Cardiovascular Diseases In India Research Articles

Combination therapy for hypertension management: insights from the Indian experts

Cardiovascular diseases (CVDs) pose a significant global health challenge, with India bearing a disproportionate burden of CVD-related morbidity and mortality. Hypertension (HTN) is a major risk factor for CVDs, affecting nearly 30% of the Indian population. Achieving target blood pressure (BP) levels is crucial for reducing cardiovascular risk, necessitating aggressive antihypertensive therapy. Combination therapy has emerged as a cornerstone in HTN management, especially in high-risk patients. This review delves into the literature and perspectives of Indian cardiologists on combination therapy for HTN management. Despite the efficacy of contemporary antihypertensive medications, a substantial proportion of patients fail to reach target BP levels with monotherapy. Combination therapy offers synergistic effects, addressing multiple pathways involved in HTN pathogenesis. Recent guidelines recommend initiating treatment with two-drug combinations, transitioning to three-drug combinations in resistant cases. Combination therapy not only enhances BP control but also reduces the risk of cardiovascular events and mortality compared to monotherapy. Optimal management of HTN requires personalized approaches, considering individual patient profiles and comorbidities such as coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, and heart failure (HF). In such cases, combination therapy plays a pivotal role in mitigating cardiovascular risks. ARB/CCB combination therapy, particularly telmisartan/amlodipine, demonstrates significant efficacy and tolerability across various patient populations, including those with metabolic risk factors and renal impairment. Expert recommendations highlight the importance of individualized therapy, patient education, early diagnosis, and initiation with dual therapy in India. Strategies to improve medication adherence and compliance, such as single-pill double or triple combinations, are emphasized. Moreover, awareness of newer treatment options and contactless diagnostic instruments is crucial for optimizing HTN management. In conclusion, combination therapy stands as a cornerstone in HTN management, offering enhanced efficacy, tolerability, and cardiovascular protection. Tailored approaches guided by expert recommendations are essential to address the growing burden of HTN and reduce the socioeconomic impact of CVDs in India.

An integrated approach in the management of Cardiovascular Diseases

Cardiovascular diseases (CVDs) are the leading cause of death globally. According to WHO an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. India has one of the highest burdens of cardiovascular disease worldwide. The annual number of deaths from CVD in India is projected to rise from 2.26 million (1990) to 4.77 million (2020). The rate of incidence of cardiac disorders is almost doubled in Indian population which is an alarming fact. Cardiovascular Disease is largely the product of interactions of modifiable risk factors like changing lifestyles, bad eating habits and rapidly evolving socio-economic determinants like access to healthcare. There is a need of developing an integrative approach which conceptualizes a unique blend of different systems to bring the balance of body, mind and spirit for perfect health. Ayurveda holds the breakthrough to the key challenges that the India and in turn the world is facing in present era in cardiac care. Various scattered literature can be brought together and a clinical cardiology in Ayurveda can be given to modern society. Present paper is an effort towards Integrative approach for the management of CVDs.

Burden, determinants and treatment status of metabolic syndrome among older adults in India: a nationally representative, community-based cross-sectional survey

IntroductionMetabolic syndrome is a significance driver of mortality and morbidity in India, but nationally representative data regarding disease burden and treatment status are lacking. Here, a cross-sectional study was undertaken...

Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level.

Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.

Gender differences in premature mortality for cardiovascular disease in India, 2017–18

BackgroundThe present study tries to provide a comprehensive estimate of gender differences in the years of life lost due to CVD across the major states of India during 2017–18.MethodsThe information on the CVD related data were collected from medical certification of causes of death (MCCD reports, 2018). Apart from this, information from census of India (2001, 2011), SRS (2018) were also used to estimate YLL. To understand the variation in YLL due to CVD at the state level, nine sets of covariates were chosen: share of elderly population, percentage of urban population, literacy rate, health expenditure, social sector expenditure, labour force participation, HDI Score and co-existence of other NCDs such as diabetes, & obesity. The absolute number of YLL and YLL rates were calculated. Further, Pearson’s correlation had been calculated and to understand the effect of explanatory variables on YLL due to CVD, multiple linear regression analysis had been applied.ResultsMen have a higher burden of premature mortality in terms of Years of life lost (YLL) due to CVD than women in India, with pronounced differences at adult ages of 50–54 years and over. The age pattern of YLL rate suggests that the age group 85 + makes the highest contribution to the overall YLL rate due to CVD. YLL rate showed a J-shaped relationship with age, starting high at ages below 1 years, dropping to their lowest among children aged 1–4 years, and rising again to highest levels at 85 + years among both men and women. In all the states except Bihar men had higher estimated YLL due to CVD for all ages than women. Among men the YLL due to CVD was higher in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. On the other hand, the YLL due to CVD among men was lowest in Jharkhand followed by Assam. Similarly, among women the YLL due to CVD was highest in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. While, the YLL due to CVD among women was lowest in Jharkhand. Irrespective of gender, all factors except state health expenditure were positively linked with YLL due to CVD, i.e., as state health expenditure increases, the years of life lost (YLL) due to CVDs falls. Among all the covariates, the proportion of a state's elderly population emerges as the most significant predictor variable for YLL for CVDs (r = 0.42 for men and r = 0.50 for women).ConclusionYLL due to cardiovascular disease varies among men and women across the states of India. The state-specific findings of gender differences in years of life lost due to CVD may be used to improve policies and programmes in India.

The socioeconomic inequity in healthcare utilization among individuals with cardiovascular diseases in India.

We assess the effects of socioeconomic inequity on healthcare utilization among individuals with cardiovascular diseases (CVDs) in India using the indirect standardization method with Erreygers' corrected concentration index. We analyze both horizontal and vertical inequities and linearly decompose the respective inequities to identify the major factors driving both kinds of inequities. Our findings show that actual healthcare utilization is highly concentrated among rich CVD individuals. After controlling for the confounding effects of health needs, horizontal inequity is found to be significantly pro-rich, and income and urban concentration are found to be the major factors driving this inequity. However, the direction and magnitude of vertical inequity vary, depending on the selection of the target group. When we use healthcare utilization of the richest 20 percent as the target, we find no significant vertical inequity among CVD individuals. However, when we take the richest 10 percent as the target, we observe a significant pro-rich differential effect of health needs on healthcare utilization between all individuals and the target group. Decomposition reveals an inappropriate differential effect of health needs and age in driving vertical inequity. Hence, the presence of vertical inequity may trigger further pro-rich socioeconomic inequity in healthcare utilization if not supported by any targeted healthcare coverage.

Improving cardiovascular health behaviors through a comprehensive lifestyle intervention program during the pandemic in India

Abstract Funding Acknowledgements Type of funding sources: None. Background We have witnessed a dramatic dip in adherence to cardiovascular health behaviors during the COVID-19 pandemic. Data from across the globe has shown that risk factors for cardiovascular disease (CVD) such as decreased physical activity, poor diet, and increased depression, loneliness, and stress have peaked during the pandemic. Having been badly affected by the pandemic and having had prolonged periods of countrywide lockdown, the at-risk and established CVD population has faced a major challenge in adhering to a healthy lifestyle in India. Purpose This study aimed to analyze the change in cardiovascular health behaviors brought about by a comprehensive lifestyle intervention program (CLIP) during the pandemic in India. Methods All at-risk and CVD patients who had participated in the CLIP from mid 2020 to mid 2022 and had completed the internally validated health behavior assessment questionnaire, pre and post-program, were included in this retrospective study. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the sessions online and/or in-person for the home-based and hybrid programs respectively. When a combination of online and in-person sessions were provided for a subject, it was called a hybrid program. The core components of the CLIP were exercise training, education on relevant health topics, nutritional guidance and psychosocial counseling. Results Age of the subjects (n=50) at enrolment was 54±13 years and 40 (80%) were male. The time between pre-program and post-program assessments was 110 (IQR 47) days. Number of at-risk and CVD patients attending home-based and hybrid programs are shown in the Figure. There were 4 couples in the study cohort; 21 (50%) of the remaining 42 subjects had at least 1 other family member attend the majority of sessions. There was a significant improvement in all the cardiovascular health behaviors, namely adequate daily intake of fruits, vegetables and whole grains, choice of heart-healthy foods between meals, sufficient weekly exercise and a reduction in self-reported chronic stress, upon completion of the CLIP (Table). Conclusions A comprehensive lifestyle intervention program that incorporates a multipronged approach to behavior modification is effective in improving cardiovascular health behaviors in individuals at-risk as well as with established cardiovascular disease in India. The ripple effect of behavior modification in the accompanying family members needs to be studied systematically.

A hospital based cross-sectional pilot study on the relation between Prakriti (psychosomatic constitution) and risk for cardiovascular diseases in adults

Cardiovascular disease (CVD) is a major cause of disability and premature death throughout the world. The epidemic of cardiovascular disease in India is advancing rapidly. The concept of Prakriti, mentioned in Ayurveda, is said to influence the vulnerability of an individual to certain diseases. Prakriti is the phenotype-based constitution of an individual, formed at the time of conception. There are basically three sets of phenotypes – Vata, Pitta and Kapha. Human beings have any one or mixed gradients of these distinct variants. The objective of this work was to study the relation between any of the Prakriti with risk for cardiovascular disease. The design was hospital based cross sectional observational study. One hundred subjects above 35 years of age who were not diagnosed with a CVD were observed. Assessment of Prakriti was done by using validated Prakriti questionnaire, CVD risk was assessed using Qrisk3®2018 score. The parameters used for this scoring system include history of diabetes, smoking, body mass index, systolic blood pressure and lipid profile. Descriptive statistic and Chi square were done after collecting the data. It was observed that all the participants were Dwandwaprakriti of which 46% belonged to Pittakapha prakriti. The mean score of CVD risk was found higher in Vatakapha Prakriti (19.77 ± 13.0) as compared to the others. This high score has significant difference (p < 0.05) with that of other two groups. It was concluded that there was a significant difference in mean CVD predictive score among individuals of Vatakapha Prakriti compared to the other two Prakriti.

Sensory characteristics of selective traditional Indian sweets using agave syrup and stevia : An observatory study

Background: Indian sweets largely contribute to the rising graph of obesity and cardiovascular diseases in India. An urgent update in lifestyle and dietary patterns has become necessary to stay risk-free. Replacement of sucrose with natural sweeteners in traditional Indian sweets is one way of dealing with the consequences of high sucrose consumption. This study tries to understand the change in sensory characteristics of selective Indian sweets on the replacement of sucrose with natural sweeteners like Agave syrup and Stevia.Objectives:In this observatory study, sensory characteristics of traditional Indian sweets (Gulab Jamun, Jalebi, and Motichoor Ladoo) are observed after sucrose replacement with natural sweeteners.Methods:In order to examine the flavour and appearance of selected Indian sweets, sucrose is substituted with agave syrup and stevia. Product characteristics namely appearance, flavour, colour, odour, aftertaste, and overall acceptability of the standardized sweets are compared with the control samples prepared with sucrose.Results: Results using the 9-point hedonic scale conclude that out of the two natural sugars used as a substitute for sucrose, stevia showed better overall acceptability for Gulab Jamun (84%) and Motichoor Ladoo (59%), but not for Jalebi (30%). Results for the paired comparison test conclude that substituting Agave syrup with sucrose had an undesirable effect on colour, taste, and mouthfeel while substituting Stevia had a detrimental effect on taste and mouthfeel only.Conclusion:The results conclude an initial understanding of sucrose replacement using natural sugars namely Stevia and Agave syrup in the context of traditional Indian sweets and Stevia is better-suited replacement in Gulab Jamun.Keywords: Natural sweeteners, Sucrose replacement, Indian sweets, Sensory evaluation, new product development, Agave syrup, Stevia

A scoping review protocol on diagnostic and treatment costs of cardiovascular disease management in India

Background: Cardiovascular disease (CVD) is a leading cause of mortality in India. Economic threats due to CVDs have surged, as diagnostic and treatment costs are out-of-pocket expenses. The increasing prevalence of CVDs in India is due to globalization, industrialization, aging, tobacco and alcohol consumption, diet, and sleep patterns. This scoping review provides a summary of the costs incurred in diagnosing and treating CVDs in India. Methods: The JBI updated methodology aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) will guide this scoping review. Searches will be conducted on PubMed, Scopus, Cochrane Library, Embase, Econ Papers, and ProQuest databases. Google Scholar and Shodhganga will be used to search for relevant gray literature. Bibliographic mining will be performed to identify additional relevant studies. The literature published from 2000 onwards will be the primary focus. All direct and indirect costs for the diagnosis and treatment of CVDs across various levels of healthcare settings will be included. A two-stage independent screening, consisting of title and abstract screening, followed by full-text screening, will be conducted to identify eligible articles. Data will be extracted from full-text studies using a customized data extraction form. The results will be compiled and presented in the scoping review performed. Ethics and dissemination: A conference presentation and scientific peer-reviewed journal publication will be the sources for disseminating the review results. This study does not require an ethics review because publicly available sources were used to retrieve data.

Correlation of vitamin D level and severity of coronary artery disease

Introduction and Aim: Cardiovascular diseases are the leading cause of death worldwide. The prevalence of cardiovascular disease in India is continuously on the rise owing to the socioeconomic changes the country is undergoing. In order to minimise the mortality due to cardiovascular disease, early detection and control of modifiable risk factors is of utmost importance. We evaluated the correlation of vitamin D deficiency, one such possible modifiable risk factor, and the severity of CAD in patients at a hospital in Southern Karnataka. Unfortunately, relevant data regarding vitamin D deficiency in coronary artery disease pertaining to the Indian subcontinent is scarce. Thus, the results of our study can provide further evidence for the potential therapeutic benefit of Vitamin D in patients with cardiovascular risk factors, which in the long run can significantly reduce the morbidity and mortality of CAD. Materials and Methods: A case-control study with 142 subjects was conducted in Kasturba Hospital. Based on coronary angiogram findings, cases were categorised as having single, double, triple or multi vessel disease. Vitamin D level was quantified into 3 categories: normal (>30ng/ml), insufficient (20-30ng/ml) and deficient (<20ng/ml). Results: Vitamin D deficiency was statistically significantly and inversely related to the number of vessels involved (multi vessel disease-83.3%, triple vessel disease-80%, double vessel disease-28.6% and single vessel disease-21.7%). The relationship between vitamin D levels and syntax scoring showed a negative correlation (-0.339). Multiple linear regression analysis showed that the severity of CAD was correlated to diabetes and vitamin D deficiency with p-value of 0.014. Conclusion: Both our results and those of previous studies suggest that vitamin D could have a potential therapeutic effect in CAD.

Premature menopausal women and risk of cardiovascular diseases in India: Longitudinal Aging Study in India, 2017–18

Women who have premature menopause are increasing in number and there is a wide regional diversity across the World, including India. However, in India, the relationship between age at menopause and cardiovascular diseases is still unclear. To fill this research gap, we undertook the present study using data from the Longitudinal Aging Study of India (Wave1, 2017–18). Bivariate logistic regression with three different models controlling for socio-economic and demographic characteristics, reproductive history, nutritional status, and co-morbidities of CVDs was used to show the relationship between CVDs and premature menopause. In all three models, the adjusted odds of having CVDs were higher for premature menopausal women than for those who had menopause between the ages of 45–50. There is a need to understand menopausal problems and their risk factors. The government should initiate a reproductive and sexual health awareness program at the macro level and provide treatment for the same.

Collaborative Quality Improvement Strategy in Secondary Prevention of Cardiovascular Disease in India: Findings from a Multi-Stakeholder, Qualitative Study using Consolidated Framework for Implementation Research (CFIR).

Cardiovascular disease (CVD) is highly prevalent in India, and little is known about the perception of patients and providers about a package of collaborative quality improvement (C-QIP) strategies consisting of provider-focused electronic health records-decision support system (EHR-DSS), non-physician health workers (NPHW), and patient-facing text messages to enhance the CVD care. To explore the barriers and enablers of the C-QIP strategy from the perspective of providers, health administrators, patients, and care givers in India. We conducted a qualitative study using the consolidated framework for implementation research (CFIR) to understand the challenges and facilitators of implementing C-QIP strategy to enhance CVD care in the Indian context. A diverse sample of 38 physicians, 14 non-physician health workers (nurses, pharmacists), 4 health administrators, and 16 patients and their caregivers participated in semi-structured interviews. All interviews were audio-recorded, transcribed, translated, anonymised, and coded using MAXQDA software. We used the framework method and CFIR domains to analyze the qualitative data. Barriers perceived from providers' and health administrators' perspectives in providing quality CVD care were high patient volume, physician burnout, lack of robust communication or referral system, paucity of electronic health records, lack of patient counsellors, polypharmacy, poor patient adherence to medications, and lack of financial incentives. Low health literacy, high cost of treatment, misinformation bias, and difficulty in maintaining lifestyle changes were barriers from patients' perspectives. The CFIR identified key enablers for the implementation of C-QIP such as standardized treatment protocol, reduced medication errors, improved physician-patient relationships, and enhanced patient self-care through trained and supported NPHW. Barriers included: heterogenous healthcare settings, diverse patient groups and comorbidities, associated costs of care and interoperability, confidentiality, and data privacy issues around the use of EHR-DSS. Strategies to enhance CVD care must be low-cost, culturally acceptable, and integrated into existing care pathways.

WOMEN AND CARDIOVASCULAR DISEASES IN INDIA – TIME TO ACT

Cardiovascular diseases (CVDs) are the leading cause of death globally and account for 32% of global deaths. Of these deaths, 85% are due to heart attack and stroke. In India, CVDs accounted for 27% of total deaths in 2017. CVDs affect Indians in their most productive mid-life years compared to later ages of the western population. Early age of onset, rapid progression, and the high mortality rate are particular causes of concern for CVD in India. Globally, ischaemic heart disease accounts for a third of all female deaths and is a cause for concern. Even the Lancet Women and Cardiovascular Disease Commission, 2021 has highlighted cardiovascular diseases as the leading cause of death in women. In India, the proportion of DALYs for CVDs amongst women has changed from 2.9% (in 1990) to 6.6% in 2016. Women are cared only during pregnancy and the immediate post-partum period, in other times their problems are overlooked. The modiable risk factors such as tobacco , alcohol consumption and obesity have increased in women since 2013. The diagnosis of heart disease is often missed out in the Indian women because of their inability to express their ailments openly, compounded by factors like low socio-economic status, lower educational attainment and constrained access to medical care. Estimates suggest that almost 52% of all NCDs can be managed in primary care. The Indian government (GOI) is addressing the preventive aspect of NCDs through Primary Health Care at the Health & Wellness Centers and promote healthy lifestyles by targeted communication and screening at community level especially for the vulnerable, such as the women and elderly. Ayushman Bharat under GOI is being implemented to reduce out of pocket expenditure incurred towards management of non-communicable diseases amongst poor.

Assessment of food environment at work and its association with cardiometabolic health among employed adults in Delhi, India

Background and aimsUnhealthy food environment at work is believed to be playing a role in the burgeoning obesity, cardiometabolic risk, diabetes and cardiovascular diseases in India. Therefore, food environment assessment at work is crucial to understand the effect of food environment and to find its association with cardiometabolic risk among adults in Delhi, India. MethodologyMix-methods study to find association between worksite food environment on the food choices, dietary behavior, and cardio-metabolic health of 455 apparently healthy adults (both males and females) aged 25–55 years was done in urban India. ResultsUnhealthy food environment, poor eating pattern and sedentary lifestyle at work resulted in clustering of CMR factors among the study participants. Work environment assessment revealed that worksites with canteens had higher overall CHEW score for all its domains (Physical, nutritional, and information environment), in comparison to worksites without or no canteens. Four out of ten apparently healthy adults had metabolic syndrome indicating poor cardiometabolic health. The odds of CMR in subjects with access to canteen (unhealthy food) were estimated to be 0.74 (CI: 0.51 to 1.07; p = 0.11) times the odds of CMR in subjects without canteen (limited access to food). Females (β:0.34; 95% CI:0.23, 0.44; p = 0.00) had high CMR factors in comparison to males. Overall cardiometabolic risk factors increased with age (β:0.01; 95% CI:0.01,0.01; p = 0.00). ConclusionFindings of the present study urge the need for dietary and lifestyle intervention along with longitudinal studies to further disentangle the association of the food and work environment on the prevalence of CMR among adults.

A Study to Assess the Knowledge of Staff Nurses Regarding First 24 Hours Care of Patients with Myocardial Infarction admitted to ICU/Emergency in Hospital Pt. B.D. Sharma PGIMS Rohtak with a View to Develop Self-Instructional Module

Coronary Artery Disease (CAD) includes-Coronary Atherosclerosis and Myocardial Infarction. The most common cause of cardiovascular disease in India is atherosclerosis, an abnormal accumulation of lipid, or fatty substances, and fibrous tissue in the lining of arterial blood vessel walls. These substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium Objectives of the study: To assess the knowledge of staff nurses regarding first 24 hours care of patients with Myocardial Infarction admitted to ICU.To analyze the relationship between knowledge of staff nurses regarding first 24 hours care of patients with Myocardial Infarction admitted to ICU with selected socio-demographic variables. To develop a self-instruction module regarding first 24 hours care of patients with Myocardial Infarction Material and Methods: The scientist conducted the study exploitation quantitative approach and non- experimental style on a hundred staff nurses by non likelihood purposive sampling technique. Structured knowledge questionnaire was used to assess the knowledge of staff .

Effectiveness of straight walking on selected parameters among hypertensive participants attending outpatient department in selected urban primary health centre at Puducherry

Chronic non-communicable diseases (NCDs) are the number one cause of mortality and morbidity in the world. World Health Organization and Global Burden of Disease (GBD) study have reported that cardiovascular diseases (CVD) are the most important reason for fatality and disability. Age-adjusted mortality has increased by 31% in last 25 years. Case control studies have reported that hypertension is most important risk factor for CVD in India. The present study was to conduct to evaluate the effectiveness of straight walking on selected parameters among hypertensive participants attending out patient department in selected urban Primary Health Centre at Puducherry. An experimental pre and posttest control group design was utilized. By using simple random sampling technique 60 subjects were selected. The data were collected by using semi-structured questionnaire (demographic performa), bio-physiological and bio-chemical parameters. The data were analyzed by descriptive and inferential statistics. The results showed that The independent ‘t’ test value for heart rate (t=3.800, p=0.0001), respiratory rate (t=4.089, p=0.0001), SPO2 (t=4.068, p=0.0001) and HDL (t=6.018, p=0.0001) was found to statistically significant at p<0.001 level.

The effectiveness of pre-operative care bundle on post-operative outcome among adult patients undergoing cardiac surgeries in selected hospitals

Background: Cardiovascular diseases (CVDs) are the leading cause of death globally, taking an estimated 17.9 million lives each year. CVDs are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other conditions. More than four out of five CVD deaths are due to heart attacks and strokes, and one-third of these deaths occur prematurely in people under 70 years of age. India has one of the highest burdens of cardiovascular disease (CVD) worldwide. The annual number of deaths from CVD in India is projected to rise from 2.26 million (1990) to 4.77 million (2020). Coronary heart disease prevalence rates in India have been estimated over the past several decades and have ranged from 1.6% to 7.4% in rural populations and from 1% to 13.2% in urban populations.Purpose: To determine the effectiveness of preoperative care packages on postoperative outcomes of CABG patients and the relationship of postoperative outcomes with clinical and demographic variables.Method: In this study, the design used was a quasi-experimental design. In this study, a simple random sampling technique was used. sample size was 40 (experimental group 20 and control group 20) Study Findings 95% of patients were diagnosed with TVD, the remaining 5% were DVD patients.Results: This shows that there is moderate with 30% and good with 70% recovery in the experimental group, while in the control group 85% is moderate, 10% is good and 5% is bad. This indicates that there is a significant difference between the postoperative outcome scores between the experimental and control groups as p<0.05Conclusion: there is a significant effect of a pre-operative care bundle in patients undergoing CABG on preventing CABG complications and increasing life expectancy.

Why and How the Indo-Mediterranean Diet May Be Superior to Other Diets: The Role of Antioxidants in the Diet.

The Seven Countries Study showed that traditional Japanese and Mediterranean diets are protective against cardiovascular diseases (CVDs). The Japanese diet is considered the healthiest because it provides Japanese populations with the highest longevity and health. DASH and Mediterranean-style diets are also considered healthy diets, although the Indo-Mediterranean-style diet may provide better protective effects among patients with CVDs compared to other diets. The concept of the Indo-Mediterranean type of diet was developed after examining its role in the prevention of CVDs in India, the value of which was confirmed by a landmark study from France: the Lyon Heart Study. These workers found that consuming an alpha-linolenic acid-rich Mediterranean-style diet can cause a significant decline in CVDs and all-cause mortality. Later in 2018, the PREDIMED study from Spain also reported that a modified Mediterranean-style diet can cause a significant decline in CVDs, type 2 diabetes mellitus (T2DM), and cancer. The Indo-Mediterranean diet may be superior to DASH and Mediterranean diets because it contains millets, porridge, and beans, as well as spices such as turmeric, cumin, fenugreek, and coriander, which may have better anti-inflammatory and cardioprotective effects. These foods are rich sources of nutrients, flavonoids, calcium, and iron, as well as proteins, which are useful in the prevention of under- and overnutrition and related diseases. It is known that DASH and Mediterranean-style diets have a similar influence on CVDs. However, the Indo-Mediterranean-style diet may be as good as the Japanese diet due to improved food diversity and the high content of antioxidants.

Yoga in Arterial Stiffness: A Review

Non-communicable diseases; especially cardiovascular disease (CVD), is expected to be a leading cause of death worldwide through till 2030. Controlling this disease and its complications requires early recognition and surveillance, and as a result the accompanying health-care expenses can be kept under control. Looking back over the past, since 5 to 6 decades, studies have revealed an increase in CVD in India; ranging from 1.0% to 9.0% and 1.0% to 4.0-6.0% in both urban and rural areas, respectively. Arterial stiffness is defined as a decrease in an artery's ability to expand and contract in response to changes in pressure. Pulse Wave Velocity (PWV), which is the speed at which forward pressure is conveyed from the aorta via the vascular tree, is one of the simplest and oldest methods for determining it. Yoga, a mind-body practice that dates back to 5,000 Before Christ in India. It is regarded as a Vedic, ancient science, as a means of mental, bodily, and social existence, and has been increasingly used as a remedial measure. An comprehensive search of the electronic databases in PubMed/Medline, Web of Science, Scopus, Science Direct, Google Scholar, and Semantic Scholar for relevant publications was conducted using the keywords "Yoga and Arterial Stiffness." This current review, based on the scientific evidence, suggests yoga to pose and deliver health favourable benefits on PWV; particularly in adolescents as opposed to middle and geriatric populations. In addition, yoga is useful for young people with obesity, hypertension, and for those who lead a sedentary lifestyle. Yoga's beneficial effects on cardiovascular disease are related to a reduction in sympathetic activity as well as concomitant mental and physical relaxation.