Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
J Assoc Physicians India ; 69(4): 11-12, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34470187

RESUMO

OBJECTIVE: Guidelines recommend prescription of statins in all high-risk patients with hypertension irrespective of their cholesterol levels. We performed a prescription audit in India to determine the application of recommendations. METHODS: A registry-based audit of patients with primary diagnosis of hypertension (n=3073) was performed. Details of co-morbidities and medications were obtained. Patients with known vascular disease were excluded. Patients were classified into subgroups based on risk factors and type of therapy. A multivariate model of risk was developed using clinical data and patients were classified into low, moderate and high risk. Statin prescriptions were divided into low, medium and high intensity based on US guidelines. Descriptive statistics are reported. RESULTS: Mean age of patients was 59±13 years, 47 % were women and 26 % were less than 50 years age. Diabetes was noted in 31.1 %, current smoking in 1.3 %, obesity in 14.7 % and hypothyroidism in 7.9 %. Statins were prescribed in 41.2 % (95% CI 39.4-42.9%), more in men compared to women (47.7% vs 33.7%, p<0.001). Most of the patients received moderate intensity statins (83.9%). In age-groups >40, 40-59, 60-79 and 80+ years, statins were prescribed in 18.7%, 36.5%, 49.5% and 49.4% respectively (ptrend <0.001). Statins were prescribed in 52.0% diabetics, 60.9% obese, 52.5% smokers and 34.8% hypothyroid. In the multivariate model statins use in low, medium and high risk patients was 28.4%, 46.6% and 55.1% respectively (ptrend <0.001). CONCLUSION: In an Indian secondary care practice only half of patients with moderate to high risk uncomplicated hypertension receive statins.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hipertensão , Adulto , Idoso , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prescrições , Fatores de Risco
2.
Diabetes Metab Syndr ; 15(1): 343-350, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503583

RESUMO

BACKGROUND & AIMS: Greater COVID-19 related mortality has been reported among persons with various non-communicable diseases (NCDs). We performed an ecological study to determine the association of state-level cases and deaths with NCD risk factors and healthcare and social indices. METHODS: We obtained cumulative national and state-level data on COVID-19 cases and deaths from publicly available database www.covid19india.org from February to end November 2020. To identify association with major NCD risk factors, NCDs, healthcare related and social variables we obtained data from public sources. Association was determined using univariate and multivariate statistics. RESULTS: More than 9.5 million COVID-19 cases and 135,000 deaths have been reported in India towards end of November 2020. There is significant positive correlation (Pearson r) of state-level COVID-19 cases and deaths per million, respectively, with NCD risk factors- obesity (0.64, 0.52), hypertension (0.28, 0.16), diabetes (0.66, 0.46), NCD epidemiological transition index (0.58, 0.54) and ischemic heart disease mortality (0.22, 0.33). Correlation is also observed with indices of healthcare access and quality (0.71, 0.61), urbanization (0.75, 0.73) and human (0.61, 0.56) and sociodemographic (0.70, 0.69) development. Multivariate adjusted analyses shows strong correlation of COVID-19 burden and deaths with NCD risk factors (r2 = 0.51, 0.43), NCDs (r2 = 0.32, 0.16) and healthcare (r2 = 0.52, 0.38). CONCLUSIONS: COVID-19 disease burden and mortality in India is ecologically associated with greater state-level burden of NCDs and risk factors, especially obesity and diabetes.


Assuntos
COVID-19/epidemiologia , Efeitos Psicossociais da Doença , Doenças não Transmissíveis/epidemiologia , COVID-19/diagnóstico , COVID-19/terapia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Índia/epidemiologia , Doenças não Transmissíveis/terapia , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/terapia , Fatores de Risco
3.
J Assoc Physicians India ; 67(12): 14-17, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31801323

RESUMO

Background: Hypertension is highly prevalent in India but frequency of resistant hypertension has not been well studied. Methods: We performed a registry-based study at a single center in patients with primary diagnosis of hypertension (n=3073). Details of co-morbidities, medications and blood pressure (BP) control were obtained. Patients with coronary heart disease, cerebrovascular disease and chronic kidney disease were excluded. Resistant hypertension was defined as uncontrolled hypertension (BP ≥140/90) with use of 3 drugs of which one was a diuretic, or any 4 drugs. Results: Mean age of patients was 59±13 years, 47% were women and 26% <50y age. Diabetes was in 31.1%, hypothyroidism in 7.9% and chronic obstructive lung disease in 4.3%. The drugs prescribed were angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) in 61.5%, beta blockers in 49.8%, dihydropyridine calcium channel blockers (CCB) in 46.8%, ARB in 44.4%, diuretics in 32.1% ACEi in 13.4%, other CCBs in 2.6% and mineralocorticoid receptor antagonists (MRA) in 1.1%. One antihypertensive drug was prescribed in 27.4%, two in 41.2%, three in 18.6% and four or more in 5.4%. Prevalence of resistant hypertension using standard definition was 19.4% (95% confidence interval, CI, 18.0-20.8%). It was more in women (23.5%) vs men (15.7%) (p<0.001). Using the alternate definition the prevalence was 6.3% (95% CI 5.3-7.0%) and also more in women (6.9%) vs men (5.4%). Resistant hypertension was more common in patients >60 years (odds ratio 1.36, 95% CI 1.18-1.58) and women (odds ratio 1.64, 95% CI 1.37-1.97). Conclusion: Prevalence of resistant hypertension is high in a secondary-care practice in India. It is significantly greater among older patients and women.


Assuntos
Hipertensão , Idoso , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos , Bloqueadores dos Canais de Cálcio , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade
4.
Indian Heart J ; 70 Suppl 3: S419-S430, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30595301

RESUMO

Global Burden of Disease study has reported that cardiovascular and ischemic heart disease (IHD) mortality has increased by 34% in last 25 years in India. It has also been reported that despite having lower coronary risk factors compared to developed countries, incident cardiovascular mortality, cardiovascular events and case-fatality are greater in India. Reasons for the increasing trends and high mortality have not been studied. There is evidence that social determinants of IHD risk factors are widely prevalent and increasing. Epidemiological studies have reported low control rates of hypertension, hypercholesterolemia, diabetes and smoking/tobacco. Registries have reported greater mortality of acute coronary syndrome in India compared to developed countries. Secondary prevention therapies have significant gaps. Low quality cardiovascular care is an important risk factor in India. Package of interventions focusing on fiscal, intersectoral and public health measures, improvement of health services at community, primary and secondary healthcare levels and appropriate referral systems to specialized hospitals is urgently required.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Prevenção Secundária/métodos , Doença da Artéria Coronariana/prevenção & controle , Humanos , Incidência , Índia/epidemiologia , Fatores de Risco , Taxa de Sobrevida/tendências
5.
J Assoc Physicians India ; 66(12): 20-26, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31315319

RESUMO

Objective: Non-communicable diseases (NCDs) are the new epidemic in India. District-specific prevalence of various NCD risk factors and their macrolevel determinants is unknown. We used National Family Health Survey-4 (NFHS-4) data to map the syndemics of obesity, hypertension and hyperglycemia in Rajasthan, the largest state of the country, and correlated their prevalence with selected social determinants of health- urbanization, human development index (HDI) and literacy. Methodology: Data on location-adjusted prevalence of various NCD risk factors among women (15-49y) and men (15-54y) were obtained from NFHS-4 data sheets. Heat maps were created to determine geographic distribution of obesity (body mass index, BMI ≥25 kg/m2), hypertension (known and/or BP ≥140/≥90 mmHg) and hyperglycemia (random glucose >140 mg/dl) in all the districts (n=33). We determined correlation of various social determinants with NCD risk factors. Results: Significant geographic variation was observed in prevalence of obesity, hypertension and hyperglycemia in women and men. High prevalence of obesity and hypertension was observed in central and northwestern districts of the state. In women and men respectively, there was a significant positive correlation of obesity with urbanization (r=0.68, 0.51), HDI (r=0.70, 0.66) and female literacy (r=0.46, 0.34). Prevalence of hypertension also showed significant correlation with urbanization (r=0.18, 0.33), HDI (r=0.38, 0.52) and literacy (r=0.32, 0.21) while no correlation was observed with hyperglycemia. Conclusion: There is significant geographic variation in prevalence of obesity, hypertension and hyperglycemia in Rajasthan. Significant correlation of obesity and hypertension with urbanization, human development and female literacy is observed..


Assuntos
Hiperglicemia/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Alfabetização , Masculino , Prevalência , Fatores de Risco , Sindemia , Urbanização/tendências
6.
BMJ Open Diabetes Res Care ; 4(1): e000275, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27648292

RESUMO

BACKGROUND: Contemporary treatment guidelines advise statin use in all patients with diabetes for reducing coronary risk. Use of statins in patients with type 2 diabetes has not been reported from India. METHODS: We performed a multisite (n=9) registry-based study among internists (n=3), diabetologists (n=3), and endocrinologists (n=3) across India to determine prescriptions of statins in patients with type 2 diabetes. Demographic and clinical details were obtained and prescriptions were audited for various medications with a focus on statins. Details of type of statin and dosage form (low, moderate, and high) were obtained. Patients were divided into categories based on presence of cardiovascular risk into low (no risk factors, n=1506), medium (≥1 risk factor, n=5425), and high (with vascular disease, n=1769). Descriptive statistics are presented. RESULTS: Prescription details were available in 8699 (men 5292, women 3407). Statins were prescribed in 55.2% and fibrates in 9.2%. Statin prescription was significantly greater among diabetologists (64.4%) compared with internists (n=53.3%) and endocrinologists (46.8%; p<0.001). Atorvastatin was prescribed in 74.1%, rosuvastatin in 29.2%, and others in 3.0%. Statin prescriptions were lower in women (52.1%) versus men (57.2%; p<0.001) and in patients aged <40 years (34.3%), versus those aged 40-49 (49.7%), 50-59 (60.1%), and ≥60 years (62.2%; p<0.001). Low-dose statins were prescribed in 1.9%, moderate dose in 85.4%, and high dose in 12.7%. Statin prescriptions were greater in the high-risk group (58.0%) compared with those in the medium-risk (53.8%) and low-risk (56.8%) groups (p <0.001). High-dose statin prescriptions were similar in the high-risk (14.5%), medium-risk (11.8%), and low-risk (13.5%) groups (p=0.31). CONCLUSIONS: Statins are prescribed in only half of the clinic-based patients in India with type 2 diabetes. Prescription of high-dose statins is very low.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...