Lipid Association of India 2023 update on cardiovascular risk assessment and lipid management in Indian patients: Consensus statement IV.

OBJECTIVE: In 2016, the Lipid Association of India (LAI) developed a cardiovascular risk assessment algorithm and defined low-density lipoprotein cholesterol (LDL-C) goals for prevention of atherosclerotic cardiovascular disease (ASCVD) in Indians. The recent refinements in the role of various risk factors and subclinical atherosclerosis in prediction of ASCVD risk necessitated updating the risk algorithm and treatment goals. METHODS: The LAI core committee held twenty-one meetings and webinars from June 2022 to July 2023 with experts across India and critically reviewed the latest evidence regarding the strategies for ASCVD risk prediction and the benefits and modalities for intensive lipid lowering. Based on the expert consensus and extensive review of published data, consensus statement IV was commissioned. RESULTS: The young age of onset and a more aggressive nature of ASCVD in Indians necessitates emphasis on lifetime ASCVD risk instead of the conventional 10-year risk. It also demands early institution of aggressive preventive measures to protect the young population prior to development of ASCVD events. Wide availability and low cost of statins in India enable implementation of effective LDL-C lowering therapy in individuals at high risk of ASCVD. Subjects with any evidence of subclinical atherosclerosis are likely to benefit the most from early aggressive interventions. CONCLUSIONS: This document presents the updated risk stratification and treatment algorithm and describes the rationale for each modification. The intent of these updated recommendations is to modernize management of dyslipidemia in Indian patients with the goal of reducing the epidemic of ASCVD among Indians in Asia and worldwide.

Angiographic outcomes in STEMI patients receiving fibrinolysis with guideline directed optimal antithrombotic therapy.

STEMI is a major public health problem requiring timely reperfusion. Fibrinolysis remains prevalent reperfusion strategy where timely primary percutaneous coronary intervention (PCI) cannot be performed. Adjunctive antithrombotic agents are of utmost importance for maximizing the benefit of fibrinolysis. This prospective study evaluates the angiographic outcomes in STEMI patients receiving fibrinolysis with optimal antithrombotic therapy and reported TIMI 3 flow rates of 33.8% and 41.5% for streptokinase and reteplase respectively, that were significantly higher than various prior studies. This data reiterates the utility of thrombolysis in resource limited settings.

Clinical and Laboratory Profile of Dengue Fever in a North Indian Tertiary Hospital.

Objectives: The present study was done to ascertain the presentations of dengue fever in a North Indian tertiary care Hospital, and to compare the clinical and laboratory features among patients with and without warning signs in dengue fever. Methods: A total of 600 patients of dengue admitted to medical wards were included in the study. A detailed history as well as a general and systemic clinical examination were carried out. Haematological profiles and biochemical investigations were done at the time of admission and were followed daily or at times twice a day. Signs of plasma leakage were assessed by chest radiograph and abdominal ultrasonography, serum albumin etc. Patients were classified as dengue fever without warning signs and with warning signs and laboratory diagnosis of dengue was established by demonstration of NS1 antigen and specific antibodies to dengue in serum. Results: Of the 600 dengue positive patients, 421 (70.2%) were males and 179 (29.8%) were females. Mean age of the patients was 27.35±11.43 years. Among all patients of dengue, 21 (3.5%) presented with bleeding from any site. Out of these, only 7 of those presenting without warning signs had bleeding episodes whereas, 22 (34.3%) of patients presenting with warning signs had bleeding and this difference was statistically significant (p=0.01). Haematocrit was an important factor to predict severity of dengue. Whereas the mean haematocrit among all patients was 39.79±3.23%, it was 39.49±4.25% among those without warning signs and 42.22±3.54% among those with warning signs of dengue, and this was significant statistically, with a p-value of 0.002. Conclusion: Early diagnosis, monitoring and prompt supportive management can reduce mortality in dengue. In the present study, it was found that newer signs and symptoms are emerging and may cause delay in the diagnosis. It was found that the mortality rate was significantly higher in patients of dengue with warning sign.

Profile and risk factors for congenital heart defects: A study in a tertiary care hospital.

INTRODUCTION: Congenital heart defects (CHDs) are an important cause of mortality and morbidity in children representing a major global health burden. It is thus important to determine their prevalence and spectrum and identify risk factors associated with the development of heart defects. MATERIALS AND METHODS: A case-control study was carried out in the Department of Pediatrics and Center of Cardiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from February 2014 to August 2015. All patients referred with complaints or clinical examination suggestive of CHDs were further evaluated with echocardiography. On Echocardiography, patients having CHDs were included as cases and those having a normal echocardiographic study were included as controls. Healthy controls were also included. 400 cases and 400 controls were thus identified; preterms having patent ductus arteriosus and patent foramen ovale and those with acquired heart defects were excluded. Risk factors among cases and controls were further studied. RESULTS: Acyanotic heart defects were 290 (72.50%) of the total heart defects, whereas the contribution of cyanotic heart defects was 110 (27.50%). Out of all CHDs, ventricular septal defect was the most common lesion with contribution of 152 (38%) cases, whereas among the cyanotic heart defects, Tetralogy of Fallot was the most common lesion (18% of total cases). Out of the total 400 cases, 261 were males (65.25%). On univariate analysis, paternal age (odds ratio, OR, 2.01), bad obstetric history (OR, 2.65), antenatal febrile illness (OR, 4.12), and advanced maternal age (OR, 3.28) were found to increase the risk of CHD whereas intake of multivitamin (OR, 3.02) was found to be protective. The risk factors were further analyzed with multivariate logistic regression analysis and all the above factors were found to be significantly associated. CONCLUSION: We noted that the profile of CHD in our population was similar to the published literature although many were missed during infancy and detected later in life. Several antenatal factors were found to be associated with the incidence of congenital heart disease emphasizing the need to prioritize antenatal care and counseling to pregnant mothers along with good maternal nutrition and folic acid supplementation.

Prevalence of nonalcoholic fatty liver disease (NAFLD) in patients of cardiovascular diseases and its association with hs-CRP and TNF-α.

BACKGROUND: There is increasing recognition of association of nonalcoholic fatty liver disease (NAFLD) with cardiovascular disease (CVD). Metabolic syndrome is common in both NAFLD and cardiovascular diseases. Our study is designed to investigate the association of NAFLD with cardiovascular disease. METHODS: It's a cross-sectional study which included 104 patients of coronary artery disease and hypertensive heart disease. Those patients having secondary causes of steatosis were excluded. Complete cardiovascular evaluation which included assessment of metabolic syndrome, routine biochemistries, viral markers, Ultrasonography (USG) abdomen, hs-CRP and TNF-α levels were obtained for all patients. RESULTS: Of all patients with cardiovascular disease, 19.2% (20/104) had essential hypertension with hypertensive heart disease the remaining 80.8% (84/104) patients had ischemic heart disease (IHD). On USG 69.2% (72/104) had NAFLD, these 50% (36/72) had grade 1 NAFLD and the rest grade 2 NAFLD. The hs-CRP levels and TNF-α were significantly higher in patients with NAFLD (p-value <0.001) and within patients with NAFLD the levels were higher in patients with grade 2 NAFLD. Also, binary logistic regression showed that high body-mass index (BMI), raised serum triglyceride levels, increased waist circumference and hypertension were significantly associated with the presence of NAFLD. CONCLUSION: Our data indicates that NALD is highly prevalent in patients of cardiovascular disease (69.2%) and is significantly associated with metabolic syndrome and its individual components. The levels of hs-CRP and TNF-α were significantly higher in patients with NAFLD and showed an increasing trend with the severity of fatty liver.

Prognostic importance of admission versus persistent glycemia in acute coronary syndrome.

BACKGROUND: Whether persistent hyperglycemia (PG) during hospitalisation has a greater impact on adverse outcomes in acute myocardial infarction (AMI) than a single random glucose measurement is not well defined. AIMS: To find out the association of admission glycemia (AG) VS PG on outcomes in patients of ACS. STUDY DESIGN AND METHODS: Prospective, cohort, hospital-based. We evaluated 200 patients of ACS for admission and in-hospital glycemia and their impacts on outcomes. AG was defined as a plasma glucose >198 mg/dl and PG as a random glucose >140 mg/dl at any point during hospitalisation. Demographic and biochemistry including risk factors recorded. A multiple regression was done to evaluate association of various parameters with worse prognosis. RESULTS: Of the 200 patients evaluated, 35 (17.5%) presented with AG. 31 (15.5%) had PG. Males were predominant and 47 (23%) previously known diabetic patients. 62 (31%) had unstable angina, 52 (26%) NSTEMI and 86 (43%) STEMI, between PG and LEF, higher troponin levels and in-hospital mortality and between LEF and age (p<0.001), serum creatinine (p 0.023) and mean in-hospital glucose (p 0.005). F-indices were compared with AG for their ability to discriminate hospitalization survivors from non-survivors. All average glucose metrics performed better than AG. The ability of these models improved as the time window increased (F-indices for admission, mean 24h, 48 h and 72 h were 2.51, 12.05, 8.3 and 5.72, respectively). CONCLUSION: The present study demonstrates that PG is a better discriminator of prognosis than AG in patients of ACS.

A study of heart rate variability and QT dispersion in patients of acute ST elevation myocardial infarction.

AIMS AND OBJECTIVES: To study the effect of Heart Rate Variability (HRV) and QT dispersion (QTd) in patients presenting with acute ST elevation myocardial infarction (STEMI). METHODS: 100 patients of Acute myocardial infarction (AMI) were evaluated by history and examination. Electrocardiogram (ECG) and Holter monitoring was done in all patients. HRV, QTd, Standard Deviation of the mean RR interval (SDNN) and Standard Deviation of the average of RR interval measured every five minutes during 24 hr (SDANN) were calculated. Results were statistically analyzed using Student 't' test, Paired 't' test and Pearson's formula. RESULTS: The most common presenting symptoms were chest pain (88%) and dyspnoea (50%). Tachycardia was seen in 565 while congestive heart failure was present in 29% patients. Mean SDNN was 61.4 +/- 24.4 ms and SDANN was 50 +/- 18.2 ms. HRV values were significantly decreased while QTd was higher in patients who died in comparison to patients who survived. A strong negative correlation was seen between HRV and QTd. CONCLUSIONS: Markers of autonomic regulation of heart like HRV and QTd provide valuable information about the future course of events in a patient following acute STEMI which can be utilized to plan the future course of management in patients especially predisposed to adverse and catastrophic outcomes.

Guillain Barré syndrome following herpes zoster: a case report and review of literature.

Herpes zoster is known to exhibit various neurological complications. Guillain Barré syndrome following herpes zoster is rare and only 25 cases have been reported to date. In this report, a case is presented and the pertinent literature is reviewed.