Pathogenic gene expression of epicardial adipose tissue in patients with coronary artery disease.

Background & objectives: Coronary artery disease (CAD), a leading cause of mortality and morbidity worldwide has multifactorial origin. Epicardial adipose tissue (EAT) has complex mechanical and thermogenic functions and paracrine actions via various cytokines released by it, which can have both pro- and anti-inflammatory actions on myocardium and adjacent coronaries. The alteration of EAT gene expression in CAD is speculated, but poorly understood. This study was undertaken to find out the difference in gene expression of epicardial fat in CAD and non-CAD patients. Methods: Twenty seven patients undergoing coronary artery bypass graft (CABG) and 16 controls (non-CAD patients undergoing valvular heart surgeries) were included in the study and their EAT samples were obtained. Gene expressions of uncoupling protein-1, monocyte chemoattractant protein-1 (MCP-1), adiponectin, adenosine A1 receptor (ADORA-1), vascular cell adhesion molecule-1 (VCAM-1) and tumour necrosis factor-alpha (TNF-α) were studied by real-time reverse transcription-polymerase chain reaction. Glucose, insulin, lipid profile, high-sensitivity C-reactive protein, homocysteine, vitamin D, TNF-α and leptin levels were estimated in fasting blood samples and analyzed. Results: Leptin levels were significantly higher in CABG group as compared to controls (P <0.05), whereas other metabolic parameters were not significantly different between the two groups. MCP-1, VCAM-1 and TNF-α were upregulated in the CABG group as compared to controls. Further, multivariate analysis showed significantly reduced adjusted odds ratio for MCP-1 [0.27; 95% confidence interval: 0.08-0.91] in the CABG group as compared to controls (P <0.05). Interpretation & conclusions: Our findings showed an alteration in EAT gene expression in CAD patients with significant upregulation of MCP-1. Further studies with a large sample need to be done to confirm these findings.

Cord blood levels of insulin and glucose in full-term pregnancies.

OBJECTIVES: This pilot study was undertaken to know the normal values of cord blood insulin and glucose levels in full-term normal pregnancies and pregnancies complicated with maternal conditions like pregnancy induced hypertension (PIH), thyroid dysfunction and Gestational Diabetes Mellitus (GDM). METHOD: Full-term pregnancies from Ketkar maternity hospital, Nagpur, since January 2011 were included in the study. A total of 121 cases have been studied. Demographic and clinical data of the included cases was obtained from the hospital records. Cord blood sample was analyzed for serum insulin and plasma glucose levels. These two metabolic parameters were used to derive (Homeostatic Model Assessment) HOMA index for insulin resistance and Glucose-to-Insulin Ratio (GIR). The data on physical and metabolic parameters was analyzed using parametric statistical significance tests for means and correlation using R-package RESULT: The difference in glucose concentration was found insignificant (p > 0.05) across complicated and uncomplicated pregnancies. However, for the comparison 'no complications' vs PIH, the insulin levels differed significantly at 10% (p = 0.09). Accordingly, for the same comparison, GIR also indicated significant difference at 10% (p = 0.07) between the two maternal groups. The mean cord blood glucose level was higher in PIH cases compared to un-complicated maternal cases; while the mean insulin level was lower in PIH cases as compared to non-complicated cases, as a result mean GIR was higher in PIH category. HOMA did not show significant difference in any comparison. The relationship of metabolic parameters and the derived variables with birth weight in the two maternal groups showed insignificant relationships between birth weight and dependent variables (p > 0.05). CONCLUSION: The levels of insulin and glucose in normal full-term pregnancies was found to be 6.75 +/- 2.96 mIU/ ml and 91.69 +/- 27.05 mg/dl respectively with GIR of 13.57 +/- 7.47 and HOMA 1.57 +/- 0.83. Low serum insulin levels with normal or high GIR was noted in pregnancies complicated by PIH. Insulin resistance as measured by HOMA IR is increased in patients with hypothyroidism. Hyperinsulinemia is seen in babies with birth weight less than 2.5 kg or more than 3.5 kg.

Effect of Obesity on Left Ventricular Systolic and Diastolic Functions Based on Echocardiographic Indices.

BACKGROUND: Left ventricular systolic and diastolic functions are known prognosticators for cardiovascular morbidity. One of the significant risk factors for cardiovascular diseases is obesity. The objective of this study is to determine the effect of obesity on the systolic and diastolic functions of the left ventricle on the basis of echocardiographic indices. METHODS: 75 obese and 75 averagely built subjects were studied. They had no other comorbidities. The indices of echocardiography of systolic and diastolic function were taken and assessed using recent recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. RESULTS: The volume indices of systolic and diastolic function (ejection diastolic volume (EDV) and ejection systolic volume (ESV)) and iso-volumetric relaxation time (IVRT) showed a significant increase in obese subjects (p<0.05); however, the relative thickness of the wall and internal diameter were comparable to non-obese subjects. The indices of contractility like ejection fraction, early diastolic filling velocity and late diastolic filling velocity (E/A) ratio, and mitral annular velocity were significantly lower in the obese subjects as compared to non-obese subjects. It was also found that left atrial diameter in systole and diastole had a moderate association (r=0.48, P<0.0001; r=0.35, P<0.0005) while mitral inflow E/A ratio had a negative association with body mass index (BMI) (r=-0.26, P=0.0166). CONCLUSIONS: Volumetric changes and ejection are significantly altered by increased BMI. More comprehensive studies in the future are recommended to assess the same.

Clinical and Demographic Profile of Diabetic Patients from Central India - Results from Diabetes Registry.

Objective: This study was done to analyse the demographic profile and presentation of diabetes in Central India. Design: Data was collected for this cross-sectional study from an electronic diabetes registry from 2014 to 2019. Demographic details, patient history and presence or absence of co-morbid conditions, duration of diabetes, age of onset of diabetes, drug history, personal history, presence of micro and/or macrovascular complications and investigations done were obtained. Statistical Analysis: The association between each factor and the outcome was studied in terms of prevalence ratio (PR) using the R-3.0.0 programming (R Foundation for Statistical Computing, Vienna, Austria) language. Statistical significance was evaluated at a 5% level. Results: Among 12,434 patients, 54.95% were below 50 years and 45.05% were above 50 years. 50.21% were females and 49.79% were males. The mean age was 47.49 ± 14.78 years and the mean body mass index (BMI) was 26.85 ± 5.19 kg/m2 with 62.29% of obese patients (>25 kg/m2). The mean overall duration of diabetes was 7.64 ± 7.63 years. Mean Glycosylated Haemoglobin (HbA1c) in patients <=50 years was 8.60 ± 2.63 and 8.90 ± 1.91 for over 50. 65.59% had uncontrolled blood sugars. 25.19% of patients had hypertension and 18.1% had dyslipidaemia. Coronary artery disease (CAD), nephropathy, neuropathy and retinopathy were observed in 21.49%, 9.60%, 33.65% and 14.65%, respectively. The adjusted PR of cardiovascular disease (CVD) was 5.374 times higher for patients over 50 (P < 0.0001); 3.775 times higher for males (P < 0.0001), 1.64 times higher for patients with BMI >25 kg/m2 (P < 0.0001) and 3.643 times higher in hypertensive cases (P < 0.0001). Similar associations were observed with nephropathy, neuropathy and retinopathy. Conclusion: From a large population study on diabetes, it was found a majority of the type 2 diabetes mellitus (T2DM) cases (65%) are sub-optimally controlled with HbA1c levels. Also, microvascular complications were related to the sub-optimal glycaemic control, but not the macro-vascular complications.

Fetal origin of vascular aging.

Aging is increasingly regarded as an independent risk factor for development of cardiovascular diseases such as atherosclerosis and hypertension and their complications (e.g. MI and Stroke). It is well known that vascular disease evolve over decades with progressive accumulation of cellular and extracellular materials and many inflammatory processes. Metabolic syndrome, obesity and diabetes are conventionally recognized as risk factors for development of coronary vascular disease (CVD). These conditions are known to accelerate ageing process in general and vascular ageing in particular. Adverse events during intrauterine life may programme organ growth and favour disease later in life, popularly known as, 'Barker's Hypothesis'. The notion of fetal programming implies that during critical periods of prenatal growth, changes in the hormonal and nutritional milieu of the conceptus may alter the full expression of the fetal genome, leading to permanent effects on a range of physiological.