Cardiovascular manifestations of people living with HIV/AIDS: Report from a hot spot in eastern India

Objective To study the profile and characteristics of cardiovascular abnormalities among patients living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) at a tertiary care hospital in India. The association of cardiovascular abnormalities with the CD4 count and disease stages, according to the World Health Organization (WHO) classification, was also analyzed. Methods A total of 200 patients with HIV/AIDS were compared with 50 healthy controls. All patients underwent blood investigations, chest X-ray, electrocardiography, and echocardiography. Results The mean age of the patients was 38.66 ± 9.22 years, with a male-to-female ratio of 3.25:1. Echocardiographic abnormalities were found in 52% of the patients and 12% of the controls, with the most common abnormality being left ventricular diastolic dysfunction. Echocardiographic abnormalities were markedly more common in patients with a CD4 count of <200/μL. The advanced stage of the disease, according to the WHO classification, was also associated with an increased incidence of echocardiographic abnormalities. Conclusions Cardiovascular abnormalities in the form of electrocardiogram and ECHO findings were present in 54.5% and 52% of patients, respectively. Echocardiographic findings showed significant correlation with CD4 count and WHO disease stage.

Glycaemic Control and Cardiovascular Outcomes in Diabetes : Review

While type 1 diabetes mellitus (DM) is characterised by insulin deficiency due to pancreatic beta-cell destruction; type 2 DM is characterised by a state of longstanding insulin resistance (IR); compensatory hyperinsulinaemia and varying degrees of elevated plasma glucose levels (PG); associated with clustering of cardiovascular (CV) risk and the development of macrovascular disease prior to the diagnosis of DM. Coronary artery disease (CAD) accounts for 70of mortality and morbidity in patients with diabetes. Studies in diabetes care have helped prevent or reduce microvascular complications in type 1 and 2 diabetes. However the same cannot be said about macrovascular disease. Despite all data concerning the association between diabetes and cardiovascular disease (CVD); the exact mechanism by which diabetes is linked to atherosclerosis is incompletely understood; and this is especially true in the case of hyperglycaemia. The positive effect of intensive glucose management in comparison to non-intensive glucose control is far from proven. The DCCT and UKPDS studies have shown that while glycaemic control is important for preventing long-term macrovascular complications; early glucose control is far more rewarding (metabolic memory). Later trials such as ACCORD; ADVANCE and VADT do not advocate tight glycaemic control. In fact; the ACCORD trial has shown increased mortality with tight glucose control. Tight glucose control may be beneficial in selected patients with short disease duration; long life expectancy and no CVD. In critically ill patients; a blood glucose target of 140-180 mg is fairly reasonable and achievable. The ESC/EASD guidelines of October 2013; like those of the ADA; AHA and ACC; continue to endorse a treatment target for glucose control in diabetes of HbAlc level 7; based predominantly on microvascular disease with acknowledged uncertainty regarding the effect of the intensive glucose control on CVD risk. Management of hyperglycaemia in diabetics should not be considered in isolation; diabetics require multifactorial intervention for hypertension; dyslipidaemia and microalbuminuria besides hyperglycaemia. In fact; the combined use of antihypertensives; aspirin and lipid-lowering agents makes it difficult to discern the beneficial effects of antihyperglycaemic therapy

Current perspectives on statins.

As the epidemic of coronary artery disease rages on round the globe, research is always on to find suitable drugs to reverse the trend. While aspirin, beta-blockers and ACE inhibitors have been shown to reduce coronary mortality and morbidity, statins are rapidly coming to fore as another important cog in the wheel of primary and secondary prevention of coronary artery disease. Newer trial like Heart Protection Study suggests benefit of statin for high risk individuals, irrespective of initial serum cholesterol concentrations. This may be of great relevance in the Indian context taking into consideration the vast majority of coronary artery disease patients having normal to mildly elevated serum cholesterol in contrast to their western counterparts.