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   2017| January-March  | Volume 6 | Issue 1  
    Online since December 26, 2016

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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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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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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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Landmark trials in pulmonary hypertension and pulmonary embolism
Rahul Mehrotra
January-March 2017, 6(1):27-30
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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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Prospective validation of San Francisco Syncope Rule in Indian population
Narayanapillai Jayaprasad, Suresh Madhavan, S Baiju, VL Jayaprakash
January-March 2017, 6(1):2-6
Context: The San Francisco Syncope Rule (SFSR) was proposed as a risk stratification tool for patients presenting to the emergency department (ED) with syncope. Aims: The aim of this study was to validate the SFSR in Indian population for predicting serious outcomes in patients presenting with syncope or near syncope. Secondary aim was to identify whether the admission rate can be safely reduced by applying this rule in the ED. Settings and Design: This was a prospective observational study conducted among patients attending the ED of a teaching hospital with syncope or near syncope. Subjects and Methods: Physicians prospectively applied the SFSR after usual evaluation, and patients were followed up to determine whether they had a serious outcome within 30 days of their ED visit. Statistical Analysis Used: Sensitivity, specificity, positive and negative predictive values of the rule for predicting serious outcomes were calculated. Results: A total of 210 patients were included in the study. There were 86 (41%) males and 124 (59%) females. Average age was 60.6 years. A total number of patients admitted were 110 out of 210 patients (52%). At least one SFSR predictor was positive in 90 (43%) patients out of 210. A total of 23 patients (11%) had at least one serious outcome at 30 days of ED visit. SFSR had a sensitivity of 95.65% and a specificity of 63.64% to predict serious outcome in the study population. Conclusions: The SFSR is valid in Indian population and application of the rule could reduce the hospital admission rates for syncope.
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From the Editor's desk
Ravi R Kasliwal
January-March 2017, 6(1):1-1
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