital mortality rate was 1.77% in young females and 2% in young males. Conclusions Obstructive CAD in young men and women accounted for 10% of all CAD cases requiring PCI. Although men account for the majority of patients, CAD in women under the age of 45 is not uncommon. Traditional risk factors are becoming more prevalent in younger women.
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Affiliation(s)
- Pankaj Jariwala
- Yashoda Hospitals, Somajiguda, Hyderabad, Telangana 500082, India.
| | | | - Rahul Patil
- Ruby Hall Clinic, Sangamvadi, Pune, Maharashtra 411001, India
| | - Kamal Deep Chawla
- Sterling Hospitals, Race Course Road, Opposite Inox Cinema Hari Nagar, Circle West, Vadodara, Gujarat 390007, India
| | - Kartik Jadhav
- Yashoda Hospitals, Somajiguda, Hyderabad, Telangana 500082, India
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Shortcomings on genetic testing of Familial hypercholesterolemia (FH) in India: Can we collaborate to establish Indian FH registry? Indian Heart J 2021; 74:1-6. [PMID: 34875256 PMCID: PMC8891005 DOI: 10.1016/j.ihj.2021.11.185] [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: 04/28/2021] [Revised: 09/20/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a common autosomal dominant disorder that affects ∼1 in 250–500 individuals globally. The only prevalence study in India shows FH in 15% of patients with premature CAD in North Indians. There are only 6 genetic studies in India of the total mutations, 32% are LDLR mutations, 4% are ApoB, 2% are PCSK9 mutations and the mutational spectrum for 37% is unknown. This calls for widespread genetic screening which could help identify definite FH patients. European Atherosclerosis Society-Familial Hypercholesterolemia Studies Collaboration (EAS- FHSC) has taken an initiative to develop a worldwide registry of FH. India is also a part of the collaboration and 3 groups from Mumbai, Delhi and Chennai are actively contributing to this registry. We believe this review might help to understand the Indian scenario of FH and investigators across India can contribute in managing FH in India and further help in the detection, diagnosis and treatment.
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Khan MY, Pandit S, Guha S, Jadhav U, Rao MS, Gaurav K, Mane A, Dubey A, Bhagwatkar H, Venkataswamy K, Shah S. Demographic profile, clinical characteristics and medical management patterns of Indian coronary artery disease patients: a nationwide urban-based, real-world, retrospective, observational electronic medical record study- report of baseline data. Expert Rev Cardiovasc Ther 2021; 19:769-775. [PMID: 34126829 DOI: 10.1080/14779072.2021.1941872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: This is the first detailed Indian electronic medical record (EMR)-based real-world observational study to understand the clinical characteristics, associated comorbidities/risk factors and treatment(s) of CAD patients across India.Methods: EMR data of adult Indians (aged ≥ 18 years) diagnosed with CAD was retrospectively analyzed.Results: The majority of the participants had stable IHD (93%), were men (68.5% in ACS, 59.8% in stable IHD), most common age group was 40-64 years in ACS (56.6%) and stable IHD (51.4%). Both are common in metros (ACS 52%, 62% stable IHD). There is a high frequency of hypertension (38.2% in ACS, 59% in stable IHD) and diabetes mellitus (32.3% in ACS, 57.6% in stable IHD). Most common treatments are antiplatelet drugs and lipid-lowering drugs (96%).Conclusions: In India, stable IHD is the most prevalent form in vast majority of patients. The patients with CAD are mostly males, are mainly located in metros and majority fall between the age group of 40-64. The major comorbidities are hypertension and diabetes mellitus. Sociodemographic and clinical characteristics for CAD in India may not be similar to what is reported from the west. There is a significant difference in drug usage and adherence to guidelines in India for CAD.
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Affiliation(s)
- Mohammed Yunus Khan
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Sucheta Pandit
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Santanu Guha
- Medical College and Hospital, Kolkata, West Bengal, India
| | | | | | - Kumar Gaurav
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Amey Mane
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Akhilesh Dubey
- Prime Health Clinic and Galaxy Hospital, Jabalpur, India
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Association of MTHFR C677T (rs1801133) and A1298C (rs1801131) Polymorphisms with Serum Homocysteine, Folate and Vitamin B12 in Patients with Young Coronary Artery Disease. Indian J Clin Biochem 2021; 37:224-231. [PMID: 35463099 PMCID: PMC8993972 DOI: 10.1007/s12291-021-00982-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
C677T (rs1801133) and A1298C (rs1801131) MTHFR gene polymorphisms and/or nutritional deficiency of folate/vitamin B12 leading to hyperhomocysteinemia is an established risk factor for CAD. The objective of this study was to evaluate the clinical usefulness of association between MTHFR C677T (rs1801133) and A1298C (rs1801131) polymorphisms with serum homocysteine, folate and vitamin B12 in addition to conventional cardiovascular risk factors in patients with young CAD. Genomic DNA was isolated from the whole blood. Genotyping of MTHFR C677T (rs1801133) and MTHFR A1298C (rs1801131) polymorphisms in young CAD patients and healthy controls was performed by ARMS-PCR method. Serum homocysteine, vitamin B12 and folate were estimated by CMIA and lipid profile parameters were measured by automated chemistry analyzers. Serum homocysteine levels were significantly higher but serum folate and vitamin B12 levels were not significantly different among young CAD group as compared to control group. Statistically significant hyperhomocysteinemia was observed in carriers of T allele for MTHFR 677C/T (rs1801133) genotype in young CAD group but this association was not significant for MTHFR 1298A/C (rs1801131) polymorphism. The association between hyperhomocysteinemia and CAD in young group was not independent of conventional cardiovascular risk factors. Risk of hyperhomocysteinemia and young CAD could be monitored by MTHFR polymorphism detection followed by serum homocysteine, folate and vitamin B12 measurements. The findings could help to prevent or delay the occurrence of young CAD through appropriate measures.
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Kalra D, Vijayaraghavan K, Sikand G, Desai NR, Joshi PH, Mehta A, Karmally W, Vani A, Sitafalwalla SJ, Puri R, Duell PB, Brown A. Prevention of atherosclerotic cardiovascular disease in South Asians in the US: A clinical perspective from the National Lipid Association. J Clin Lipidol 2021; 15:402-422. [PMID: 33846108 DOI: 10.1016/j.jacl.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
It is now well recognized that South Asians living in the US (SAUS) have a higher prevalence of atherosclerotic cardiovascular disease (ASCVD) that begins earlier and is more aggressive than age-matched people of other ethnicities. SA ancestry is now recognized as a risk enhancer in the US cholesterol treatment guidelines. The pathophysiology of this is not fully understood but may relate to insulin resistance, genetic and dietary factors, lack of physical exercise, visceral adiposity and other, yet undiscovered biologic mechanisms. In this expert consensus document, we review the epidemiology of ASCVD in this population, enumerate the challenges faced in tackling this problem, provide strategies for early screening and education of the community and their healthcare providers, and offer practical prevention strategies and culturally-tailored dietary advice to lower the rates of ASCVD in this cohort.
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Affiliation(s)
- Dinesh Kalra
- Division of Cardiology, Rush University Medical Center, 1620W. Harrison St, Kellogg Suite 320, Chicago, IL 60612, United States.
| | | | - Geeta Sikand
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Nihar R Desai
- Yale School of Medicine, New Haven, CT, United States
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Anurag Mehta
- Emory University School of Medicine, Atlanta, GA, United States
| | - Wahida Karmally
- Columbia University Irving Medical Center, New York, NY, United States
| | - Anish Vani
- New York University Langone Health, New York, NY, United States
| | | | - Raman Puri
- Lipid Association of India, New Delhi, India
| | - P Barton Duell
- Oregon Health and Science University, Portland, OR, United States
| | - Alan Brown
- Advocate Lutheran General Hospital, Park Ridge, IL, United States
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Gupta PK, Balachander J. Predictor of in-stent restenosis in patients with drug-eluting stent (PRIDE)- a retrospective cohort study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33:184-194. [PMID: 33622608 DOI: 10.1016/j.arteri.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND It is a fact that coronary artery disease (CAD) is more prevalent in India as compared to western countries. The major risk factors associated with the early CAD are a high prevalence of diabetes mellitus, atherogenic lipid profile, smoking habits, sedentary lifestyle, low socioeconomic condition and high prevalence of obesity. Is this true for restenosis after drug-eluting stent (DES) implantation and factors associated with it? The main objective of the study was to determine the rate of in-stent restenosis (ISR) in patients with DES and risk factors associated with it from our region. METHODS It was a single-center, retrospective cohort study in which 550 patients who underwent DES implantation were included. Patient's demographic data, coronary angiography findings, procedural characteristics and development of ISR were noted. RESULTS Out of 550 patients, 31 developed ISR with a rate of restenosis of 5.63% and target lesion revascularization (TLR) of 5.63%. On multiple Cox-regression analysis, only diabetes mellitus (DM) (p=0.008, adjusted hazard ratio (HR): 2.757, 95% confidence interval (CI): 1.296-5.863), deployment of stent in the left anterior descending (LAD) artery (p=0.031, adjusted HR: 3.342, 95% CI: 1.115-10.017) and periprocedural complication during percutaneous coronary intervention (p=0.040, adjusted HR: 2.824, 95% CI: 1.049-7.603) were found to be significantly associated with increased risk of ISR. Kaplan-Meier survival analysis of event-free survival for restenosis showed patients with DM had significantly lower event-free survival compared to patients without DM (p=0.005 by log-rank test). CONCLUSIONS In our study, the rate of restenosis after DES implantation was 5.63%. The presence of DM, the stent in the LAD territory and the periprocedural complication is strongly associated with the development of ISR.
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Affiliation(s)
- Praveen K Gupta
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Jayaram Balachander
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Revaiah PC, Vemuri KS, Vijayvergiya R, Bahl A, Gupta A, Bootla D, Kasinadhuni G, Nevali KP, Palanivel Rajan M, Uppal L, Gawalkar A, Rohit M. Epidemiological and clinical profile, management and outcomes of young patients (≤40 years) with acute coronary syndrome: A single tertiary care center study. Indian Heart J 2021; 73:295-300. [PMID: 34154745 PMCID: PMC8322929 DOI: 10.1016/j.ihj.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/16/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To study the epidemiological and clinical profile, angiographic patterns, reasons for the delay in presentation, management, and outcomes of the acute coronary syndrome (ACS) in young patients (≤40yrs) presenting to a tertiary care hospital in North India. Methods: We included a total of 182 patients aged ≤40 years and presenting with ACS to the cardiology critical care unit of our department from January 2018 to July 2019. Results: The mean age of the study population was 35.5 ± 4.7years. 96.2% were males. Risk factors prevalent were smoking (56%), hypertension (29.7%), family history of premature coronary artery disease (18.2%), and diabetes (15.9%). The median time to first medical contact and revascularization was 300 (10–43200) minutes and 2880 (75–68400) minutes, respectively. ST-elevation ACS (STE-ACS) accounted for 82% and Non-ST-elevation ACS (NSTE-ACS) accounted for 18% of cases. Thrombolysis was done in 51.7% of the cases. Coronary angiography was done in 91.7% and percutaneous coronary intervention (PCI) in 52.2% (95/182) of the total cases. Coronary artery bypass surgery (CABG) was done in 2 patients (1.1%). Among those who underwent coronary angiography, single-vessel disease (SVD) was seen in 53% of the cases. There were no deaths in hospital, and only one patient died during the 30 days follow up. Conclusions: STE-ACS was the most common presentation of ACS in the young population. Smoking was the most common risk factor. The majority of the patients had single-vessel disease, and there was a significant delay in first medical contact and revascularization.
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Affiliation(s)
- Pruthvi C Revaiah
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Krishna Santosh Vemuri
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Krishna Prasad Nevali
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - M Palanivel Rajan
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Atit Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Manojkumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
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Dalal J, Kapoor A. ACPTI study: Being positive in a negative situation is not naivety - Trimetazidine still has role in symptomatic CAD patients. Indian Heart J 2020; 73:135-137. [PMID: 33714401 PMCID: PMC7961246 DOI: 10.1016/j.ihj.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022] Open
Abstract
RESULTS of the efficAcy and safety of Trimetazidine in patients with angina pectoris having been treated by Percutaneous Coronary Intervention (ATPCI) study showed no significant difference in the incidence of primary endpoint events between trimetazidine and placebo group in angina patients who recently underwent percutaneous coronary intervention. However, the study had limitations specific to both, design and selection of patient population. Here, we present some explanations for the null effects of trimetazidine in the ATPCI study and their relevance in routine clinical practice.
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Affiliation(s)
- Jamshed Dalal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Aditya Kapoor
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Basnet TB, G. C. S, Basnet R, Neupane B. Dietary nutrients of relative importance associated with coronary artery disease: Public health implication from random forest analysis. PLoS One 2020; 15:e0243063. [PMID: 33301496 PMCID: PMC7728256 DOI: 10.1371/journal.pone.0243063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/14/2020] [Indexed: 01/09/2023] Open
Abstract
Dietary nutrients have significant effects on the risk of cardiovascular diseases. However, the results were not uniform across different countries. The study aims to determine the relative importance of dietary nutrients associated with coronary artery disease (CAD) among the Nepalese population. A hospital-based matched case-control study was carried out at Shahid Gangalal National Heart Center in Nepal. In the present study, patients with more than seventy percent stenosis in any main coronary artery branch in angiography were defined as cases, while those presenting normal coronary angiography or negative for stressed exercise test were considered controls. Dietary intakes of 612 respondents over the past 12 months were evaluated using a semi-quantitative customized food frequency questionnaire. In conditional regression model, the daily average dietary intake of β-carotene (OR: 0.54; 95%CI: 0.34, 0.87), and vitamin C (OR: 0.96; 95%CI: 0.93, 0.99) were inversely, whereas dietary carbohydrate (OR: 1.16; 95%CI: 1.1, 1.24), total fat/oil (OR: 1.47; 95%CI: 1.27, 1.69), saturated fatty acid (SFA) (OR: 1.2; 95%CI: 1.11, 1.3), cholesterol (OR: 1.01; 95%CI: 1.001, 1.014), and iron intakes (OR: 1.11; 95%CI: 1.03, 1.19) were positively linked with CAD. Moreover, in random forest analysis, the daily average dietary intakes of SFA, vitamin A, total fat/oil, β-carotene, and cholesterol were among the top five nutrients (out of 12 nutrients variables) of relative importance associated with CAD. The nutrients of relative importance imply a reasonable preventive measure in public health nutrients specific intervention to prevent CAD in a resource-poor country like Nepal. The findings are at best suggestive of a possible relationship between these nutrients and the development of CAD, but prospective cohort studies and randomized control trials will need to be performed in the Nepalese population.
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Affiliation(s)
- Til Bahadur Basnet
- Little Buddha College of Health Sciences, Prubanchal University, Kathmandu, Nepal
- * E-mail:
| | - Srijana G. C.
- Maharajgunj Nursing Campus, Tribhuvan University, Kathmandu, Nepal
| | - Rajesh Basnet
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Bidusha Neupane
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. Arch Cardiovasc Dis 2020; 114:150-172. [PMID: 33309203 DOI: 10.1016/j.acvd.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
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Ramaka S, Nazir NT, Murthy VS, Hoek TV, Prabhakar BS, Chodavarapu R, Peri S, Uppuleti A, Jatoth R, Murthy SV, Mohammed AS, Weine SM. Epidemiology of out-of-Hospital Cardiac Arrests, knowledge of cardiovascular disease and risk factors in a regional setting in India: The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR). Indian Heart J 2020; 72:517-523. [PMID: 33357639 PMCID: PMC7772591 DOI: 10.1016/j.ihj.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/17/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Out-of-Hospital Cardiac Arrest (OHCA) is a global public health problem. There is inadequate data on OHCA in India. The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR) was planned to understand OHCA in a regional setting in India. METHODS WACAR is a prospective one-year observational cohort study of OHCA in the Warangal area, Telangana, India. The study included 814 subjects of OHCA of presumed cardiac etiology brought to the Mahatma Gandhi Memorial Hospital during January 1, 2018, and December 31, 2018. The data collected included; standard Utstein variables with additional data on clinical characteristics (modified Utstein template). RESULTS The majority of OHCA subjects were male with a median age of 60 years, and mostly occurring in residential locations within 1 h of onset of symptoms. Individuals with knowledge of CVD risk factors were more likely to report symptoms before OHCA. Data on resuscitation characteristics were inadequate. CONCLUSIONS The WACAR study provides baseline data regarding OHCA in a regional setting in India. The study demonstrated barriers involving data collection, patient knowledge of CVD risk factors and disease, and access to healthcare, which; impacted the data registry.
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Affiliation(s)
- Srinivas Ramaka
- Principal Investigator WACAR Study, Srinivasa Heart Centre, Warangal, Telangana, India.
| | - Noreen T Nazir
- Department of Internal Medicine, Division of Cardiology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Vemuri S Murthy
- Coinvestigator WACAR Study,Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Terry Vanden Hoek
- Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Bellur S Prabhakar
- Department of Microbiology and Immunology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Ravikumar Chodavarapu
- Department of Pediatrics, Pinnamaneni Institute of Medical Sciences and Research, Vijayawada, Andhra Pradesh, India
| | - Sundaresh Peri
- Dept of Social and Preventive Medicine, Kakatiya Medical College, Warangal, Telangana, India
| | | | - Rakesh Jatoth
- Kakatiya Medical College, Warangal, Telangana, India
| | - Sindgi Vasudeva Murthy
- Department of Pharmacology, Jayamukhi College of Pharmacy, Narsampet, Warangal, Telangana, India
| | | | - Stevan M Weine
- Departments of Global Health & Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
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Gopalakrishnan A, Sivadasanpillai H, Ganapathi S, Mohanan Nair KK, Sivasubramonian S, Valaparambil A. Clinical profile & long-term natural history of symptomatic coronary artery disease in young patients (<30 yr). Indian J Med Res 2020; 152:263-272. [PMID: 33107486 PMCID: PMC7881811 DOI: 10.4103/ijmr.ijmr_1090_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background & objectives: Several studies have shown a high prevalence of cardiovascular risk factors in patients in the age group of 30-74 yr, but there is a paucity of data in young patients below 30 yr. We analyzed the clinical and coronary angiographic profile of patients <30 yr of age with symptomatic coronary artery disease (CAD) and also assessed their intermediate and long-term outcomes. Methods: All patients less than 30 yr of age who presented with symptomatic CAD from 1978 to 2017 in the department of Cardiology of a tertiary care hospital in south India, were studied for coronary risk factors and angiographic and treatment patterns, and the follow up data were collected. Results: The mean age of the 159 patients <30 yr of age was 26.7±3.29 yr. Male preponderance was observed (91.8%), 63.5 per cent patients were smokers and 88.3 per cent were dyslipidaemic. Acute myocardial infarction was the most common mode of presentation. Forty one per cent patients were non-adherent to medications. Risk factor control was inadequate with respect to smoking cessation, alcoholism, physical activity and dietary regulation. The predictors of long-term mortality were multivessel CAD [hazard ratio (HR): 1.927, 95% confidence interval (CI): 1.003-3.701] and reduction in ejection fraction (EF) (10% decrease in EF; HR: 1.349, 95% CI: 1.096-1.662). Overall mortality was 30 per cent at 10 yr and 48 per cent at 20 yr. Interpretation & conclusions: Decreasing EF and multivessel involvement were found to be the strong correlates for long-term mortality in young patients below 30 yr of age with CAD. High long-term mortality rates and poor risk factor control suggest the vast scope for the improvement of outcomes in these patients with aggressive risk factor control.
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Affiliation(s)
- Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Harikrishnan Sivadasanpillai
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Sanjay Ganapathi
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Sivasankaran Sivasubramonian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
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Sudevan R, Vasudevan D, Raj M, Thachathodiyl R, Vijayakumar M, Abdullakutty J, Thomas P, George V, Kabali C. Compliance to secondary prevention strategies for coronary artery disease: a hospital-based cross-sectional survey from Ernakulam, South India. BMJ Open 2020; 10:e037618. [PMID: 33039999 PMCID: PMC7549465 DOI: 10.1136/bmjopen-2020-037618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The primary objective of the study was to report the compliance to secondary prevention strategies for coronary artery disease (CAD), such as smoking cessation, weight management, low-density lipoprotein (LDL) cholesterol control, blood pressure control, glycaemic control, physical activity and cardiovascular drug therapy from a resource-limited setting. DESIGN Analytical cross-sectional survey with data collection using questionnaire administered by study personnel. SETTING Institutional-two tertiary care hospitals and two cardiology clinics. PARTICIPANTS Patients in the age group of 30-80 years with documented CAD with a minimum of 1 year and a maximum of 6 years of follow-up after diagnosis. MAIN OUTCOME MEASURES The main outcome measures were the prevalence of individual compliance to secondary prevention strategies for CAD such as smoking cessation, weight management, LDL cholesterol control, blood pressure control, glycaemic control, physical activity and cardiovascular drug therapy. The secondary outcomes were the association of secondary prevention strategies with age, sex, domicile, socioeconomic status, insurance and type of treatment. RESULTS We recruited a total of 1206 patients among whom 879 (72.9%) were males. The median age of patients was 62 (14) years. The compliance to smoking cessation was 93.86% (95% CI 91.66% to 96.06%), ideal body mass index was 63.76% (95% CI 61.05% to 66.47%), blood pressure control was 65.11% (95% CI 62.42% to 67.80%), LDL compliance was 36.50% (95% CI 33.18% to 39.82%), diabetes control was 51.23% (95% CI 46.10% to 56.36%) and adequate physical activity was 39.22% (95% CI 36.46% to 41.98%)respectively. Reported compliance for cardiovascular drugs therapy was 96% for antiplatelets, 89.4% for statins, 68.2% for beta blockers, 37.7% for renin angiotensin aldosterone system blockers, 81.28% for oral hypoglycaemic agents and 22% for insulin therapy. CONCLUSION Compliance to secondary prevention strategies for CAD in resource limited settings are moderate. This needs further improvement for better outcomes related to CAD in future.
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Affiliation(s)
- Remya Sudevan
- Departments of Health Sciences Research & Cardiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Damodaran Vasudevan
- Department of Health Sciences Research, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Manu Raj
- Pediatrics, Pediatric Cardiology & Public Health Research, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rajesh Thachathodiyl
- Department of Cardiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Maniyal Vijayakumar
- Department of Cardiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | | | | | - Conrad Kabali
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Rehman H, Kalra A, Kochar A, Uberoi AS, Bhatt DL, Samad Z, Virani SS. Secondary prevention of cardiovascular diseases in India: Findings from registries and large cohorts. Indian Heart J 2020; 72:337-344. [PMID: 33189191 PMCID: PMC7670271 DOI: 10.1016/j.ihj.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
Several registries and quality improvement initiatives have focused on assessing and improving secondary prevention of CVD in India. While the Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE), Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF), and Trivandrum Heart Failure (THF) registries are limited to collecting data, the Tamil Nadu-ST-Segment Elevation Myocardial Infarction (TN-STEMI) program was aimed at examining and improving access to revascularization after an ST-elevation myocardial infarction (STEMI). The Acute Coronary Syndromes: Quality Improvement in Kerala (ACS-QUIK) study recruited hospitals from the Kerala ACS registry to assess a quality improvement kit for patients with ACS while the Practice Innovation and Clinical Excellence India Quality Improvement Program (PIQIP) provides valuable data on outpatient CVD quality of care. Collaborative efforts between health professionals are needed to assess further gaps in knowledge and policy makers to utilize new and existing data to drive policy-making.
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Affiliation(s)
- Hasan Rehman
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ajar Kochar
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Angad S Uberoi
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, New York, NY, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Zainab Samad
- Department of Medicine, Section of Cardiology, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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Valensi P, Henry P, Boccara F, Cosson E, Prevost G, Emmerich J, Ernande L, Marcadet D, Mousseaux E, Rouzet F, Sultan A, Ferrières J, Vergès B, Van Belle E. Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. DIABETES & METABOLISM 2020; 47:101185. [PMID: 32846201 DOI: 10.1016/j.diabet.2020.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Paul Valensi
- Unit of Endocrinology Diabetology Nutrition, AP-HP, Jean Verdier hospital, CINFO, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-Inserm UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | - Emmanuel Cosson
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Gaetan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie Univ, UNIROUEN, Rouen University Hospital, Centre d'Investigation Clinique (CIC-CRB)-Inserm 1404, Rouen University Hospital, 76000 Rouen, France
| | - Joseph Emmerich
- Service de Médecine Vasculaire, Groupe Hospitalier Paris Saint-Joseph, Université de Paris, Inserm UMR1153-CRESS, 75674 Paris cedex 14, France
| | - Laura Ernande
- Service des explorations fonctionnelles, Hôpital Henri Mondor, AP-HP et Inserm U955, Université Paris-Est Créteil, France
| | - Dany Marcadet
- Centre Coeur et Santé Bernoulli - Cardiologie du sport et Réadaptation Cardiaque, 3, rue Bernoulli, 75008 Paris, France
| | - Elie Mousseaux
- Radiology Department, Hôpital Européen Georges Pompidou & Inserm U 970; Assistance Publique - Hôpitaux de Paris, University of Paris, French Society of Cardiovascular Imaging (SFICV), Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP Paris - Université de Paris, Laboratory for Vascular Translational Science, Inserm, UMR 1148, 75018 Paris, France
| | - Ariane Sultan
- Physiologie et Médecine Expérimentale du Coeur et des Muscles (PHYMEDEX), U1046 Inserm, UMR9214 CNRS, Université de Montpellier, 34295 Montpellier; Département Endocrinologie, Nutrition, Diabète, Equipe Nutrition, Diabète, CHRU Montpellier, 34090 Montpellier, France
| | - Jean Ferrières
- Department of Cardiology and UMR Inserm 1027, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Bruno Vergès
- Service Endocrinologie-Diabétologie, CHU Dijon - Inserm LNC-UMR 1231, Dijon, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm, U1011, Institut Pasteur de Lille, EGID, Lille, France; Department of Medicine, Université de Lille, Lille, France
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Krittanawong C, Kumar A, Wang Z, Narasimhan B, Mahtta D, Jneid H, Baber U, Mehran R, Tang W, Ballantyne CM, Virani SS. Coronary artery disease in the young in the US population-based cohort. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:189-194. [PMID: 32923100 PMCID: PMC7486526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although most prevalent in the elderly, coronary artery disease (CAD) also affects younger adults. However, CAD in young adults is not as well characterized. OBJECTIVE To explore factors associated with CAD in young patients. METHODS We investigated the prevalence and baseline characteristics of young patients with CAD using the National Health and Nutrition Examination Survey (NHANES) survey between 1999 and 2016. The primary outcome was a reported history of CAD at age <55 years old, defined based on the subject's response to survey questions 'Have you ever been told by a physician that you had coronary artery disease?' and 'How old were you when were told you had coronary heart disease?'. Multivariable logistic regression models were used to assess factors associated with CAD in young patients. RESULTS Of 42,038 NHANES participants, 707 (1.7%) reported CAD at young age. Young patients with CAD were more likely to be male, non-whites, cigarette smokers, recreational drug users, had a family history of CAD, compared to young patients without CAD (all p-values <0.05). In multivariable logistic regression models, diabetes (OR: 3.94; 95% CI: 1.32-11.8; P=0.01), cigarette smoking (OR: 2.86; 95% CI: 1.52-5.53; P=0.001), alcohol consumption (OR: 1.17; 95% CI: 1.04-1.35; P=0.01) and cocaine use (OR: 4.48; 95% CI: 1.33-15.1; P=0.01) were independently associated with CAD in young patients. CONCLUSION CAD in young patients may be influenced by lifestyle factors such as alcohol consumption or cocaine use, as well as conventional risk factors such as smoking or diabetes.
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Affiliation(s)
- Chayakrit Krittanawong
- Section of Cardiology, Baylor College of MedicineHouston, TX, USA
- Michael E. DeBakey VA Medical CenterHouston, TX, USA
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai HeartNew York, NY, USA
| | - Anirudh Kumar
- Heart, Vascular and Thoracic Institute, Cleveland ClinicCleveland, OH, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for The Science of Health Care Delivery, Mayo ClinicRochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo ClinicRochester, MN, USA
| | - Bharat Narasimhan
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai HeartNew York, NY, USA
| | - Dhruv Mahtta
- Section of Cardiology, Baylor College of MedicineHouston, TX, USA
| | - Hani Jneid
- Section of Cardiology, Baylor College of MedicineHouston, TX, USA
- Michael E. DeBakey VA Medical CenterHouston, TX, USA
| | - Usman Baber
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai HeartNew York, NY, USA
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai HeartNew York, NY, USA
| | - Wilson Tang
- Heart, Vascular and Thoracic Institute, Cleveland ClinicCleveland, OH, USA
| | | | - Salim S Virani
- Section of Cardiology, Baylor College of MedicineHouston, TX, USA
- Michael E. DeBakey VA Medical CenterHouston, TX, USA
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Garavand A, Rabiei R, Emami H, Pishgahi M, Vahidi-Asl M. The attributes of hospital-based coronary artery diseases registries with a focus on key registry processes: A systematic review. Health Inf Manag 2020; 51:63-78. [PMID: 32677480 DOI: 10.1177/1833358320929366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The management of data on coronary artery disease (CAD) plays a significant role in controlling the disease and reducing the mortality of patients. The diseases registries facilitate the management of data. OBJECTIVE This study aimed to identify the attributes of hospital-based CAD registries with a focus on key registry processes. METHOD In this systematic review, we searched for studies published between 2000 and 2019 in PubMed, Scopus, EMBASE and ISI Web of Knowledge. The search terms included coronary artery disease, registry and data management (MeSH terms) at November 2019. Data gathering was conducted using a data extraction form, and the content of selected studies was analysed with respect to key registry processes, including case finding, data gathering, data abstracting, data quality control, reporting and patient follow-up. RESULTS A total of 17,604 studies were identified in the search, 55 of which were relevant studies that addressed the 21 registries and were selected for the analysis. Results showed that the most common resources for case finding included admission and discharge documents, physician's reports and screening results. Patient follow-up was mainly performed through direct visits or via telephone calls. The key attributes used for checking the data quality included data accuracy, completeness and definition. CONCLUSION CAD registries aim to facilitate the assessment of health services provided to patients. Putting the key registry processes in place is crucial for developing and implementing the CAD registry. The data quality control, as a CAD registry process, requires developing standard tools and applying appropriate data quality attributes. IMPLICATIONS The findings of the current study could lay the foundation for successful design and development of CAD registries based on the key registry processes for effective data management.
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Affiliation(s)
- Ali Garavand
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rabiei
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Emami
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Pishgahi
- Department of Cardiology, Faculty of Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Vahidi-Asl
- Faculty of Computer Science and Engineering, Shahid Beheshti University G.C., Tehran, Iran
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Mahtta D, Khalid U, Misra A, Samad Z, Nasir K, Virani SS. Premature Atherosclerotic Cardiovascular Disease: What Have We Learned Recently? Curr Atheroscler Rep 2020; 22:44. [PMID: 32671484 DOI: 10.1007/s11883-020-00862-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD. RECENT FINDINGS In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed.
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Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Umair Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Arunima Misra
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khurram Nasir
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. .,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
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Chacko M, Sarma PS, Harikrishnan S, Zachariah G, Jeemon P. Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study. Wellcome Open Res 2020; 5:70. [PMID: 32518841 PMCID: PMC7256470 DOI: 10.12688/wellcomeopenres.15829.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7-17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Affiliation(s)
- Manas Chacko
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Heart Care, Mother Hospital, Thrissur, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Chacko M, Sarma PS, Harikrishnan S, Zachariah G, Jeemon P. Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study. Wellcome Open Res 2020; 5:70. [PMID: 32518841 PMCID: PMC7256470 DOI: 10.12688/wellcomeopenres.15829.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 03/30/2024] Open
Abstract
Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7-17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Affiliation(s)
- Manas Chacko
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Heart Care, Mother Hospital, Thrissur, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Kavita K, Thakur J, Vijayvergiya R, Ghai S. Nurses role in cardiovascular risk assessment and communication: Indian nurses perspective. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_29_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Poorzand H, Tsarouhas K, Hozhabrossadati SA, Khorrampazhouh N, Bondarsahebi Y, Bacopoulou F, Rezaee R, Jafarzadeh Esfehani R, Morovatdar N. Risk factors of premature coronary artery disease in Iran: A systematic review and meta-analysis. Eur J Clin Invest 2019; 49:e13124. [PMID: 31038733 DOI: 10.1111/eci.13124] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/25/2019] [Accepted: 04/26/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to determine the mean age at which coronary artery disease (CAD) hase decreased in recent years in Iran. This systematic review and meta-analysis compares the prevalence of different risk factors of premature CAD (PCAD) in patients vs healthy individuals. METHODS Medline, Web of Science, Embase and Scientific Information Database were searched for studies about PCAD risk factors in Iran until 28 October 2017. Observational studies of Iranians, comparing risk factors between patients with PCAD and age- and sex-matched healthy subjects, were included. Fixed-effects and random-effects model were used for pooling data. Odds ratio (OR) with 95% CI and mean difference were used for effect size estimation among studies. RESULTS Twelve studies were eligible for meta-analysis. Diabetes mellitus (OR: 2.4, 95% CI: 1.9-3.03; P = 0.0001, I2 = 25.5%; P = 0.2), family history of CAD (OR: 2.09, 95% CI: 1.22-3.6; P = 0.007, I2 = 86%; P = 0.0001), dyslipidaemia (OR: 2.05, 95% CI: 1.15-3.64; P = 0.01, I2 = 54%; P = 0.08), smoking (OR: 1.65, 95% CI: 1.11-2.46; P = 0.01, I2 = 77.2%; P = 0.000) and hypertension (OR: 1.35, 95% CI: 1.21 to-1.50; P < 0.001, I2 = 31%, P = 0.1) associated with PCAD. Sensitivity analysis demonstrated that patients with PCAD had significantly lower levels of high-density lipoprotein (HDL) cholesterol and significantly higher levels of triglycerides compared to healthy subjects (MD: -2.56, 95% CI: -3.54 to -1.58, P < 0.001, I2 = 42%, P = 0.01 and MD: 21.17, 95% CI: 14.73-27.62, P < 0.001, I2 = 80.12%, P < 0.001, respectively). It should be noted that although high levels of heterogeneity in LDL and HDL values among the studies were observed, when dyslipidaemia was studied as a binary variable, no significant heterogeneity among studies was observed. CONCLUSION Diabetes mellitus, family history of CAD, dyslipidaemia, smoking, and hypertension were significantly and positively associated with CAD in young adults compared to healthy age- and sex-matched population in Iran.
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Affiliation(s)
- Hoorak Poorzand
- Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Konstantinos Tsarouhas
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece.,Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Nastaran Khorrampazhouh
- Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Yones Bondarsahebi
- Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Chemical Engineering, Aristotle University of Thessaloniki, Environmental Engineering Laboratory, University Campus, Thessaloniki, Greece.,HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki, Greece
| | - Reza Jafarzadeh Esfehani
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Sawhney JPS, Prasad SR, Sharma M, Madan K, Mohanty A, Passey R, Mehta A, Kandpal B, Makhija A, Jain R, Mantri RR, Vivek BS, Manchanda SC, Verma IC. Prevalence of familial hypercholesterolemia in premature coronary artery disease patients admitted to a tertiary care hospital in North India. Indian Heart J 2019; 71:118-122. [PMID: 31280822 PMCID: PMC6620422 DOI: 10.1016/j.ihj.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/27/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022] Open
Abstract
Aims The prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown. Methods A total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded. Results Of total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%). Conclusion FH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used.
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Affiliation(s)
- J P S Sawhney
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | | | - Manish Sharma
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Kushal Madan
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - A Mohanty
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Rajiv Passey
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Ashwani Mehta
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - B Kandpal
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Aman Makhija
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Rajneesh Jain
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - R R Mantri
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | | | - S C Manchanda
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - I C Verma
- Institute of Medical Genetics and Genomics, Sir Gangaram Hospital, New Delhi 110060, India.
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Gupta R, Khedar RS, Gaur K, Xavier D. Low quality cardiovascular care is important coronary risk factor in India. Indian Heart J 2018; 70 Suppl 3:S419-S430. [PMID: 30595301 PMCID: PMC6309144 DOI: 10.1016/j.ihj.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023] Open
Abstract
Global Burden of Disease study has reported that cardiovascular and ischemic heart disease (IHD) mortality has increased by 34% in last 25 years in India. It has also been reported that despite having lower coronary risk factors compared to developed countries, incident cardiovascular mortality, cardiovascular events and case-fatality are greater in India. Reasons for the increasing trends and high mortality have not been studied. There is evidence that social determinants of IHD risk factors are widely prevalent and increasing. Epidemiological studies have reported low control rates of hypertension, hypercholesterolemia, diabetes and smoking/tobacco. Registries have reported greater mortality of acute coronary syndrome in India compared to developed countries. Secondary prevention therapies have significant gaps. Low quality cardiovascular care is an important risk factor in India. Package of interventions focusing on fiscal, intersectoral and public health measures, improvement of health services at community, primary and secondary healthcare levels and appropriate referral systems to specialized hospitals is urgently required.
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Affiliation(s)
- Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Raghubir S Khedar
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Kiran Gaur
- Department of Statistics, SKN Agricultural University, Jobner, Jaipur, India
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore, India
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Brainin M, Feigin V, Martins S, Matz K, Roy J, Sandercock P, Teuschl Y, Tuomilehto J, Wiseman A. Cut stroke in half: Polypill for primary prevention in stroke. Int J Stroke 2018; 13:633-647. [PMID: 29461155 DOI: 10.1177/1747493018761190] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This review summarizes the potential for polypill therapies for stroke prevention. While a number of studies applying different approaches regarding polypill have been performed, none of them has had a focus on stroke as the main outcome. A combination pill containing drugs such as statins, diuretics, and other antihypertensives is currently available in various formats. Estimates focusing mostly on primary prevention show that using such a combination drug a reduction in the 5-year stroke incidence by 50% can be achieved - especially in low- and middle-income countries with a high prevalence of risk factors even among people at young ages. A combination of a large supporting population-wide program with a registry-based quality control is the most likely perspective and can be achieved within a reasonable time frame and potentially have significant influence in young stroke populations.
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Affiliation(s)
- Michael Brainin
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- 2 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Sheila Martins
- 3 Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Karl Matz
- 4 Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - Jayanta Roy
- 5 AMRI Institute of Neurosciences, Kolkata, India
| | - Peter Sandercock
- 6 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yvonne Teuschl
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Jaakko Tuomilehto
- 7 Dasman Diabetes Institute, Kuwait City, Kuwait.,8 Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,9 Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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