How predictive is the Framingham's risk prediction algorithm in Indian perspective? A retrospective case-control study from Kolkata.

OBJECTIVE: In this retrospective case-control study, an attempt was made to assess the predictive efficacy of Framingham's risk prediction algorithm in Indian perspective. METHODS: A total of 350 patients and 293 age- and sex-matched controls were considered in the study. Those patients, who were presenting for the first time with acute coronary syndrome (ACS) and who did not have any prior manifestation of coronary heart disease (CHD) formed the patient group. The risk prediction algorithm was applied to obtain the risk score and the corresponding 10-year risk in each patient and control. They were divided into two groups: diabetic and nondiabetic. Depending on the 10-year risk, they were further grouped into high risk (10-year risk > 20%), moderately high risk (10-year risk between 10% to 20%), and low risk (10-year risk < 10%). The results were compared and statistically analyzed. RESULTS: In the diabetic patients with ACS, 14.29% qualified as high risk, 32.79% as moderately high risk, and 52.94% as low risk. The corresponding figures for diabetic subjects without ACS were 3.26%, 54.35%, and 42.39%, respectively. In nondiabetic patients with ACS, 19.91% were in the high-risk group, 38.96% in moderately high risk, and 41.13% in the low-risk group; while among the controls, the corresponding figures were 9.95%, 21.89%, and 68.16%, respectively. In nondiabetic subjects, the mean risk was significantly higher for patients compared to controls (14.13 vs. 8.61, p < 0.01). However, in diabetic subjects, there was no significant difference in the mean projected risk between those with ACS and those without ACS (11.37 vs. 10.41, p = NS). CONCLUSION: In the Indian perspective, Framingham's risk prediction protocol has a fair amount of predictive efficacy since the difference of mean risk score between the patients and controls was statistically significant. However, it fails to identify a large proportion of high-risk nondiabetic patients. Hence, a better protocol for the Indian perspective is badly needed.

Atypical coarctation with severe hypertension: a case report.

A young man of 16 years presented with sudden onset of right sided headache and vomiting for one day. No neurological or visual disturbances were noticed. On examination his BP was 240/120 mmHg. All upper extremity pulses were felt but from the femoral artery down to arteria dorsalis pedis these were absent. He was diagnosed as a case of coarctation of aorta following various biological and radiological investigations. After confirming the findings on aortography an aortoplasty was attempted with a long cordis balloon used to dilate the middle aortic lesion of 15 mm.

Risk factors for coronary heart disease in Indians: a case-control study from Eastern India.

We conducted a hospital-based case-control investigation (150 cases and 176 controls) to examine the putative role of conventional risk factors in subjects with and without coronary heart disease from Eastern India. Multivariate binary logistic regression revealed the following as significant risk factors for coronary heart disease: male sex (OR = 4.6, p = 0.001), elevated total cholesterol/high-density lipoprotein ratio (OR = 4.0, p = 0.001), systolic blood pressure (OR = 3.0, p = 0.004), diastolic blood pressure (OR = 3.6, p = 0.002), fasting plasma glucose (OR = 3.0, p = 0.05), post-pondrial plasma glucose (OR = 3.2, p = 0.005), Impaired fasting glucose (OR = 3.7, p = 0.002), elevated triglyceride (OR = 3.1, p = 0.018), increased total cholesterol (OR = 3.0, p = 0.029), low-density lipoprotein (OR = 3.1, p = 0.001), low-density lipoprotein/high-density lipoprotein ratio (OR = 3.4, p = 0.004), central obesity (OR = 3.0, p = 0.006), smoking (OR = 3.7, p = 0.001) and urban residence (OR = 3.1, p = 0.003). In this study, the discriminant analysis showed that 77.2% of all entry for cases and 72.6% of all entry for controls were correctly classified using conventional risk factors and warrant early intervention for conventional risk factors.