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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.
J Am Coll Cardiol ; 76(6): 703-714, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32762905

RESUMO

BACKGROUND: Genome-wide polygenic scores (GPS) integrate information from many common DNA variants into a single number. Because rates of coronary artery disease (CAD) are substantially higher among South Asians, a GPS to identify high-risk individuals may be particularly useful in this population. OBJECTIVES: This analysis used summary statistics from a prior genome-wide association study to derive a new GPSCAD for South Asians. METHODS: This GPSCAD was validated in 7,244 South Asian UK Biobank participants and tested in 491 individuals from a case-control study in Bangladesh. Next, a static ancestry and GPSCAD reference distribution was built using whole-genome sequencing from 1,522 Indian individuals, and a framework was tested for projecting individuals onto this static ancestry and GPSCAD reference distribution using 1,800 CAD cases and 1,163 control subjects newly recruited in India. RESULTS: The GPSCAD, containing 6,630,150 common DNA variants, had an odds ratio (OR) per SD of 1.58 in South Asian UK Biobank participants and 1.60 in the Bangladeshi study (p < 0.001 for each). Next, individuals of the Indian case-control study were projected onto static reference distributions, observing an OR/SD of 1.66 (p < 0.001). Compared with the middle quintile, risk for CAD was most pronounced for those in the top 5% of the GPSCAD distribution-ORs of 4.16, 2.46, and 3.22 in the South Asian UK Biobank, Bangladeshi, and Indian studies, respectively (p < 0.05 for each). CONCLUSIONS: The new GPSCAD has been developed and tested using 3 distinct South Asian studies, and provides a generalizable framework for ancestry-specific GPS assessment.


Assuntos
Doença da Artéria Coronariana/genética , Estudo de Associação Genômica Ampla , Herança Multifatorial , Adulto , Idoso , Bangladesh , Estudos de Casos e Controles , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade
3.
Lung India ; 37(2): 100-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32108592

RESUMO

Background: Respiratory disorders are important contributors to disease burden across the world. The aim is to assess the proportionate burden of types of respiratory diseases and their seasonal patterns in India we are performing a field study. The present report describes methodological aspects of a respiratory disease point prevalence survey from India. Methods: A total of 4108 chest physicians were invited. Acceptance was received from 420 sites. Chest physicians were classified according to location of practice one as medical college, district government hospital, private hospital, and private clinics. Qualifications of practicing chest physicians were postgraduate in chest medicine, including Doctorate of Medicine (68.4%), diploma in chest medicine (22.1%), and Postgraduate in Medicine (9.5%). The study questionnaire was designed to record demographic data, comorbidities, risk factors, and respiratory conditions based on ICD-10. Results: A total of 366 sites provided baseline data, and the response rate of recruitment of the study sites was 8.9% in the baseline phase. However, government and private medical colleges, as well as government and private hospitals across India, were part of recruitment of respiratory patients for this survey. Conclusions: It is feasible to conduct a large multisite study to assess respiratory disease burden. Challenges include low response rate and logistic issues.

4.
Indian Heart J ; 70 Suppl 3: S221-S223, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30595262

RESUMO

BACKGROUND: About 40-50% of patients undergoing coronary artery bypass graft (CABG) surgery have diabetes. The prevalence of impaired glucose tolerance (IGT) is also high in this group, however, incidence of new diabetes following CABG surgery is unknown. OBJECTIVES: To determine incidence of new diabetes and the impact on ICU and hospital stay in patients undergoing CABG surgery in India, we performed a registry-based study. METHODS: Prospectively collected data among consecutive adult cardiac surgical patients who underwent CABG surgery at a single hospital were analyzed. Descriptive statistics are reported. RESULTS: We recruited 1559 consecutive patients (men 1355, women 204) and analyzed data among 933 non-diabetic patients. Patients with known diabetes (n = 626, 40%) were excluded. 57 (6.1%) of the 933 non-diabetic patients developed persistently high glucose levels at discharge with incidence rate of 61 + 5/1000. Patients who developed diabetes had similar age and body mass index vs those who did not, but had greater preoperative IGT (44.6 vs 13.7%) and more time-period in intensive care unit (102.0 + 75 vs 80.2 + 29 hours) as well as in hospital (11.7 + 5.7 vs 9.6 + 2.4 days) (p < 0.001). CONCLUSION: In a significant proportion of non-diabetic patients diabetes is unmasked after CABG. This is more likely in those with impaired glucose tolerance and prolonged period in intensive care and hospital.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus/epidemiologia , Complicações Pós-Operatórias , Sistema de Registros , Doença da Artéria Coronariana/complicações , Diabetes Mellitus/etiologia , Feminino , Humanos , Incidência , Índia/epidemiologia , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
5.
Indian Heart J ; 68(6): 832-840, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27931556

RESUMO

OBJECTIVE: To evaluate usefulness of non-physician health workers (NPHW) to improve adherence to medications and lifestyles following acute coronary syndrome (ACS). METHODS: We randomized 100 patients at hospital discharge following ACS to NPHW intervention (n=50) or standard care (n=50) in an open label study. NPHW was trained for interventions to improve adherence to medicines - antiplatelets, ß-blockers, renin-angiotensin system (RAS) blockers and statins and healthy lifestyles. Intervention lasted 12 months with passive follow-up for another 12. Both groups were assessed for adherence using a standardized questionnaire. RESULTS: ST elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 51, mean age was 59.0±11 years. 57% STEMI were thrombolyzed. On admission majority were physically inactive (71%), consumed unhealthy diets (high fat 77%, high salt 58%, low fiber 57%) and 21% were smokers/tobacco users. Coronary revascularization was performed in 90% (percutaneous intervention 79%, bypass surgery 11%). Drugs at discharge were antiplatelets 100%, ß-blockers 71%, RAS blockers 71% and statins 99%. Intervention and control groups had similar characteristics. At 12 and 24 months, respectively, in intervention vs control groups adherence (>80%) was: anti platelets 92.0% vs 77.1% and 83.3% vs 40.9%, ß blockers 97.2% vs 90.3% and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 89.5% vs 46.1%, and statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 0.0% vs 12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and 37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p<0.01 for all). Intervention vs standard group at 12 months had significantly lower mean systolic BP, heart rate, body mass index, waist:hip ratio, total cholesterol, triglyceride, and LDL cholesterol (p<0.01). CONCLUSIONS: NPHW-led educational intervention for 12 months improved adherence to evidence based medicines and healthy lifestyles. Efficacy continued for 24 months with attrition.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Agentes Comunitários de Saúde , Estilo de Vida Saudável , Adesão à Medicação/estatística & dados numéricos , Prevenção Secundária/métodos , Síndrome Coronariana Aguda/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
6.
Indian Heart J ; 68 Suppl 2: S202-S206, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27751289

RESUMO

We present a patient with asymptomatic apical hypertrophic cardiomyopathy (AHCM) who recently developed cardiac arrhythmias, and shortly discuss the diagnostic modalities, differential diagnosis, and treatment strategy for this condition. AHCM is a rare form of hypertrophic cardiomyopathy, which usually involves the apex of the left ventricle. AHCM can occur with varied presentations such as chest pain, palpitations, dyspnea, syncope, atrial fibrillation, myocardial infarction, embolic events, ventricular fibrillation, and congestive heart failure. The most peculiar electrocardiogram findings are giant T-waves inversion in the precordial leads with left ventricular (LV) hypertrophy. A transthoracic echocardiogram is the initial diagnostic modality in the evaluation of AHCM and shows hypertrophy of the LV apex. Other diagnostic modalities, including left ventriculography, multislice spiral computed tomography, and cardiac magnetic resonance imagings, are also valuable tools. Medications used to manage include verapamil, beta-blockers, and antiarrhythmic agents. An implantable cardioverter defibrillator (ICD) is recommended for high-risk patients.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Hemodinâmica/fisiologia , Taquicardia Ventricular/etiologia , Idoso , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/terapia , Desfibriladores Implantáveis , Ecocardiografia , Humanos , Masculino , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Tomografia Computadorizada por Raios X
7.
Indian J Endocrinol Metab ; 20(3): 354-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27186553

RESUMO

OBJECTIVES: To compare clinical characteristics, treatment, and utilization of evidence-based medicines at discharge from hospital in acute coronary syndrome (ACS) patients with or without diabetes at a tertiary care cardiac center in India. METHODS: We performed an observational study in consecutive patients discharged following management of ACS. We obtained demographic details, comorbid conditions, and cardiovascular risk factors, physical and biochemical parameters, and management. Descriptive statistics are reported. RESULTS: We enrolled 100 patients (diabetics = 28) with mean age of 59.0 ± 10.8 years (diabetics 59.3 ± 11.6, nondiabetics 58.9 ± 8.5). Forty-nine patients had ST-elevation myocardial infarction (STEMI) (diabetics = 14, 28.7%) while 51 had nonSTEMI/unstable angina (diabetics = 14, 27.4%) (P = nonsignificant). Among diabetics versus nondiabetics there was greater prevalence (%) of hypertension (78.6% vs. 44.4%), obesity (25.0% vs. 8.3%), abdominal obesity (85.7% vs. 69.4%) and sedentary activity (89.2% vs. 77.8%), and lower prevalence of smoking/tobacco use (10.7% vs. 25.0%) (P < 0.05). In STEMI patients 28 (57.1%) were thrombolysed (diabetes 17.8% vs. 31.9%), percutaneous coronary interventions (PCI) was in 67.8% diabetics versus 84.7% nondiabetics and coronary bypass surgery in 21.4% versus 8.3%. At discharge, in diabetics versus nondiabetics, there was similar use of angiotensin converting enzyme inhibitors (67.9% vs. 69.4%) and statins (100.0% vs. 98.6%) while use of dual antiplatelet therapy (85.7% vs. 95.8%) and beta-blockers (64.3% vs. 73.6%) was lower (P < 0.05). CONCLUSIONS: Diabetic patients with ACS have greater prevalence of cardiometabolic risk factors (obesity, abdominal obesity, and hypertension) as compared to nondiabetic patients. Less diabetic patients undergo PCIs and receive lesser dual anti-platelet therapy and beta-blockers.

8.
Indian J Endocrinol Metab ; 20(2): 211-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27042418

RESUMO

OBJECTIVE: To determine gender differences and secular trends in total, low-density lipoprotein (LDL) and high DL (HDL) cholesterol and triglycerides using a large hospital database in India. METHODS: All blood lipid tests evaluated from July 2007 to December 2014 were analyzed. Details of gender and age were available. Statin therapy was obtained at two separate periods. Trends were calculated using linear regression and Mantel-Haenszel X(2). RESULTS: Data of 67395 subjects (men 49,904, women 17,491) aged 51 ± 12 years were analyzed. Mean levels (mg/dl) were total cholesterol 174.7 ± 45, LDL cholesterol 110.7 ± 38, non-HDL cholesterol 132.1 ± 44.8, HDL cholesterol 44.1 ± 10, triglycerides 140.8 ± 99, and total: HDL cholesterol 4.44 ± 1.5. Various dyslipidemias in men/women were total cholesterol ≥200 mg/dl 25.4/36.4%, LDL cholesterol ≥130 mg/dl 28.1/35.0% and ≥100 mg/dl 54.4/66.4%, non-HDL cholesterol ≥160 mg/dl 25.5/29.6%, HDL cholesterol <40/50 mg/dl 54.4/64.4%, and triglycerides ≥150 mg/dl 34.0/26.8%. Cholesterol lipoproteins declined over 7 years with greater decline in men versus women for cholesterol (Blinear regression = -0.82 vs. -0.33, LDL cholesterol (-1.01 vs. -0.65), non-HDL cholesterol (-0.88 vs. -0.52), and total: HDL cholesterol (-0.02 vs. -0.01). In men versus women there was greater decline in prevalence of hypercholesterolemia (X(2) trend 74.5 vs. 1.60), LDL cholesterol ≥130 mg/dl (X(2) trend 415.5 vs. 25.0) and ≥100 mg/dl (X(2) trend 501.5 vs. 237.4), non-HDL cholesterol (X(2) trend 77.4 vs. 6.85), total: HDL cholesterol (X(2) trend 212.7 vs. 10.5) and high triglycerides (X(2) trend 10.8 vs. 6.15) (P < 0.01). Use of statins was in 2.6% (36/1405) in 2008 and 9.0% (228/2527) in 2014 (P < 0.01). Statin use was significantly lower in women (5.8%) than men (10.3%). CONCLUSIONS: In a large hospital - database we observed greater hypercholesterolemia and low HDL cholesterol in women. Mean levels and prevalence of high total, LDL, non-HDL and total: HDL cholesterol declined over 7 years. A lower decline was observed in women. This was associated with lower use of statins.

9.
PLoS One ; 11(2): e0149437, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26881429

RESUMO

OBJECTIVE: Urbanization is an important determinant of cardiovascular disease (CVD) risk. To determine location-based differences in CVD risk factors in India we performed studies among women in rural, urban-poor and urban middle-class locations. METHODS: Population-based cross-sectional studies in rural, urban-poor, and urban-middle class women (35-70 y) were performed at multiple sites. We evaluated 6853 women (rural 2616, 5 sites; urban-poor 2008, 4 sites; urban middle-class 2229, 11 sites) for socioeconomic, lifestyle, anthropometric and biochemical risk factors. Descriptive statistics are reported. RESULTS: Mean levels of body mass index (BMI), waist circumference, waist-hip ratio (WHR), systolic BP, fasting glucose and cholesterol in rural, urban-poor and urban-middle class women showed significantly increasing trends (ANOVAtrend, p <0.001). Age-adjusted prevalence of diabetes and risk factors among rural, urban-poor and urban-middle class women, respectively was, diabetes (2.2, 9.3, 17.7%), overweight BMI ≥25 kg/m2 (22.5, 45.6, 57.4%), waist >80 cm (28.3, 63.4, 61.9%), waist >90 cm (8.4, 31.4, 38.2%), waist hip ratio (WHR) >0.8 (60.4, 90.7, 88.5), WHR>0.9 (13.0, 44.3, 56.1%), hypertension (31.6, 48.2, 59.0%) and hypercholesterolemia (13.5, 27.7, 37.4%) (Mantel Haenszel X2 ptrend <0.01). Inverse trend was observed for tobacco use (41.6, 19.6, 9.4%). There was significant association of hypertension, hypercholesterolemia and diabetes with overweight and obesity (adjusted R2 0.89-0.99). CONCLUSIONS: There are significant location based differences in cardiometabolic risk factors in India. The urban-middle class women have the highest risk compared to urban-poor and rural.


Assuntos
Doenças Cardiovasculares/epidemiologia , Disparidades nos Níveis de Saúde , Síndrome Metabólica/epidemiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Antropometria , Cidades , Intervalos de Confiança , Gorduras na Dieta , Feminino , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
10.
PLoS One ; 11(1): e0145730, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26808523

RESUMO

Insulin resistance (IR) and type 2 diabetes mellitus (T2DM) have been found to be associated with postprandial hypertriglyceridemia (PPHTg). However, whether PPHTg can cause IR and diabetes is not clear. We therefore investigated the role of PPHTg in development of T2DM in rat model of T2DM. 96 male Wistar rats were randomized into four groups (24 rats each). Control Group A, high sucrose diet (HSD) Group B, HSD+Pioglitazone (10 mg/kg/day) Group C and HSD+Atorvastatin (20 mg/kg/day) Group D. Fat and glucose tolerance tests were done at regular intervals in all groups besides insulin and body weight measurement. At 26 weeks, low dose streptozotocin (15 mg/kg, i.p.) was given to half of the rats. All rats were followed up till 48 weeks. PPHTg developed as early as week 2 in Group B and stabilized by week 14. Group B displayed highest PPHTg compared to other groups. Atorvastatin treatment (Group D) abolished PPHTg which became comparable to controls, pioglitazone treatment partially blunted PPHTg resulting in intermediate PPHTg. Group B with highest PPHTg showed highest subsequent IR, glucose intolerance (GI) and highest incidence of prediabetes at week 26 and diabetes at week 34 and 46 compared to other groups. Group D rats displayed lower IR, GI, low incidence of prediabetes and diabetes at these time points compared to Groups B and C. ROC analysis showed that triglyceride area under the curve of each time point significantly predicts the risk of diabetes. Present study provides the evidence that PPHTg predicts the development of IR, GI and T2DM in rat model of diet induced T2DM.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Gorduras na Dieta/toxicidade , Sacarose na Dieta/toxicidade , Intolerância à Glucose/etiologia , Hipertrigliceridemia/complicações , Resistência à Insulina , Período Pós-Prandial , Estado Pré-Diabético/fisiopatologia , Animais , Atorvastatina/uso terapêutico , Glicemia/análise , Peso Corporal , Causalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Progressão da Doença , Intolerância à Glucose/fisiopatologia , Teste de Tolerância a Glucose , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertrigliceridemia/tratamento farmacológico , Hipertrigliceridemia/fisiopatologia , Hipoglicemiantes/uso terapêutico , Gordura Intra-Abdominal/patologia , Lipídeos/sangue , Fígado/química , Fígado/patologia , Masculino , Pâncreas/patologia , Pioglitazona , Estado Pré-Diabético/tratamento farmacológico , Distribuição Aleatória , Ratos , Ratos Wistar , Tiazolidinedionas/uso terapêutico
11.
Indian J Endocrinol Metab ; 19(6): 775-80, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26693427

RESUMO

OBJECTIVE: To determine the association of educational status (ES), as marker of socioeconomic status, with the prevalence of microvascular complications in diabetes. METHODS: Successive patients (n = 1214) presenting to our center were evaluated for sociodemographic, anthropometric, clinical, and therapeutic variables. Subjects were classified according to ES into Group 1 (illiterate, 216); Group 2 (≤ primary, 537), Group 3 (≤ higher secondary, 312), and Group 4 (any college, 149). Descriptive statistics is reported. RESULTS: Mean age of patients was 52 ± 10 years, duration of diabetes 7 ± 7 years and 55% were men. Prevalence of various risk factors was smoking/tobacco 25.5%, obesity body mass index ≥25 kg/m(2) 64.0%, abdominal obesity 63.4%, hypertension 67.5%, high fat diet 14.5%, low fruits/vegetables 31.8%, low fiber intake 60.0%, high salt diet 16.9%, physical inactivity 27.5%, coronary or cerebrovascular disease 3.0%, and microvascular disease (peripheral, ocular or renal) in 20.7%. Microvascular disease was significantly greater in illiterate (25.9%) and low (23.6%) compared to middle (15.0%) and high (14.7%) ES groups (P < 0.05). Age- and sex-adjusted logistic regression analysis revealed that in illiterate and low ES groups respectively, prevalence of smoking/tobacco use (odds ratio 3.84, confidence interval: 09-7.05 and 2.15, 1.36-3.41); low fruit/vegetable (2.51, 1.53-4.14 and 1.99, 1.30-3.04) and low fiber intake (4.02, 2.50-6.45 and 1.78, 1.23-2.59) was greater compared to high ES. Poor diabetes control (HbA1c >.0%) was significantly greater in illiterate (38.0%), low (46.0%), and middle (41.0%) compared to high (31.5%) ES subjects (P < 0.05). CONCLUSIONS: There is a greater prevalence of the microvascular disease in illiterate and low ES diabetes patients in India. This is associated with the higher prevalence of smoking/tobacco use, poor quality diet, and sub-optimal diabetes control.

12.
Indian J Endocrinol Metab ; 19(5): 667-72, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26425480

RESUMO

OBJECTIVE: To determine the association of educational status (ES), as a marker of socioeconomic status, with the prevalence of microvascular complications in diabetes. METHODS: Successive patients (n = 1214) presenting to our centre were evaluated for sociodemographic, anthropometric, clinical, and therapeutic variables. Subjects were classified according to ES into Group 1 (illiterate, 216); Group 2 (8.0%) was significantly greater in illiterate (38.0%), low (46.0%) and middle (41.0%) compared to high (31.5%) ES subjects (P < 0.05). CONCLUSIONS: There is a greater prevalence of the microvascular disease in illiterate and low ES diabetes patients in India. This is associated with the higher prevalence of smoking/tobacco use, poor quality diet and sub-optimal diabetes control.

13.
Indian Heart J ; 67(4): 347-50, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26304567

RESUMO

BACKGROUND: Agarwal is one of the largest business communities in India. To determine prevalence of cardiovascular risk factors and their distribution according to educational status (ES) in this community we performed a study. METHODS: 1781 (men 1039, women 742) of 2500 selected subjects (71.2%) were evaluated and fasting blood sample obtained in 1130. RESULTS: Age-adjusted prevalence of risk factors was tobacco use 12.2%, sedentary habits 54.2%, overweight/obesity 54.4%, obesity 19.5%, abdominal obesity 61.2%, hypertension 36.0%, diabetes 19.2%, hypercholesterolemia ≥200 mg/dl 25.8%, low HDL cholesterol 29.2%, hypertriglyceridemia 32.8% and metabolic syndrome 22.3%. Low ES subjects had significantly greater prevalence of sedentary habits, low fruit/vegetable intake, hypertension, low HDL cholesterol and diabetes. CONCLUSIONS: Cardiometabolic risk factors are highly prevalent in the Agarwal business community. Prevalence is greater in subjects with low educational status.


Assuntos
Doenças Cardiovasculares/epidemiologia , Estilo de Vida , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Medição de Risco/métodos , Fumar/efeitos adversos , População Urbana , Adulto , Distribuição por Idade , Doenças Cardiovasculares/etiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Prevalência , Fumar/epidemiologia
14.
J Glob Health ; 5(1): 010411, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25969733

RESUMO

OBJECTIVE: To determine epidemiology of cardiovascular risk factors according to geographic distribution and macrolevel social development index among urban middle class subjects in India. METHODS: We performed cross-sectional surveys in 11 cities in India during years 2005-2009. 6198 subjects aged 20-75 years (men 3426, women 2772, response 62%) were evaluated for cardiovascular risk factors. Cities were grouped according to geographic distribution into northern (3 cities, n = 1321), western (2 cities, n = 1814), southern (3 cities, n = 1237) and eastern (3 cities, n = 1826). They were also grouped according to human social development index into low (3 cities, n = 1794), middle (5 cities, n = 2634) and high (3 cities, n = 1825). Standard definitions were used to determine risk factors. Differences in risk factors were evaluated using χ(2) test. Trends were examined by least squares regression. FINDINGS: Age-adjusted prevalence (95% confidence intervals) of various risk factors was: low physical activity 42.1% (40.9-43.3), high dietary fat 49.9% (47.8-52.0), low fruit/vegetables 26.9% (25.8-28.0), smoking 10.1% (9.1-11.1), smokeless tobacco use 9.8% (9.1-10.5), overweight 42.9% (41.7-44.1), obesity 11.6% (10.8-12.4), high waist circumference 45.5% (44.3-46.7), high waist-hip ratio 75.7% (74.7-76.8), hypertension 31.6% (30.4-32.8), hypercholesterolemia 25.0% (23.9-26.9), low HDL cholesterol 42.5% (41.3-43.7), hypertriglyceridemia 36.9% (35.7-38.1), diabetes 15.7% (14.8-16.6), and metabolic syndrome 35.7% (34.5-36.9). Compared with national average, prevalence of most risk factors was not significantly different in various geographic regions, however, cities in eastern region had significantly lower prevalence of overweight, hypertension, hypercholesterolemia, diabetes and metabolic syndrome compared with other regions (P < 0.05 for various comparisons). It was also observed that cities with low human social development index had lowest prevalence of these risk factors in both sexes (P < 0.05). CONCLUSIONS: Urban middle-class men and women in eastern region of India have significantly lower cardiometabolic risk factors compared to northern, western and southern regions. Low human social development index cities have lower risk factor prevalence.

15.
Heart Asia ; 7(1): 1-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-27326202

RESUMO

OBJECTIVE: To determine association of socioeconomic status, defined by educational status (ES), with awareness, treatment and control of cardiovascular risk factors. METHODS: We performed an epidemiological study at 11 cities in India using cluster sampling. 6198 subjects (3426 men, 2772 women, response 62%, age 48±10 years) were evaluated for sociodemographic, lifestyle, anthropometric and biochemical factors. ES was categorised according to years of schooling into low (≤10 years), medium (11-15 years) and high (>15 years). Risk factors were diagnosed according to current guidelines. Awareness, treatment and control status were determined for hypertension, diabetes and hypercholesterolaemia. For smoking/tobacco use, quit rate was determined. Descriptive statistics are reported. RESULTS: Age-adjusted and sex-adjusted prevalence (%) of various risk factors in low, medium and high ES subjects was hypertension 31.8, 29.5 and 34.1, diabetes 14.5, 15.3 and 14.3, hypercholesterolaemia 24.0, 23.9 and 27.3, and smoking/tobacco use 24.3, 14.4 and 19.0. Significantly increasing trends with low, medium and high ES were observed for hypertension awareness (30.7, 37.8, 47.0), treatment (24.3, 29.2, 35.5) and control (7.8, 11.6, 15.5); diabetes awareness (47.2, 51.5, 56.4), treatment (38.3, 41.3, 46.0) and control (18.3, 15.3, 22.8); hypercholesterolaemia awareness (8.9, 22.4, 18.4), treatment (4.1, 6.2, 7.9) and control (2.8, 3.2, 6.9), as well as for smoking/tobacco quit rates (1.6, 2.8, 5.5) (χ(2) for trend, p<0.05). CONCLUSIONS: Low ES subjects in India have lower awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia and smoking quit rates.

16.
BMJ Open Diabetes Res Care ; 2(1): e000048, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25489485

RESUMO

OBJECTIVES: To determine the prevalence of diabetes and awareness, treatment and control of cardiovascular risk factors in population-based participants in India. METHODS: A study was conducted in 11 cities in different regions of India using cluster sampling. Participants were evaluated for demographic, biophysical, and biochemical risk factors. 6198 participants were recruited, and in 5359 participants (86.4%, men 55%), details of diabetes (known or fasting glucose >126 mg/dL), hypertension (known or blood pressure >140/>90 mm Hg), hypercholesterolemia (cholesterol >200 mg/dL), low high-density lipoprotein (HDL) cholesterol (men <40, women <50 mg/dL), hypertriglyceridemia (>150 mg/dL), and smoking/tobacco use were available. Details of awareness, treatment, and control of hypertension and hypercholesterolemia were also obtained. RESULTS: The age-adjusted prevalence (%) of diabetes was 15.7 (95% CI 14.8 to 16.6; men 16.7, women 14.4) and that of impaired fasting glucose was 17.8 (16.8 to 18.7; men 17.7, women 18.0). In participants with diabetes, 27.6% were undiagnosed, drug treatment was in 54.1% and control (fasting glucose ≤130 mg/dL) in 39.6%. Among participants with diabetes versus those without, prevalence of hypertension was 73.1 (67.2 to 75.0) vs 26.5 (25.2 to 27.8), hypercholesterolemia 41.4 (38.3 to 44.5) vs 14.7 (13.7 to 15.7), hypertriglyceridemia 71.0 (68.1 to 73.8) vs 30.2 (28.8 to 31.5), low HDL cholesterol 78.5 (75.9 to 80.1) vs 37.1 (35.7 to 38.5), and smoking/smokeless tobacco use in 26.6 (23.8 to 29.4) vs 14.4 (13.4 to 15.4; p<0.001). Awareness, treatment, and control, respectively, of hypertension were 79.9%, 48.7%, and 40.7% and those of hypercholesterolemia were 61.0%, 19.1%, and 45.9%, respectively. CONCLUSIONS: In the urban Indian middle class, more than a quarter of patients with diabetes are undiagnosed and the status of control is low. Cardiovascular risk factors-hypertension, hypercholesterolemia, low HDL cholesterol, hypertriglyceridemia, and smoking/smokeless tobacco use-are highly prevalent. There is low awareness, treatment, and control of hypertension and hypercholesterolemia in patients with diabetes.

17.
Diabetes Metab Syndr ; 8(3): 156-61, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25220918

RESUMO

OBJECTIVE: Metabolic syndrome is an important cardiovascular risk factor. To determine its prevalence among urban subjects in India we performed a multisite study. METHODS: The study was performed at eleven cities using cluster sampling. 6198 subjects (men 3426, women 2772, response 62%, age 48±10 years) were evaluated for socio-demographic, lifestyle, anthropometric and biochemical factors. Prevalence of metabolic syndrome was determined using harmonized Asian-specific criteria. Significant socioeconomic and lifestyle associations were determined. RESULTS: Age adjusted prevalence (%, 95% confidence intervals) of metabolic syndrome in men and women was 33.3 (31.7-34.9) and 40.4 (38.6-42.2) (harmonized criteria), 23.9 (22.4-26.4) and 34.5 (32.0-36.1) (modified Adult Treatment Panel-3, ATP-3) and 17.2 (15.3-19.1) and 22.8 (20.1-24.2) (ATP-3). Individual components of metabolic syndrome in men and women, respectively, were: high waist circumference 35.7 (34.1-37.3) and 57.5 (55.6-59.3), high blood pressure 50.6 (48.9-52.3) and 46.3 (44.4-48.1), impaired fasting glucose/diabetes 29.0 (27.5-30.5) and 28.0 (26.3-29.7), low HDL cholesterol 34.1 (32.5-35.7) and 52.8 (50.9-54.7) and high triglycerides 41.2 (39.5-42.8) and 31.5 (29.7-33.2) percent. Prevalence of metabolic syndrome was significantly greater in subjects with highest vs. lowest categories of education (45 vs. 26%), occupation (46 vs. 40%), fat intake (52 vs. 45%), sedentary lifestyle (47 vs. 38%) and body mass index (66 vs. 29%) (p<0.05). CONCLUSION: There is high prevalence of metabolic syndrome in urban Indian subjects. Socioeconomic (high educational and occupational status) and lifestyle (high fat diet, low physical activity, overweight and obesity) factors are important.


Assuntos
Doenças Cardiovasculares/epidemiologia , Dieta/efeitos adversos , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Fumar/efeitos adversos , População Urbana/estatística & dados numéricos , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Análise por Conglomerados , Feminino , Humanos , Índia/epidemiologia , Estilo de Vida , Masculino , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Obesidade/complicações , Vigilância da População , Prevalência , Fatores de Risco , Classe Social , Fatores Socioeconômicos
18.
Indian Heart J ; 66(3): 280-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24973832

RESUMO

OBJECTIVE: To determine levels of cholesterol lipoproteins and prevalence of dyslipidemias in urban Asian Indians. METHODS: Population based 6123 subjects (men 3388) were evaluated. Mean±1SD of various cholesterol lipoproteins (total, HDL, LDL and non-HDL cholesterol) and triglycerides were reported. Subjects were classified according to US National Cholesterol Education Program. RESULTS: Age-adjusted levels in men and women were cholesterol total 178.4 ± 39 and 184.6 ± 39, HDL 44.9 ± 11 and 51.1 ± 11, LDL 102.5 ± 33 and 106.2 ± 33, total:HDL 4.15 ± 1.2 and 3.79 ± 1.0 and triglycerides 162.5 ± 83 and 143.7 ± 83 mg/dl. Age-adjusted prevalence (%) in men and women, respectively were, total cholesterol ≥200 mg/dl 25.1 and 24.9, LDL cholesterol ≥130 mg/dl 16.3 and 15.1 and ≥100 mg/dl 49.5 and 49.7, HDL cholesterol <40/<50 mg/dl 33.6 and 52.8, total:HDL cholesterol ≥4.5 29.4 and 16.8, and triglycerides ≥150 mg/dl 42.1 and 32.9%. Cholesterol level was significantly greater in subjects with better socioeconomic status, body mass index and waist circumference while triglycerides were more among those with high socioeconomic status, fat intake, body mass index and waist circumference (p < 0.05). Hypercholesterolemia awareness (15.6%), treatment (7.2%) and control (4.1%) were low. CONCLUSIONS: Mean cholesterol and LDL cholesterol are low and triglycerides were high in urban Asian Indians. Most prevalent dyslipidemias are borderline high LDL, low HDL and high triglycerides. Subjects with high socioeconomic status, high fat intake and greater adiposity have higher total and LDL cholesterol and triglyceride and lower HDL cholesterol.


Assuntos
Colesterol/sangue , Dislipidemias/epidemiologia , Lipoproteínas/sangue , População Urbana , Biomarcadores/sangue , Estudos Transversais , Dislipidemias/sangue , Feminino , Humanos , Índia/epidemiologia , Masculino , Prevalência , Fatores de Risco
20.
Indian Heart J ; 65(3): 250-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23809376

RESUMO

OBJECTIVE: To determine use of class and type of cardioprotective pharmacological agents in patients with stable coronary heart disease (CHD) we performed a prescription audit. METHODS: A cross sectional survey was conducted in major districts of Rajasthan in years 2008-09. We evaluated prescription for classes (anti-platelets, ß-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and statins) and specific pharmacological agents at clinics of physicians in tertiary (n = 18), secondary (n = 69) and primary care (n = 43). Descriptive statistics are reported. RESULTS: Prescriptions of 2290 stable CHD patients were audited. Anti-platelet use was in 2031 (88.7%), ß-blockers 1494 (65.2%), ACE inhibitors 1196 (52.2%), ARBs 712 (31.1%), ACE inhibitors - ARB combinations 19 (0.8%), either ACE inhibitors or ARBs 1908 (83.3%), CCBs 1023 (44.7%), statins 1457 (63.6%) and other lipid lowering agents in 170 (7.4%). Among anti-platelets aspirin-clopidogrel combination was used in 88.5%. Top three molecules in ß-blockers were atenolol (37.8%), metoprolol (26.4%) and carvedilol (11.9%); ACE inhibitors ramipril (42.1%), lisinopril (20.3%) and perindopril (10.9%); ARB's losartan (47.7%), valsartan (22.3%) and telmisartan (14.9%); CCBs amlodipine (46.7%), diltiazem (29.1%) and verapamil (9.5%) and statins were atorvastatin (49.8%), simvastatin (28.9%) and rosuvastatin (18.3%). Use of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was more at tertiary care, and atenolol, lisinopril, losartan, amlodipine and simvasatin in primary care (p < 0.01). CONCLUSIONS: There is low use of ß-blockers, ACE inhibitors, ARBs and statins in stable CHD patients among physicians in Rajasthan. Significant differences in use of specific molecules at primary, secondary and tertiary healthcare are observed.


Assuntos
Cardiotônicos/classificação , Doença da Artéria Coronariana/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Cardiotônicos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico
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