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Diagonal earlobe crease: Prevalence and association with medical ailments
Yugantara Ramesh Kadam, Yogesh M Shah, Parth Kore
April-June 2018, 7(2):49-53
Context: It has been hypothesized that diagonal earlobe crease (DELC), “Frank's sign” is indicative of coronary artery disease (CAD) and/or diabetes mellitus (DM). Several studies have confirmed an association between DELC and cardiac morbidity, mortality, and hypertension (HTN). However, some studies have not found any significant association. Aims: This study aims to find out the prevalence of DELC and its association with CAD, DM, and HTN. Settings and Design: Sangli-Miraj-Kupwad Corporation area. This was a cross-sectional analytical study. Subjects and Methods: Study participants: Adults from 18 to 60 years age. Inclusion criteria: willing to participate in the study Exclusion criteria: Wearing heavy ear rings and excessive normal generalized wrinkling of the skin. Sample size: Sample size 6310, determined after a pilot study revealing DELC in 1.5%. Sampling technique: Two-stage cluster sampling. Duration of study: 6 months. Study tools: Predesigned, pilot tested pro forma. Statistical Analysis: Statistical analysis was done by using SPSS 22 software. Prevalence and percentages were calculated, and Chi-square test was applied. Results: Out of 6638 participants, 179 had DELC. The prevalence of bilateral DELC was 2.7%. The prevalence was significantly high among males (4.13%) and in the 51–60 years age group (5.29%). The prevalence of Grade 3 DELC was high and 91% of young adults had Grade 3 DELC. There were 408 (6.15%) participants who gave a history of CAD, 827 (12.46%) of DM, and 670 (10.09%) HTN. Significantly high association observed between DELC and CAD, DM, and HTN. CAD, DM, and HTN were significantly associated with Grade 3. Conclusions: The prevalence of bilateral DELC was 2.7% and is significantly associated with CAD, DM, and HTN.
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Saturated fats and cardiovascular disease risk: A review
Ishi Khosla, Gayatri C Khosla1
April-June 2017, 6(2):56-59
Saturated fats have been in the line of fire for more than three decades. The major mistake in understanding fats was to equate all saturated fatty acids as one. The oversimplification of the relationship of saturated fats with cardiovascular disease (CVD) led to unwarranted removal of some valuable fats from our diets. Recently, the relationship of dietary saturated fats and that of individual saturated fatty acids (SFAs) to CVD risk has been reevaluated. All saturated fats are not equal and these fats are not as bad as they are made out to be. Thus, not all SFAs in natural fats are atherogenic (formation of fatty deposits in arteries). Butter, clarified butter (desi ghee), coconut oil, and palm oil as a part of a healthy diet are not contraindicated. The review of literature clearly suggests a relook at saturated fats with respect to atherogenicity and over health.
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Fragmented QRS: A simple electrocardiographic prognostic marker in cardiovascular disease
Sita Ram Mittal
July-September 2016, 5(3):94-98
Fragmented QRS is defined as the presence of R' wave or notching of R or S wave in the presence of narrow QRS. It indicates heterogeneous depolarization of the ventricular myocardium that can occur due to ischemia, fibrosis, or scar. It may also be a marker of coronary microvascular dysfunction. In the context of epicardial coronary artery disease, it is associated with multivessel disease and greater incidence of cardiac events. It has been shown to be an indicator of higher incidence of arrhythmias and sudden death in arrhythmic right ventricular dysplasia, Brugada syndrome, and acquired long QT syndrome. Its regression following cardiac resynchronization therapy suggests electrical reverse remodeling. It has also been shown to be a marker of myocardial involvement in congenital heart diseases and is helpful in diagnosing subclinical cardiac involvement in various systemic diseases.
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Oats: A multi-functional grain
Purvi Varma, Hitha Bhankharia, Shikha Bhatia
January-March 2016, 5(1):9-17
Oats are predominantly a European and North American crop, as they have cool moist climate; Russia, Canada, the United States, Finland, and Poland are leading oat producing countries. Oats have been used as livestock and human foods since ancient times. Oats (Avena sativa) is a class of cereal grain essentially grown for human consumption as well as for livestock fodder. Food industry fundamentally alter agricultural commodities into foods making it edible, palatable as well as appealing; by innumerable physical and chemical operations increasing shelf-life, bioavailability of the nutrients, stabilizing colour, flavour along with increase in the economic value of the grain. Recent observational and human interventional studies indicate that oats can have an impact on various non-communicable diseases like cardiovascular disease, diabetes; obesity and hypertension etc. Therefore it is important to increase awareness of oats and its health benefits among individuals thereby encouraging them to increase the frequency of oats in the diet. In the year 1997, USFDA approved the use of a health claim "3g/day of oat Beta- glucan may help lower blood total and low-density lipoprotein (LDL-C) cholesterol". Over all consumption of oats has increased in the recent years due to its nutritional benefits; presence of Beta-glucan, antioxidants like Avenanthramides, vitamin E (tocotrienols and tocopherols).
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Exercise for prevention of cardiovascular disease: Evidence-based recommendations
Geevar Zachariah, Anoop George Alex
July-September 2017, 6(3):109-114
Sedentary lifestyle is one of the major risk factors for cardiovascular disease (CVD). In India, a large percentage of the people are physically inactive with fewer than 10% engaging in recreational physical activity. Physical activity has many beneficial effects on the risk factors for CVD. Apart from improving fitness level, it decreases myocardial oxygen demand and improves myocardial perfusion. There is an inverse association between physical activity and all-cause mortality. In primary prevention, physical inactivity is associated with a two-fold increase in the risk for coronary events. In secondary prevention, data confirm the existence of an inverse dose–response relationship between cardiovascular fitness and the all-cause mortality in large populations of cardiovascular patients. Guidelines from the American authorities as well as the European Society of Cardiology provide specific recommendations for exercise depending on the clinical setting (primary or secondary prevention of CVD) and the patient-specific factors (the patient's physical activity level and the perceived CVD risk). The present review summarizes the clinical evidence regarding the role of exercise in CVD prevention and the exercise recommendations from the leading Cardiac societies.
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Marathon running for amateurs: Benefits and risks
Nitin Burkule
October-December 2016, 5(4):113-124
The habitual level of physical activity of the human race has significantly and abruptly declined in the last few generations due to technological developments. The professional societies and government health agencies have published minimum physical activity requirement guidelines to educate the masses about the importance of exercise and to reduce cardiovascular (CV) and all-cause mortality at the population level. There is growing participation in marathon running by amateur, middle-aged cases with a belief that more intense exercise will give incremental health benefits. Experts have cautioned the nonathlete amateurs about the "exercise paradox" and probable deleterious effects of high-intensity prolonged exercise on CV and musculoskeletal system. The epidemiological studies suggest a "reverse J shaped" relationship between running intensity and CV mortality. The highest benefits of reduction in CV and all-cause mortality are achieved at a lower intensity of running while the benefits tend to get blunted at a higher intensity of running. The physicians should have a balanced discussion with the amateur runners training for a marathon, about risks and benefits of high-intensity exercise, and should evaluate them to rule out the occult coronary disease.
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From the Editor's desk
Ravi R Kasliwal
October-December 2016, 5(4):107-107
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The Lipid Association of India Expert Consensus Statement 2016: A sea change for management of dyslipidemia in Indians
Enas A Enas, TS Dharmarajan
April-June 2016, 5(2):62-66
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Syncope: Approach to diagnosis
Om Murti Anil
July-September 2016, 5(3):84-93
Syncope is a transient loss of consciousness (LOC) due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Here, the term "transient LOC" encompasses all disorders characterized by self-limited LOC irrespective of the mechanism. Central point in pathophysiology of the development of syncope is fall in systemic blood pressure (BP) with a decrease in global cerebral blood flow. The evaluation and treatment of syncope are very challenging because syncope is not the only cause of transient LOC. Moreover, symptoms of syncope are fleeting, patient is usually asymptomatic at the time of evaluation, and most of the events are often unwitnessed. The guiding principle of assessment is to differentiate syncope from other causes of transient LOC and the more benign causes of syncope from the potentially serious ones. Initial assessment of syncope consists of a detailed history and examination complemented by 12-lead electrocardiography and supine and standing BP. If the cause is suspected, then further investigations may be needed to confirm the particular disorder. A deliberate approach based on initial risk stratification is more likely to give a correct diagnosis. Despite the difficulties, a thorough evaluation of the cause of syncope is warranted in all patients, not just in those deemed to be at high mortality risk. The goal in every case should be to determine the cause with sufficient confidence to provide a reliable assessment of prognosis and treatment options.
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Mobile communication: Boon or bane? Possible dangers of mobile phone usage
Jitendra Kumar Meena, Mahendra Singh Rathore
April-June 2017, 6(2):70-72
The ever-increasing use of radio devices (mobile phones) has led to widespread concerns among consumers, operators, and governmental authorities regarding environmental and health risks of their use. Various studies have demonstrated the relationship of radiowave exposure with biological effects in the body ranging from molecular to organ scale damage. However, most of them considerably failed to establish a causal association primarily owing to potential biases and errors in their conduct and analysis. Mobile usage also has both social and environmental impacts which have prompted the public health agencies to enforce certain regulations which however remain controversial due to lack of credible research evidence. In such scenario, it is recommended that mobile exposure should be minimized, especially among vulnerable populations. In addition, unbiased high-quality research is needed so as to bring more clarity to the subject and guide governmental policy and regulations.
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Management options for coronary microvascular dysfunction: Present status and future perspectives
Sita Ram Mittal
January-March 2016, 5(1):18-24
Coronary micro vessels are not visible on coronary angiography. These include prearterioles, arterioles, and capillaries. Significant number of patients of angina have coronary microvascular dysfunction alone or in combination with stenosis and/or spasm of epicardial coronary arteries. Its management is challenging. Several different therapeutic options have been tried with variable success. The present review provides overview of the available evidence with various therapeutic modalities for the treatment of microvascular angina.
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Recent landmark trials in clinical cardiology
Biswajit Paul
April-June 2016, 5(2):73-75
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Medication adherence and its determinants in myocardial infarction patients: An Indian scenario
Satish Balaji Gonarkar, Priti Pravin Dhande
January-March 2016, 5(1):2-8
Background: Myocardial infarction (MI) is one of the leading causes of death. Along with lifestyle factors, poor medication adherence is one of the causes. This study was planned to find out the level of adherence in post-MI patients and its related factors. Objectives: Monitoring medication adherence in patients of MI attending cardiac outpatient department and to reveal causes of nonadherence to drug therapy in them. Methods: One hundred and one newly diagnosed MI patients were included in the study. Data collected were patient characteristics, habits, comorbidities, and drugs prescribed. Morisky 8 item scale was used to find out the medication adherence at the end of 1 st and 6 th month of cardiac event. Data were analyzed using McNemar test, Chi-square test, and logistic regression analysis. Results: Most common preventive cardiovascular drugs given were aspirin, clopidogrel, and statins, 98%, 88.1%, and 90%, respectively. Medication adherence at 6 th month post-MI was significantly decreased compared to 1 st month (P < 0.0001). Factors which were related to good adherence were associated comorbidities such as hypertension (P = 0.017), age group of 56-65 years (P = 0.049), higher education (P = 0.045), employees (P = 0.008), and nonsmoker (P = 0.023). Determinants associated with poor adherence were affordability (P = 0.02) and medication complexity (P = 0.03). Conclusion: Medication adherence in post-MI subjects of our study was seen to be reducing over 6 months due to factors such as low monthly income and low educational status of the subjects. Employed, higher educated, and those with comorbidities showed good adherence.
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Assessment of high-sensitivity C-reactive protein values in chronic periodontitis patients with and without cardiovascular disease: A cross-sectional study
D Deepa, Chandni Gupta, Abhishek Gupta
October-December 2016, 5(4):108-112
Background: Periodontal disease is characterized by inflammation and destruction of supporting tissues of the affected teeth. Pro-inflammatory cytokines originating at the site of local pathology activate hepatocytes to produce acute-phase proteins including C-reactive protein (CRP). Numerous cross-sectional studies have suggested that chronic periodontitis is a risk factor for cardiovascular disease (CVD) linked by inflammatory factors including CRP. Materials and Methods: A total of forty patients, twenty with chronic periodontitis only with no CVD (Group A) and twenty with CVD and chronic periodontitis (Group B), were selected for the study. Clinical parameters including gingival index (GI), plaque index, gingival bleeding index, Pocket probing depth (PD), and clinical attachment level (CAL) were recorded. In addition, high-sensitivity CRP (hsCRP) levels were measured from the peripheral blood using turbidimetric immunoassay technique. Results: As compared to the patients in Group A, those in Group B had more severe periodontitis with greater CAL (6.02 ± 0.53 mm vs. 6.63 ± 0.85 mm, P = 0.009), probing pocket depth (PPD) (5.20 ± 0.31 mm vs. 5.73 ± 0.52 mm, P < 0.001), and GI score (2.25 ± 0.51 vs. 2.65 ± 0.76, P = 0.06). Group B patients also had significantly higher hsCRP levels (12.3 ± 8.84 mg/L vs. 2.28 ± 0.38 mg/L; P < 0.001). The hsCRP levels had a significant positive correlation with PPD and GI. Multivariate regression analysis showed that the presence of CVD was independently associated with elevated hsCRP levels in the study population. Conclusion: The present study shows that CVD is associated with more severe periodontitis which is reflected in higher hsCRP levels. In addition, elevated hsCRP showed an independent association with CVD, incremental to various periodontitis measures. These findings suggest that periodontitis may add to the inflammation burden of the individual, which may potentially increase inflammatory activity in atherosclerotic lesions and thus the risk for cardiovascular events.
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Lipid Association of India Expert Consensus Statement on Management of Dyslipidemia in Indians 2016: Part 1 - Executive summary
Shamanna S Iyengar, Raman Puri, SN Narasingan
April-June 2016, 5(2):51-61
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Cholesterol controversy
G Vijayaraghavan
January-March 2018, 7(1):2-4
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Influence of hypertension and diabetes mellitus in pattern of coronary artery disease in women
Biji Soman, Muneer A Rahaman, Govindan Vijayaraghavan
January-March 2017, 6(1):7-11
Introduction: Coronary artery disease (CAD) among women is an ignored entity in India. The aim of this study was to evaluate the role of hypertension (HT) and diabetes mellitus (DM) on the extent of CAD in women, admitted with ischemic chest pain. Materials and Methods: We conducted a retrospective analysis of the data of female patients admitted with chest pain suspected of cardiac origin and then underwent diagnostic coronary angiography. We obtained the ages, blood pressures, blood sugar levels, and angiographic findings of these patients after analyzing the patient records and reviewing the coronary angiograms. Results: We studied 163 female patients with a mean age of 58 ± 10.5 years. Of them, 71 (43.5%) had HT, 46 (28%) had DM, and 46 patients (28%) had neither HT nor DM. DM prevalence was higher (12/25, 48.0%) among women with ST-segment elevation myocardial infarction (STEMI) as compared to those with non-STEMI (6/26, 23.1%) or unstable angina (28/112, 25.0%; P = 0.06). In contrast, a higher proportion of the women with unstable angina had neither HT nor DM. Coronary angiography revealed a significant CAD in 86 (52.8%) women. Of them, 34 had DM (odds ratio: 3.542, 95% confidence interval [CI]: 1.669-7.516, P = 0.001) and forty had HT (odds ratio: 1.290, 95% CI: 0.693-2.404, P = 0.422) while12 had neither of the two risk factors. Triple vessel disease was more common in women >50 years of age, but the relationship between risk factors and CAD remained same in both the age groups. Conclusion: We conclude that increasing age along with DM is major risk factors for CAD among women. However, while older women tend to present with more extensive CAD, presentation with noncritical CAD or normal coronaries and muscle bridge is more common in younger women with suspected acute coronary event.
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Hypertension management: Old drug revisited - Cilnidipine
Soumitra Kumar
January-March 2017, 6(1):24-26
Cilnidipine is a promising fourth-generation calcium channel blocker which along with inhibition of the L-type Ca 2+ channels in vascular smooth muscle cells, also inhibits the N-type Ca 2+ channels in sympathetic neurons. As a result, in addition to hypotensive action secondary to vascular relaxation, it also demonstrates significant sympatholytic action, whereby it attenuates platelet activation (and consequent arterial thrombosis), tachycardia, oxidative stress, and also inhibits activation of renin-angiotensin system in blood vessels. By virtue of the latter effect, they relieve constriction of postglomerular vessels and thereby ameliorate glomerular hypertension and render renoprotective effect. Besides these, cilnidipine also improves insulin resistance, nitric oxide production, and protects against retinal neuronal injury. Thus, it is expected to be a very useful addition in the current armamentarium for the treatment of hypertension.
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Association of inflammatory cytokines/biomarkers with acute coronary syndrome and its correlation with severity and hospital outcome
Mohd Mahmudullah Razi, Nasar Abdali, S Mohammed Asif, MalikMohammed Azharuddin
April-June 2017, 6(2):44-49
Objective: Coronary atherosclerosis is one of the major causes of coronary artery disease. Atherosclerosis is an inflammatory process involving vascular wall cells, monocytes, T-lymphocytes, pro-inflammatory cytokines, chemoattractant cytokines (chemokines), and growth factors. The presence of inflammatory cells in the atherosclerotic lesion and elevated levels of the inflammatory markers in peripheral circulation correspond to an active inflammatory process in the body. In view of this background, this study was undertaken to evaluate the association between activation of inflammatory cytokines and acute coronary syndrome (ACS). Furthermore, the correlation of these factors with severity of ACS and in-hospital mortality outcomes was studied. Study Design: It is a prospective case–control study, including forty cases of ACS (as per the inclusion criteria listed below) and twenty controls. The levels of inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and troponin I were estimated in cases and controls. The levels of these markers in the peripheral circulation were also stratified on the basis of the presenting ACS type (unstable angina, non-ST-elevation myocardial infarction, and ST-elevation myocardial infarction). All statistical data were analyzed using SPSS software version 19 Statistical package for windows (Chicago, Inc., IL, USA). Results: The levels of inflammatory markers such as IL-6, TNF-α, and troponin I were higher in the ACS group than the control, and difference was statistically significant. Furthermore, there was a statistically significant difference in the levels of these markers between the various ACS groups. Conclusions: The circulating levels of inflammatory markers such as IL-6 and TNF-α are significantly elevated in patients with ACS, supporting the view that inflammatory cytokines are associated with ACS. There is a direct correlation of the levels of IL-6 and TNF-α with the severity of ACS and in-hospital mortality in these cases.
  1,632 235 -
Physician factors affecting cardiac rehabilitation referral among cardiac specialists: The Philippine Heart Center CRAVE study (Cardiac Rehabilitation Attitudes and Viewpoints on Engagement)
Lucky R Cuenza, Edward Nino Gacrama, Kent Tan, Benjamin Jose Quito, Edgardo Ebba
April-June 2016, 5(2):44-50
Background: Cardiac rehabilitation (CR), despite numerous evidence of a positive impact on morbidity and mortality, still remains underutilized due to multifactorial reasons. Physician endorsement has been shown to be a very powerful predictor of CR referral. The objective of the study was to describe physicians' attitudes and preferences regarding referral of patients to CR. Methods: A cross-sectional survey of a stratified random sample of 160 physicians specializing in cardiology was conducted at the Philippine Heart Center. One hundred and four physicians responded (65% response rate) to a survey that investigated clinical factors and perceptions affecting referral. Included in the survey was a hypothetical case scenario that elicited open-ended responses affecting physician management preferences. Results: About 78.9% of the physicians stated that they would refer the hypothetical case to CR although there were varied responses in their management practices. The most important factor affecting CR referral was financial limitation, followed by geographic location and issues on program accessibility and benefit. While there is general agreement regarding knowledge of the indications of CR, there is a disparity in the responses with regard to actual referral and management preferences. Conclusions: Financial considerations, accessibility, perceived benefit, and health-care system-related aspects are some of the identified factors that affect physician preferences toward referral to CR. Assessment of physician attitudes and factors affecting CR referral practices provides insight regarding potential targets of improvement to ensure adequate CR referral and provision.
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Role of electrocardiogram in identification of culprit vessel occlusion in acute ST elevation myocardial infarction in relation to coronary angiography
Kunal K Salunke, Rajesh J Khyalappa
October-December 2017, 6(4):128-132
Objective: The objective of the study is to study the usefulness of electrocardiography in localizing the culprit vessel in acute ST-elevation myocardial infarction (STEMI) and to assess the diagnostic accuracy of the electrocardiogram (ECG) findings by comparing them with coronary angiographic findings. Materials and Methods: This study is prospective observational study, conducted on fifty patients in tertiary care center attached to medical college. Patients with ST-segment elevation in ECG was evaluated to identify culprit vessel and later correlated with their coronary angiography. Results: Among fifty patients in the study, 34 had anterior wall, and 16 had inferior wall myocardial infarction. ST↑ >1 mm in V4R, ST↓V3/ST↑LIII <0.5 were equally sensitive for diagnosing proximal right coronary artery occlusion. For left circumflex occlusion, ST elevation in lead III >lead II was the most sensitive and ratio of ST↓V3/ST↑LIII >1.2 was the most specific criterion. In anterior wall STEMI, 52.9% patients had occlusion proximal to first septal (S1), 17.6% had occlusion proximal to first diagonal (D1), 8.8% had occlusion distal to S1, and 20.5% had occlusion distal to D1. Q wave in aVL had maximum sensitivity for identifying occlusion proximal to D1 and Q wave in leads V4-V6 for occlusion distal to S1. Conclusion: The admission ECG in patients with STEMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.
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Contributions of the South Asian Society on Atherosclerosis and Thrombosis and the Indian Society for Atherosclerosis Research, to our understanding of Atherosclerosis and Thrombosis
Gundu H R Rao
April-June 2016, 5(2):67-72
South Asians (Indians, Bangladeshis, Pakistanis and Sri Lankans) have very high incidence of cardiometabolic diseases, such as hypertension, central abdominal obesity, metabolic syndrome, type-2 diabetes, ischemic heart disease and stroke. To create awareness, develop educational and a prevention program, a professional society was started at the University of Minnesota in 1993. This society (South Asian Society on Atherosclerosis Thrombosis) organized international conferences in India every other year, on the topic of "Atherosclerosis and Thrombosis" and published several monographs on this subject. During the same period, another sister society, Indian Society of Atherosclerosis Research (ISAR) was started in India, which organized conferences on topics related to basic research and clinical aspects of atherosclerosis. Together, these professional societies have contributed significantly to our understanding of chronic cardiometabolic diseases. SASAT is currently located at the Division of Clinical and Preventive Cardiology, Medanta, The MediCity, New Delhi, India and is affiliated with the professional journal; Journal of Clinical and Preventive Cardiology. For information on ISAR, readers are urged to visit their web site: www. isar.co.in.
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Cardiopulmonary resuscitation: What is new in 2017
ST Yavagal
October-December 2017, 6(4):147-153
A timely and effective cardiopulmonary resuscitation (CPR) is crucial for saving lives of the individuals who suffer sudden cardiac arrest. Different relevant authorities have published guidelines for educating the caregivers in delivering effective CPR. The present report summarizes the recent changes in the CPR guidelines.
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Cardiovascular health in women: The role of diet
Shikha Sharma, Vinita Sharma, Reena Rawat, Swati Arya
January-March 2017, 6(1):18-23
The prevalence of cardiovascular diseases (CVDs) has been increasing over the years and is one of the leading causes of deaths in the Indian population. While women may have a lower risk of CVD, as compared to men, during the early phases of life, it has been determined that in the later stages of life, more number of women suffer from CVD as compared to men. Moreover, women might also experience disproportionately high mortality due to CVD. Obesity is among one of the most important reasons underlying greater burden of CVD in women. The problem of obesity is continuously growing even in developing countries like India and is more common in females and urban populations. Females are particularly prone to weight gain because of certain bodily changes which they have to go through during their life span. Obesity is associated with several risk factors such as type 2 diabetes, hypertension, dyslipidemia, which increase the risk of CVD. Additionally, obesity also leads to various other health problems such as uterine cancer, gallbladder disease, osteoarthritis, and breast cancer. Accordingly, prevention and management of obesity is an important health goal and diet plays an integral role in this. Diets rich in foods with high glycemic index (GI), high sodium content and low fruit and vegetable intake have been correlated with greater risk of CVD. Therefore, foods with low GI should be incorporated in the diets. In general, diets rich in dietary fiber have been associated with lower plasma cholesterol levels. Adequate intake of dietary fiber, phytochemicals, and antioxidants such as polyphenols, isothiocyanates, carotenoids, flavonoids, ascorbic acid and folates in the form of fresh fruits and vegetables offer cardioprotective benefits.
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Proprotein convertase subtilisin kexin 9 inhibitors: Current status and future directions
JPS Sawhney, Saurabh Bagga
January-March 2017, 6(1):12-17
The discovery of proprotein convertase subtilisin kexin 9 (PCSK9) has considerably changed the therapeutic options in the field of lipid management. PCSK9 reduces low-density lipoprotein receptor (LDLR) recycling, leading to a decrease of LDL cholesterol (LDL-C) receptors on the surface of hepatocytes and a subsequent increase of circulating LDL-C levels. Among the various approaches to PCSK9 inhibition, human data are only available for inhibition of PCSK9 binding to LDLR by monoclonal antibodies. In Phase II studies, the two most advanced monoclonal antibodies in development (alirocumab and evolocumab) decreased atherogenic lipoproteins very effectively and were well tolerated. Sixty percent to seventy percent of reduction in LDL-C was observed, especially when subcutaneous injections were performed regularly every 2 weeks. No significant side effects were observed, with the exception of injection-site reactions. Three large Phase III programs with the new anti-PCSK9 antibodies are currently underway in patients with acute coronary syndrome and LDL-C inadequately controlled by standard treatments. In this review, we will discuss the effect of PCSK9 inhibition, its current status, and future perspectives.
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