Coronary Artery Disease In India Research Articles

Importance of Dyslipidemias in Very Premature Coronary Artery Disease in India: A Registry-based Study.

Premature coronary artery disease (CAD) is an important cause of death in India. To identify risk factors in patients with premature CAD, we performed a registry-based study. Consecutive patients admitted for percutaneous coronary intervention (PCI) from October 2020 to June 2021 were recruited. The patients were classified into three groups-group I (very premature CAD < 40 years), group II (premature CAD 40-59 years), and group III (nonpremature CAD > 60 years). Major risk factors were determined, and intergroup comparison was performed. A total of 627 patients were enrolled (men 541, women 86). Group I had 79 (12.4%), group II had 420 (66.9%), and group III had 128 (20.4%) patients. The prevalence of risk factors in groups I, II, and III, respectively, were-CAD family history in 45.1, 41.1, and 26.6% (p = 0.005), current smoking/tobacco use in 29.1, 21.0, and 10.2% (p = 0.002), hypertension in 31.6, 43.6, and 59.4% (p < 0.001), and diabetes in 22.8, 34.3, and 46.1% (p < 0.001). High total cholesterol (>170 mg/dL) was present in 50.0, 38.0, and 29.9% (p = 0.005), nonhigh-density lipoprotein (HDL) cholesterol (>100 mg/dL) in 76.9, 64.4, and 54.5% (p = 0.001), low-density lipoprotein (LDL) cholesterol (>70 mg/dL) in 85.9, 76.8, and 76.4% (p = 0.167), triglycerides (>150 mg/dL) in 56.4, 45.3, and 33.1% (p = 0.001), and very low density lipoprotein (VLDL) cholesterol (>30 mg/dL) in 24.4, 10.4, and 9.4% (p = 0.005). Age- and sex-adjusted odds ratios (OR) and 95% confidence intervals (CI) for smoking/tobacco use in groups I and II compared to group III, respectively, were 3.17 (1.60-6.27) and 2.59 (1.51-4.46); high total cholesterol 2.39 (1.29-4.13) and 1.42 (0.92-2.17); high non-HDL cholesterol 2.70 (1.45-5.03) and 1.48 (0.99-2.20); and high triglycerides 2.57 (1.44-4.58) and 1.64 (1.08-2.49). Important coronary risk factors in very premature and premature CAD in India are a family history of CAD, any tobacco use, and dyslipidemias (raised total, LDL, non-HDL, and VLDL cholesterol and triglycerides).

CSI clinical practice guidelines for dyslipidemia management: Executive summary

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the ‘CSI: Clinical Practice Guidelines for Dyslipidemia Management’ published in this issue of the Indian Heart Journal. The summary is focused on the busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttransplant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also presented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the individual clinician judgement who remains the sole arbiter in management of the patient.

To analyze how LDL-C/HDL-C ratio and inflammatory marker CRP are organized in acute myocardial infarction

There is an increasing incidence of coronary artery disease in India. We therefore need a tool to evaluate the severity and prognosis of this acute myocardial infarction. In acute myocardial infarction, the function of plaque rupture and inflammation has already been identified. Aim: To study the organization of LDL-C/HDL-C ratio and inflammatory marker CRP in acute myocardial infarction. Methods and Material: Patients who have been diagnosed as acute myocardial infarction (ST Elevation Acute myocardial Infarction or Unstable angina/Non ST Elevation Myocardial Infarction) and admitted to ICCU of Government of medical sciences, Kadapa, AP. July 2021 to December 2021, are the subjects. Sample consists of 100 cases of acute myocardial infarction. Case history was taken from the patients, and studied according to proforma. Conclusion: Elevated levels of CRP are independent indicators of adverse effects. When contrast with the LDL / HDL ratio, CRP is used for risk stratification and as a prognostic predictor. These findings suggest that in patients with acute myocardial infarction, raised CRP Levels is significant as compared to LDL/HDL ratio.

Gender Bias in Cardiovascular Disease Prevention, Detection, and Management, with Specific Reference to Coronary Artery Disease.

Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD.

To study the organization of LDL-C/HDL-C ratio and inflammatory marker CRP in acute myocardial infarction

&#x0D; &#x0D; &#x0D; &#x0D; There is an increasing incidence of coronary artery disease in India. We therefore need a tool to evaluate the severity and prognosis of this acute myocardial infarction. In acute myocardial infarction, the function of plaque rupture and inflammation has already been identified. Aim: To study the organization of LDL-C/HDL-C ratio and inflammatory marker CRP in acute myocardial infarction. Methods and Material: Patients who have been diagnosed as acute myocardial infarction (ST Elevation Acute myocardial Infarction or Unstable angina/Non ST Elevation Myocardial Infarction) and admitted to ICCU of Rajiv Gandhi institute of Medical Sciences, Kadapa, AP. are the subjects. Sample consists of 100 cases of acute myocardial infarction. Case history was taken from the patients, and studied according to proforma. Conclusion: Elevated levels of CRP are independent indicators of adverse effects. When contrast with the LDL / HDL ratio, CRP is used for risk stratification and as a prognostic predictor. These findings suggest that in patients with acute myocardial infarction, raised CRP Levels is significant as compared to LDL/HDL ratio.&#x0D; &#x0D; &#x0D; &#x0D;

Heterozygosity in LDLR rs2228671 and rs72658855 Gene is Associated with Increased Risk of Developing Coronary Artery Disease in India –A Case-Control Study

Coronary artery disease (CAD) is one of the most common causes of death worldwide. Risk factors of CAD include high LDL-C, low high-density lipoprotein (HDL), hypertension, lack of exercise, genetic factors, etc. Polymorphisms of the LDLR gene have been associated with CAD in previous studies. The LDLR-rs72658855 C>T genotyping was detected by using allele-specific PCR (ASPCR). The association of rs2228671 and rs72658855 with CAD in a south Indian cohort (200 CAD patients and 200 matched healthy controls was studied. Our findings showed that rs2228671 gene variability is associated with increased susceptibility to coronary artery disease in the codominant inheritance model for variant CC vs. CT OR 3.42(1.09-10.7), with P<0.034. A non-significant association was reported in the recessive inheritance model for the variant (CC+CT) vs. TT OR 0.56(0.16-1.95), at P<0.36. and in the dominant inheritance model for variant CC vs. (CT+TT) OR 2.8(1.07-7.34), at P<0.032 .In case of allelic comparison, it was indicated that the LDLR rs2228671-T allele was associated with an increased risk of developing CAD compared to C allele OR=2.4, with 95% CI (1.05-5.64) and P< 0.036 . Our findings showed that LDLR rs72658855 C>T gene variability was associated with an increased susceptibility to coronary artery disease in the codominant inheritance model for variant CC vs. CT OR 1.7(1.1-2.6), at P<0.015 and in the dominant inheritance model for variant CC vs. (CT+TT) OR 1.66(1.07-2.58), at P<0.0.02.. In case of allelic comparison, a non-significant association was reported in LDLR rs72658855-T and C allele. We concluded that the heterozygosity in LDLR-rs72658855 and rs2228671 and T allele in LDLR rs2228671 are strongly associated with increased susceptibility to coronary artery disease. These results must be validated by future well-designed studies with larger sample sizes and different populations.

Effectiveness of quick relaxation technique on pain associated with chest tube removal among postoperative coronary artery bypass grafting patients in a Tertiary Care Hospital, Delhi

The current burden of coronary artery disease in India is >32 million. Chest tube removal (CTR) is a common procedure in critical care units and post coronary care units and is associated with moderate-to-severe pain. The pain management protocols remain unsatisfactory for most patients and researchers recommend the development and introduction of new protocols. Even with pharmacological management, most patients remember chest removal as a painful and discontented moment. Advanced practice nurses remove chest tubes most often. The aim of the present study was to assess the effectiveness of quick relaxation technique (QRT) on CTR for reducing the pain levels experienced by patients and also adopting it as a routine practice in cardiac surgical units. An experimental design was used. Sixty patients who were posted for coronary artery bypass grafting (CABG) were selected using purposive consecutive sampling method and randomly allotted to the experimental and control group. QRT was implemented to experimental group patients along with the regular protocol before drain removal. Control group patients underwent the regular protocol followed in surgical intensive care unit. The structured assessment tool was developed and used for data collection, which consisted of demographic data, information related to chest tube and numerical rating scale for pain assessment. Out of the 60 patients majority were in the age group of 60–70 years and majority were male in the control and experimental groups. Control group had mean post-procedure pain score of 5.1 ± 1.14, whereas the experimental group had mean pain score of 3.7 ± 1.05. QRT was highly effective in reducing the pain level on chest tube drain removal of post-CABG patients (Unpaired t-test value of 5.6394 with df 58, P

Potential Impact of COMT-rs4680 G > A Gene Polymorphism in Coronary Artery Disease.

Purpose: Catechol-O-methyltransferase (COMT) plays a central role in DNA repair and estrogen-induced carcinogenesis. The nonsynonymous single nucleotide polymorphism (SNP) in exon 4 G > A or Val108 > 158Met or rs4680 G > A influences COMT enzyme activity. The three phenotypes of the COMT enzyme activities include COMT A/A with low enzyme activity, COMT A/G with medium enzyme activity and COMT G/G with high enzyme activity. The Met allele is associated with low enzymatic activity resulting in higher levels of prefrontal dopamine. Conversely, the Val allele is associated with high enzymatic activity and lower levels of prefrontal dopamine. The Met allele has been associated with several psychiatric disorders such as panic disorder. Many recent epidemiologic studies have investigated the association between the COMT Val158Met polymorphism and coronary artery diseases risk, but the results are inconclusive. Therefore our study was aimed to explore the association between COMT Val158Met polymorphism and the risk of coronary artery disease in India. Methology: This study was conducted on 100 clinically confirmed cases of coronary artery diseases and 100 healthy controls. COMT Val158Met genotyping was performed by allele-specific polymerase chain reaction (AS-PCR). Results: A significant correlation was observed in the COMT Val158Met genotype distribution between the coronary artery disease cases and healthy controls (p = 0.008). The frequencies of all three genotypes, GG, GA, AA, reported in the CAD patients were 10%, 70%, and 20%, and 30%, 60%, and 10% in the healthy controls respectively. An increased risk of coronary artery disease was observed in the codominant inheritance model for COMT-GA vs. GG genotype with an OR of 3.5, 95% CI (1.58–7.74) p = 0.002) and COMT-AA vs. GG genotype with an OR of 6.0 95% CI (2.11–17.3) p = 0.003). The higher risk of coronary artery disease was observed in the dominant inheritance model for COMT (GA + AA) vs. GG genotype (OR 3.85, 95% CI 1.76–8.4, p < 0.007), whereas a non-significant association was found in recessive model for COMT (GG + GA vs. AA) (OR = 2.01, 95% CI (0.86–4.7) p = 0.72). The results indicated that A allele significantly increased the risk of coronary artery disease compared to the G allele (OR = 1.8, 95% CI (1.20–2.67) p = 0.004). COMT Val158Met polymorphism leads to a 6.0, 3.5 and 1.8-fold increased risk of developing coronary artery disease in the Indian population and providing novel insights into the genetic etiology and underlying biology of coronary artery disease. Conclusions: It is concluded that COMT-AA genotype and A allele are significantly associated with an increased susceptibility to coronary artery disease in Indian population. A larger sample size can be the key to progress in establishing the genetic co-relationship of COMT polymorphism and cardiovascular disease.

Familial Hypercholesterolemia: Cascade Screening in Children and Relatives of the Affected.

Familial Hypercholesterolemia (FH) is an inherited disorder of lipid metabolism characterized by very high low density lipoprotein (LDL) cholesterol since birth, resulting in premature atherosclerosis and coronary artery disease (CAD). Cascade screening of children and family members of proven FH individuals can identify more subjects who have high LDL cholesterol or the family mutation and appropriate intervention can reduce their risk of atherosclerosis and prevent its complications. Cascade screening by molecular testing, was carried out in 133 family members, comprising 24 children, of 31 probands with FH having a pathogenic mutation in LDLR/ApoB gene. Lipid profiles were obtained in 44 family members including 11 children. Of 133 family members tested, 88 (66.1%) were identified to carry the family mutation. Twelve of these were children below 18 y of age and 76 were adults. CAD was present in 15 (11.2%) family members and 63(47.4%) family members, including nine children, were already on Lipid Lowering Therapy. Cascade screening led to identification of 88 new cases, with a pathogenic mutation, who were at a very high risk of developing premature CAD. The authors identified 12 children with family specific mutation, out of which 9 were initiated on low dose statin therapy. Four homozygous children were treated with high dose statins because of substantially increased risk of CAD. Cascade screening, therefore, proved to be a successful initiative towards primary prevention of CAD in India.

Cardiovascular research convergence 2018

The Cardiovascular Research Convergence 2018 was held at International Centre for Genetic Engineering and Biotechnology and All India Institute of Medical Sciences on October 13 and 14, 2018. The program highlights were interactive sessions between clinical and basic scientists and case-based learning on cases of Eisenmenger syndrome, familial heart failure, and young patients with myocardial infarction. Some of the best research presentations included papers on vitamin deficiency in rats, cytochrome b5 reductase 3 as target to counter hypertension, high throughput screening for molecules for antihypertensive compounds in plants, Dhadkan: A smartphone app for heart failure (HF) patients, genetic variants in association with coronary artery disease in India, biomarkers after mitral interventions, the Indian experience with angiotensin receptor neprilysin inhibitor, and the AIIMS yoga program Kardiac Rehabilitation Yoga Trial in patients with HF. A program for training nurses in HF management was also conducted.

Coronary artery disease in India: A paradigm shift from west

Coronary artery disease in India: A paradigm shift from west

Challenges and Opportunities of Nuclear Cardiology in India

Nuclear Cardiology in India is underutilized. Contributing factors include high cost of starting Nuclear medicine facility, stringent regulations, small pool of trained nuclear physicians and technologists, high cost of radio pharmaceuticals and supply issues, poor penetrance of nuclear medicine in rural areas, inadequate exposure of cardiologists during training to the advantages of nuclear cardiology. India is poised to see an epidemic of coronary artery disease (CAD) and diabetes by end of few decades and nuclear cardiology would make significant contributions to handle this epidemic. Government and insurance companies advocacy is necessary for nuclear Cardiology to get its important rightful place in the management of CAD in India.

Lifestyle risk factors for coronary artery disease among young male patients of urban and rural Dakshina Kannada - A cross-sectional study

Background: There has been an increase in morbidity and mortality due to coronary artery disease (CAD) in developing countries due to multiple risk factors. India’s concern is not only the high burden of CAD but also its impact on the productive workforce aged 25-55 years in both rural and urban population. Aims and Objective: To study the demographic profile and lifestyle determinants among young male patients with CAD. Materials and Methods: A cross-sectional study was conducted in urban and rural field practice area of a private medical college in Dakshina Kannada. One hundred male CAD patients in the age group 25-55 years were asked to answer a pretested validated questionnaire to assess their demographic and lifestyle risk factors leading to CAD. Results: Out of 100 patients, 55 were rural and 45 were from urban area. Significant numbers of urban CAD patients were graduates lived in independent house and used Liquefied Petroleum Gas as cooking fuel, while most rural patients were less literate. No significant difference was seen in physical activity. The source of drinking water in significant majority of urban CAD patients is from the tap in the house. Rural CAD patients used significantly more tobacco products. Most urban patients consumed nonvegetarian and fast food and had higher total caloric intake. Conclusion: The lifestyle differences seen between rural and urban population have drastically decreased in the recent time because of urbanization and globalization. Health education regarding appropriate lifestyle changes required to reduce the burden of CAD in India is the need of the hour.

Management standards for stable coronary artery disease in India

Coronary artery disease (CAD) is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. An increasing burden of CAD in India is a major cause of concern with angina being the leading manifestation. Stable coronary artery disease (SCAD) is characterised by episodes of transient central chest pain (angina pectoris), often triggered by exercise, emotion or other forms of stress, generally triggered by a reversible mismatch between myocardial oxygen demand and supply resulting in myocardial ischemia or hypoxia. A stabilised, frequently asymptomatic phase following an acute coronary syndrome (ACS) is also classified as SCAD. This definition of SCAD also encompasses vasospastic and microvascular angina under the common umbrella.

Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry

BackgroundCoronary artery disease (CAD) occurs at younger age in India but only a limited number of studies have evaluated risk factors and management status. This is a multisite observational registry to assess risk factors and treatment patterns in young patients presenting with acute coronary syndrome (ACS) and stable ischemic heart disease (IHD). MethodsWe recruited 997 young patients (men <55, women <65y) presenting with ACS or stable IHD successively at 22 centers across India. Details of baseline risk factors and management status were obtained. Descriptive statistics are reported. ResultsMean age of participants was 49.1±8y, 72% were men and 68% had ACS. Family history of CAD was in 50%, diabetes 44%, hypertension 49%, history of dyslipidemia 11%, smoking/tobacco use 39%, and sedentary habits in 20%. 1.3% had “possible familial hypercholesterolemia”. Metabolic risk factors (high BMI, diabetes and hypertension) were significantly greater in women (p<0.01). Women were older at diagnosis of CAD and presented more often with non-ST elevation ACS. In the study cohort antiplatelet use was in 85%, beta-blockers 38%, statins 63% and ACE inhibitors/ARBs in 41% while in ACS patients it was 80.5%, 54.6%, 80.8% and 40.8%, respectively. 35.9% patients underwent percutaneous coronary intervention while coronary bypass surgery was performed in 10.4%. ConclusionsConventional risk factors including family history continue to play a pivotal role in premature CAD in Indians. Women have more of metabolic risk factors, present at a later age and have non-ST elevation ACS more often. There is a need to focus on improving use of evidence-based drug therapies and interventions.

Management Protocols of stable coronary artery disease in India: Executive summary

Management Protocols of stable coronary artery disease in India: Executive summary

Abstract 179: Documented Medication Use among Coronary Artery Disease Outpatients in India: Insights from PINNACLE India Outpatient Registry

Introduction: Coronary artery disease (CAD) affects Indians with greater frequency and at a younger age than people in other countries, and is the leading cause of death in India. For patients with CAD, treatment is aimed at controlling symptoms and progression of disease through lifestyle change and medication therapy. Secondary prevention with medication therapy reduces cardiac mortality and CAD-related complications. To our knowledge, there is no published literature that details medication use in India among CAD patients. In a country that is in the midst of an escalating CVD epidemic, examining documented medication patterns for CAD in India is needed to focus prevention and control efforts. Methods: PINNACLE India is the first CV data collection and reporting program implemented in India. The database receives clinical data through transmission from paper scanners and an electronic data collection tool. Patients are followed longitudinally if they return to a data collecting outpatient site. Results: A total of 9,047 patients in PINNACLE India are documented as having CAD. Aspirin, Beta Blockers and Clopidogrel are the three most frequently documented medications. Conclusion: A study examining US PINNACLE data found among CAD patients eligible, beta-blockers were prescribed in 73.3% (63,800/86,999), ACEI/ARBs in 69.4% (55,933/80,552), and statins in 68.2% (18,833/27,628) of patients. Although the rates of documented medication use among CAD patients in the PINNACLE India registry is lower than in PINNACLE US, contraindications are not often documented in PINNACLE India, and thus, not all patients in our cohort may have been eligible for such medications, which may explain the lower rates of usage. Additionally, we suspect under-documentation of medications that are inexpensive and readily available, such as aspirin. While the data on documented medication use among CAD patients in PINNACLE India are still limited, the information it reveals thus far elicits meaningful questions. Taking a closer examination at the trends in medication use in the Indian population would impel investigation into the socioeconomic, cultural, and genetic factors that influence CAD prevalence in this country.

The journey of surgery for coronary artery disease in India: adoption, customization and innovation

The journey of surgery for coronary artery disease in India: adoption, customization and innovation

Comparison of 128-Slice Dual Source CT Coronary Angiography with Invasive Coronary Angiography.

Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India as well as worldwide and last decade has seen a steep rise in incidence of CAD in India. Direct visualization of the coronary arteries by invasive catheterization still represents the cornerstone of the evaluation of CAD. Cardiac imaging is a challenge of 21 (st) century and is being answered by 128 slice dual source CT as it has good temporal resolution, high scanning speed as well as low radiation dose. To assess the diagnostic accuracy of 128-slice dual source CT Cardiac Angiography in comparison with Conventional Catheter Cardiac Angiography. Forty patients attending the cardiology OPD with complaint of chest pain and suspected of having CAD were evaluated by CT coronary angiography and conventional invasive Catheter coronary angiography and the results were compared. All patients were checked for serum creatinine and ECG before the angiography. Computed Tomography (CT) coronary angiography was done using SIEMENS 128-slice Dual Source Flash Definition CT Scanner under either Retrospective or Prospective mode depending on the heart rate of the patient. Oral/IV beta-blocker were used whenever required. Coronary arteries were assessed as per 17- segment AHA model. A total of 600/ 609 segments were evaluable in 40 suspected patients on CT coronary angiography, of which 21 were false positives and 8 were false negatives with specificity of 95.12% and sensitivity and positive predictive value of 95.26% & 88.46% respectively. Non-invasive assessment of CAD is now possible with high accuracy on 128-slice dual source CT scanner.

Translating intentions to prescriptions: Mind the gap!

Translating intentions to prescriptions: Mind the gap!