Management of diabetic dyslipidemia in Indians: Expert consensus statement from the Lipid Association of India.

In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians.

Unmet Need for Further LDL-C Lowering in India despite Statin Therapy: Lipid Association of India Recommendations for the Use of Bempedoic Acid.

Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.

API-ISG Consensus Guidelines for Management of Gastrooesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is a common problem in the community. The Indian Society of Gastroenterology and Association of Physicians of India have developed this evidence-based practice guideline for management of GERD in adults. A modified Delphi process was used to develop this consensus containing 43 statements, which were generated by electronic voting iteration as well as face-to-face meeting, and review of the supporting literature primarily from India. These statements include 4 on epidemiology, 9 on clinical presentation, 11 on investigations, 18 on treatment (including medical, endoscopic, and surgical modalities), and one on complications of GERD. The statement was regarded as accepted when the proportion of those who voted either to accept completely or with minor reservation was 80% or higher. The prevalence of GERD in large population-based studies in India is approximately 10% and is probably increasing due to lifestyle changes and increase in obesity. The diagnosis of GERD in the community should be mainly based on presence of classical symptoms like heartburn and sour regurgitation, and empiric treatment with a proton pump inhibitor (PPI) or H2 receptor antagonist should be given. All PPIs in equipotent doses are similar in their efficacy in the management of symptoms. Patients in whom symptoms do not respond adequately to PPI are regarded as having PPIrefractory GERD. Invasive investigations should be limited to patients with alarm symptoms and those with refractory GERD.

Study of Diversity of Metformin Related Gastrointestinal Side Effects.

INTRODUCTION: Digestive disorders represent the most common metformin related side-effects in type 2 diabetics. GI side effects of metformin are not so uncommon rather under reported or wrongly diagnosed as primary gastrointestinal disorder. This study is to estimate metformin related GI side effects in Indian population. METHODOLOGY: This is a retrospective cross sectional study, conducted in tertiary care hospital at Kota. 120 type 2 diabetic patients were included after detailed history, physical examination and inclusion/exclusion criteria, who were on metformin tablet only, for variable duration. All patients were evaluated for gastrointestinal side effects. RESULTS: Mean age of study group was 52.8±11.9 years with mean weight 72.4±10.3 kg. Mean duration of metformin therapy was 3 years (6 weeks to 6 years) and mean metformin dose was 1000mg (500 mg - 2500 mg). 62 (51.66%) patients presented with GI side effects. These side effects are diarrhea (33), nausea/vomiting (28), pain abdomen (23), flatulence (16), retching (13), dysgeusia (7). On the basis of duration of therapy, most of patients had side effects during initial phase of treatment but some patients also presented after long duration of treatment. CONCLUSION: Gastrointestinal side effects being most common side effect of metformin can lead to discontinuation of therapy. So before extensive evaluation of any GI problem in patient on metformin, other methods can be tried like temporary discontinuation, dose titration or proper intake of medicine. These side effects may also occur even after prolonged treatment with metformin.

A Study of Clinico-radiological and Socio-demographic Profile of Patients with Stroke in a Terttary Care Hospital of South West Rajasthan.

INTRODUCTION: Cerebrovascular disorders (CVD) are increasing in prevalence and incidence in Indian population. Global burden of disease study shows that of the 9.4 million deaths in India, 619,000 were due to stroke. A matter of concern is that in the last two decades there is a significant increase in prevalence rate of stroke. AIM: To find the demographic characteristics along with clinico-radiological profile and of patients presenting with stroke in a tertiary care hospital in Rajasthan. METHODOLOGY: This cross sectional study was conducted for a period of 6 months from Aug 2015 to Jan 2016 in a tertiary care hospital .A sample size of 360 patients with aged >18 years were recruited after obtaining written consent from those who attended the medical OPD or were admitted to the government hospital with the newly diagnosed stroke and confirmed by neuroimaging. RESULT: The mean age of stroke in present study was 60.46 ± 14.84 years. The stroke in the young age group defined as 40 years or less comprised only 6%. Hypertension as a risk factor was present in 52.5% of our patients followed by Dyslipidaemia (25.8%). 79.4% had ischemic stroke and 19.4 % haemorrhagic stroke. Supratentorial lesions were seen in 86.4% patients, infratentorial lesions in only 10% anterior circulation strokes (MCA>ACA) are more common than posterior circulation strokes. Motor and sensory symptoms are common in acute strokes rather than change in consciousness or speech abnormalities. 70.2% patients had moderate disability at the end of 28 days. Early presentation to hospital (<3hrs) is associated with better outcome and less morbidity in a stroke patient.

Early Detection of Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease by Echocardiography.

OBJECTIVE: This study is designed to investigate the effects of pulmonary arterial hypertension on RV systolic and diastolic functions in cases of COPD and to correlate RV systolic and diastolic functions with pulmonary arterial pressure. MATERIALS AND METHODS: 100 patients admitted in various medical wards of tertiary care Hospital and a primary care hospital with stable chronic obstructive pulmonary disease persons with age and sex-matched. 35 age and sex matched person without any associated and known disease were taken as control subjects. Selection of cases has been made on basis of detailed history, thorough clinical examination, electrocardiography, chest x-ray, pulmonary function tests. OBSERVATION: RV Systolic function (RVEF and RVWT) are significantly abnormal in patients of stable compensated COPD and they are significantly correlated with PAP(p< 0.002). RV diastolic function i.e., E/A ratio and PFR are altered in 60%(n-60) of patients of COPD studied against control subjects and significantly correlated with PAP(p< 0.002). CONCLUSION: Echocardiography is a non invasive method to detect changes of right ventricular dysfunctions in early stages with very good significant sensitivity and specificity.