Sildenafil improves survival in idiopathic pulmonary arterial hypertension.

AIMS AND OBJECTIVES: Idiopathic Pulmonary Arterial Hypertension (IPAH) is a serious disorder of unknown etiology with limited therapeutic options. Sildenafil has been shown to decrease symptoms, improve hemodynamics and quality of life. Its impact on survival is uncertain. We studied the efficacy of sildenafil in improving survival in patients with IPAH. METHODS AND RESULTS: Data on survival of patients with IPAH was collected from prospectively maintained registry at our hospital from January 1999 to December 2005. Thirty nine patients who were treated with conventional therapy including digoxin, diuretics, anticoagulants and calcium channel blockers prior to January 2001 served as historical controls (control group). One hundred and thirty nine patients received sildenafil additionally from January 2001 (sildenafil group). All patients in sildenafil group showed improvement in symptoms. Survival of patients in sildenafil group was significantly better compared to historical controls receiving only conventional therapy. It was 89%, 43% and 19% in the control group Vs 93%, 75% and 54% in the sildenafil group at the end of 1, 3 and 5 years respectively (P Value=0.0002). Sildenafil was well tolerated and none of the patients had to discontinue the treatment. CONCLUSION: Sildenafil when added to conventional therapy improves symptoms as well as survival significantly compared to conventional therapy alone. Further randomized controlled trials are needed to evaluate its impact on survival when used either alone or in combination with other drugs.

Clinical Evaluation of an Indigenous Paclitaxel-Eluting Stent in De NovoCoronary Artery Stenosis.

BACKGROUND, Drug-eluting stents have enabled considerable reduction in restenosis in patients subjected to angioplasty. However, in view of high cost of drug-eluting stents, efforts to develop medicated stents at reduced cost using alternative polymers in Indian setting are imperative. Hence a multi-center study was undertaken to evaluate the safety and efficacy of the indigenously developed paclitaxel-eluting RELEASE-T stent. METHODS, The study included 100 patients (male:86, Female:14) who were undergoing angioplasty for various indications at four centres viz. Delhi, Hyderabad, Pune and Warangal. The age range was 29 - 76 years; 37 patients were diabetic. All patients were pre-treated with aspirin 150-325 mg plus clopidogrel 75 mg daily four days before procedure or clopidogrel alone. Aspirin was continued indefinitely. RESULTS, Direct stenting ws done in majority of patients. One patient, in whom stent could not be delivered, received only baloon angioplasty. Sixty-four patients had stenting of left anterior descending artery. The stent diameter ranged from 2.5 to 3.5 mm, and the length, 15 to 20 mm. All patients were followed up at 1,3 and 6 months. There was two deaths: one had subacute thrombosis on both stents, and the other (who was HIV positive) had sudden cardiac death. The 6-month rate of major adverse cardiac events was 4% and target lesion revascularization rate ws 2%. CONCLUSION, This ulti-locational study brings out that the use of indigenously developed paclitaxel-eluting stent is safe and clinically efficacious.

Lipid profile and apolipoprotein E polymorphism in essential hypertension.

BACKGROUND: Studies in several populations have indicated that genetic variation at the apolipoprotein E structural locus influences atherosclerosis leading to cardiovascular diseases. The possible role of apolipoprotein E polymorphism in the development of essential hypertension has not been sufficiently investigated. In this case-control study, we aimed to determine the significance of association between essential hypertension and apolipoprotein E genotypes. In addition, apolipoprotein E genotypes were correlated with serum lipid levels in order to understand the possible interaction between the specific genotype and the lipid profiles that can contribute to hypertension. METHODS AND RESULTS: The apolipoprotein E genotypes were assayed in 185 patients and 200 controls by polymerase chain reaction followed by enzymatic digestion with Hha I. Using logistic regression analysis, the multivariate-adjusted odds of hypertension were calculated. The incidence of epsilon4 allele was found to be significantly higher in patients (12.16%) than in controls (5.75%, chi2=10.87; p<0.05) and also in patients with positive family history (16.7%) as compared to negative family history (8.87%, chi2 = 8.45; p<0.1). Further, it was observed that carriers of epsilon4 allele have twice as much risk (p<0.05) for developing hypertension as compared to carriers of other alleles. Patients with epsilon4 allele had significantly higher levels of total cholesterol and low-density lipoprotein- cholesterol as compared to epsilon4 allele non-carriers (p<0.05). The adjusted odds ratios for epsilon4 and epsilon2 alleles versus epsilon3 allele were 2.2 (95% confidence interval 1.2 to 3.8, p<0.05) and 1.2 (95% CI, 0.75 to 1.77, p<0.514), respectively. CONCLUSIONS: Our study revealed a strong association of apolipoprotein E locus with hypertension and lipid profile. However, large population-based studies are needed to understand the exact role played by the locus in causing the condition.

Non-surgical transpericardial catheter ablation of post-infarction ventricular tachycardia.

Non-surgical transpericardial approach for catheter-based epicardial radiofrequency ablation of post-infarction left ventricular tachycardia has been described as an alternative and additive procedure to standard endocardial technique for delivery of radiofrequency energy in difficult situations. We report our initial experience with this approach in three patients of post-infarction recurrent ventricular tachycardia, refactory to multiple antiarrhythmic drugs. Ablation was successful in terminating the tachycardia in two and in modifying the circuit to be amenable for control with single antiarrhythmic drug in one patient. There were no serious acute or long-term complications related to the procedure. Epicardial approach is an effective and safe adjunct to standard endocardial ablative technique for patients of post-infarction ventricular tachycardia.

Plasma Lipoprotein (a) levels in patients with untreated essential hypertension.

Lipoprotein (a) [Lp (a)] is considered as a risk factor for vascular diseases, especially those associated with renal failure. Adequate studies have not been conducted on the lipoprotein (a) in essential hypertensive patients. There is a controversy on the mechanisms by which Lp (a) is associated with essential hypertension. It is unclear whether Lp (a) contributes to atherogenesis or to thrombogenesis or both. Recent studies suggest that Lp (a) can act as a marker for determining vascular or tissue injury. Reports on Indian population indicate elevated levels of Lp (a), together with other serum lipoproteins emphasizing an important role in Coronary Heart Disease (CHD) and peripheral atherosclerosis. In the present study we aimed to evaluate the relation between plasma levels of Lp (a) and the parameters of the lipid profile in a group of essential hypertensive patients, who are not receiving pharmacological treatment and with no clinical signs of associated pathologies or organ damage. A total of 37 essential hypertensive patients (27 men and 10 women) were compared with 50 controls (32 men and 18 women). It was observed that the hypertensive patients had higher plasma concentrations of Lp (a), Total Cholesterol (TC), Low-Density Lipoprotein-Cholesterol (LDL-C), and Triglycerides (TG) as compared to controls (P< 0.01). Hypertensive patients were also observed to have significantly low levels of High-Density Lipoprotein Cholesterol levels (HDL-C) as compared to controls (P<0.01). Only 14 hypertension patients and 4 controls had plasma concentrations of Lp (a) of over 30 mg/dl. Lp (a) values correlated significantly ( P<0.05 ) with systolic blood pressure (SBP), diastolic blood pressure (DBP) and the main parameters of the lipid profile. We conclude that elevated plasma Lp (a) levels were associated with hypertension and show significant correlation with lipid levels. However higher plasma concentrations of Lp (a), albeit with in the normal range, could be an independent risk factor for atherosclerosis, and could contribute towards increasing the risk for cardiovascular disease in persons with essential hypertension.

Prevalence of risk factors for coronary atherosclerosis in a cross-sectional population of Andhra Pradesh.

BACKGROUND: The prevalence of risk factors for atherosclerosis is increasing in India due to changing socioeconomic factors and lifestyles. Data for the state of Andhra Pradesh are scanty in this regard. METHODS AND RESULTS: The prevalence of conventional risk factors for atherosclerosis was prospectively assessed in a unique sample of 3307 workers of a political party drawn from all over the state of Andhra Pradesh. Demographic, anthropometric, clinical and laboratory data were collected prospectively over a period of 6 months. The mean age of the subjects was 43.12+/-9.5 years, 2955 (88%) were males and 385 (12%) females. The prevalence of risk factors was as follows: diabetes in 810 (24%); hypertension in 924 (28%); lipid abnormality in 1908 (58%); smoking in 805 (24%) and positive family history in 555 (17%). Obesity was prevalent in 1178 (36%) of the population. All coronary risk factors, excepting family history, were significantly more prevalent in males [diabetes: 777 (26%) v. 34 (9%), p<0.001; hypertension: 833 (28%) v. 72 (19%), p<0.001; lipid abnormality: 1729 (59%) v. 172 (45%), p<0.001; smoking: 801 (27%) v. 7 (2%), p<0.001; and family history: 497 (17%) v. 60 (16%), p=0.54]. Region-wise analysis showed a high prevalence of diabetes in the Andhra and Rayalaseema regions, hypertension in the Andhra region, and smoking in the Rayalaseema region. Lipid disorders were equally prevalent in all the regions. CONCLUSIONS: The present report shows a disturbing burden of coronary risk factors in the study population. There is an urgent need to undertake population-based measures to reverse the trend.