Professor Tada Yipintsoi: beloved teacher, great researcher and practicing cardiologist (10 February 1934 - 9 January 2011)

Professor Tada Yipintsoi was born to a wealthy family in Thailand, the fourth of five children. Most of his early years were spent in education abroad. He received his undergraduate and medical degrees from the Welsh National School of Medicine at Cardiff and obtained his MRCP from the Royal College of Physicians of London. After spending two years at Royal Hammersmith and Brompton Hospitals at London as house officer in Cardiology, he returned for two years to work as a teaching cardiologist at Siriraj Hospital, Bangkok. He then moved to the Mayo Graduate School of Medicine at Rochester, Minnesota as fellow in Cardiology where he was awarded his PhD from the University of Minnesota. Subsequently, he was appointed a faculty member at the Montefiore Hospital in New York. He became Professor of Medicine and Physiology and Director of the Basic Cardiovascular Research Laboratory at the Medical Center and at Albert Einstein College of Medicine. He later became associated with Yeshiva University of New York, where he was also appointed as the Associate Director of the Cardiology Fellowship Training Program.

Atorvastatin attenuates TLR4-mediated NF-κB activation in a MyD88-dependent pathway.

Antigen presenting cells such as dendritic cells and macrophages have recently been detected in atherosclerotic plaques. Toll-like receptors expressed on the surface of these cells, have been implicated in ongo-ing inflammatory responses in the plaques. In this study, we investigated the anti-inflammatory effect of atorvas-tatin, a lipid lowering drug, via Toll-like receptor 4 (TLR4) in vitro, employing murine pro-B cell lines transfected with hTLR4/MD2 and MyD88/hTLR4/MD2 systems. The results showed that atorvastatin at 10 μM significantly attenu-ated NF-κB activation within 24 hours while at lower doses of 0.1 and 1 μM, treatment time had to be prolonged up to 48 hours for a significant inhibition to occur. The inhibition of NF-κB was also observed in a cell line co-transfected with MyD88 and TLR4 suggesting that the attenuation of NF-κB by atorvastatin occurred in a MyD88 dependent fashion.

Lipid treatment assessment project II in Thailand (LTAP-II Thailand).

OBJECTIVE: Evaluate treatment practices and their outcomes in Thai patients with hyperlipidemia. The factors contributing to success of treatment were also determined. MATERIAL AND METHOD: A multi-center cross-sectional survey with the support of 98 physicians from 48 hospitals was done. Each physician enrolled up to 20 dyslipidemic patients by simple randomization. RESULTS: One thousand nine hundred twenty one cases, 45.1% males with a mean age of 58.6 years (SD = 9.6) were recruited. The patients were divided into three groups: 1,178 patients with coronary heart disease (CHD) and CHD equivalents, 424 patients with high risk, and 319 patients with low risk. The main targets for treatment were LDL-C levels of< 100, < 130 and < 160 mg/dL for each respective group. As a whole, the risk factors listed in order of frequency were age at risk (78%), hypertension (69. 8%), diabetes mellitus (43.6%), smoking (24.6%), and family history of CHD (6.9%). Obesity (body mass index > or = 25 kg/m2) was found in 53.8% of the patients. Twenty eight percent of the patients experienced CHD or other atherosclerotic diseases. Statin was the commonest prescribed drug (64%) followed by fibrate (25%). The overall success rate was 46.5%. Percentage of cases achieving LDL-C targets in the CHD and CHD equivalents, high and low risk group was 34.6%, 56.4%, and 76.8%, respectively. The patients in the low risk group, being under specialist care and receiving statin therapy reached target of treatment at a significantly higher rate. CONCLUSION: The present study showed that statin was the most common drug used in the management of hyperlipidemia. Patients with CHD and CHD equivalents were the group with least achievement of LDL-C target. The factors contributing to achievement of LDL-C target were lower risk patient, specialist care, and statin therapy.

Costs of payment in Thai acute coronary syndrome patients.

BACKGROUND: Acute coronary syndrome (ACS) is a major health care syndrome that can financially burden patients throughout the world, including Thailand. Few studies purposed estimating the costs of treatment. The data from the ACS registry database represented the costs of hospital charges paid by ACS patients. Although these were not the actual treatment costs, the authors can approximately estimate the total expenditure for the first admission. OBJECTIVES: First, calculate the cost of ACS to the patients, including diagnostic, demographic data, treatment modalities, type of payers, hospital profile, and outcomes. Second, find the appropriate model to identify the independent factors for predicting the treatment costs. MATERIAL AND METHOD: The present study collected data from the second and third phase of a national multicenter prospective registry of ACS in Thailand, Thai ACS registry (TACSR). 3,552 patients with new onset of ACS were analyzed. RESULTS: Median age was 67 years (range 26.5-105.5) with predominately male and median length of stay (LOS) was 7 days (range, 1-184). 42% referred from other hospitals. The median cost of the total population was 47,908 baht (range, 633-1,279,679). When classified into those of STEMI, NSTEMI, and UA, the costs were 82,848.5, 40,531 and 26,116 baht respectively, p < 0.0001. Patients in the government hospital had to pay the total cost with PCI and CABG, 152,081-161,374 baht and 203,139-223,747 baht respectively, while the private hospital charged almost twice as much. For the types of payers, private insurance including private employee security fund paid significantly more than others. Costs in patients paid by "30 baht na tional health scheme and social security fund" were significantly less than those of others. For modality of treatment in STEMI, primary PCI was significantly more costly than thrombolytics and no reperfusion therapy, 161,096.5 vs. 60,043.0 and 33,335.0 baht respectively p < 0.0001. Early invasive groups in NSTEMI/UA had much higher median costs 145,794.0 baht when compared to those of the conservative group, 47,908 baht, p < 0.0001. Two multiple linear regression models according to the diagnostic group identified the independent factors for predicting cost. PCI, LOS, CABG, admission in a private hospital, Death, GPIIb/IlIa inhibitors use, major bleeding, coronary angiogram, thrombolytics use, age and diabetes were independent predictors for the cost in STEMI patients, R2 = 0.58. For those of NSTEMI/UA, the independent predictors for the cost were PCI, LOS, CABG, admission in a private hospital, death, GP IIb/IIIa inhibitors use, major bleeding, coronary angiogram, age, ventricular arrhythmia, CHF and referred patients, R2 =0.62. CONCLUSION: Costs in ACS patients were markedly different among diagnostic groups. The clinical risk factors were hospital type, type of payers, referred system, treatment procedures, drugs used and complications including outcome. Some of these factors could independently predict the costs.

Association between serum homocysteine, folate and B12 concentration with coronary artery disease in Thai patients.

BACKGROUND: Hyperhomocysteinemia, associated with low folate and low B12 levels, is known to be an independent risk factor for atherosclerosis. Only a few available data has been demonstrated in Thai patients. OBJECTIVE: To evaluate serum fasting homocysteine, folate and B12 levels whether to see they are associated with coronary artery disease (CAD). METHOD AND RESULT: Three hundred and one consecutive suspected CAD patients who underwent coronary angiography at the Police General Hospital were studied. The mean age of the patients, 195 males and 106 females, was 63.0 +/- 10.0 year (range 39-85). A total of 218 patients were angiographically demonstrated as having CAD. The mean serum homocysteine level of CAD patients had a non significant higher level than those of 83 non CAD patients: 11.4 +/- 6.2 vs 10.2 +/- 4.2 umol/L, p = 0.06. Means of folate and B12 level in the CAD patients and non CAD patients were 6.6 +/- 4.6 vs 7.0 +/- 4.3 nmol/L, p = 0.49 and 650.9 +/- 415.4 vs 613.3 +/- 443.2 pmol/L, p = 0.56 respectively. No significant correlations were found between homocysteine with folate and B12 levels. Logistic regression analysis showed a significant association between homocysteine and CAD with OR = 1.08 (95%CI, 1.01-1.16), p = 0.03 after being adjusted for age, sex, DM, HT history of hyperlipidemia, smoking, BMI, folate and B12 levels. No significant association between homocysteine level with the number of coronary vessel stenosis, age, BMI, DM, HT smoking and history of hyperlipidemia was observed in the present study. CONCLUSION: Hyperhomocyteinemia, but not folate and B12 levels, may be an independent risk factor for coronary artery disease in Thai patients.

A longitudinal causal relationship among cardiovascular risk factors in the employees of the government savings bank.

A longitudinal structural causal model was generated to examine the causal relationship among determinants which were composed of four personal factors, stress, four health behaviors, and BMI on five physiological risks for cardiovascular disease: SBP, DBP, FBS, TC and HDL-C in 1,019 bank employees, within a five-year interval. A fourteen-item food frequency questionnaire for assessing eating habits and the Health Opinion Survey for the stress test were included in the self-administered questionnaires. Weight, height and blood pressure were measured and blood samples were collected for blood chemical analysis. Data analysis by LISREL showed that the determinants in the proposed model explained as much as 96 per cent variation in physiological risks for CVD (R2 = 0.96, relative chi-square = 1.92, RMSEA = 0.03, GFI = 0.96 and AGFI = 0.95). The findings also indicated that current physiological status was affected by their status of age, education, health behaviors, BMI and physiological status 5 years ago.

Acceptability and tolerability of lacidipine in hypertensive patients.

A multicenter study on the efficacy and tolerability of lacidipine in ambulatory Thai hypertensive patients was carried out in the Out-patient Department at Siriraj Hospital, Ramathibodi Hospital and Rajvidhi Hospital from October 1996 to July 1997. There were 46 patients who had mild to moderate hypertension (DBP>95 mmHg and <115mmHg). The enrolled-patients consisted of male : female = 20 : 26, age ranged between 23-69 years (51.98+9.49 years). The study showed that lacidipine 2-6 mg given once daily was able to normalize sitting BP (DBP < 90 mmHg) in 32 cases (69.4%). Among them, normalization of BP could be achieved by lacidipine 2 mg/d in 24 cases (52.2%), 4 mg/d in 4 cases and 6 mg/d in 2 cases. This study revealed that lacidipine in the therapeutic dose of 2-6 mg/d did not induce reflex tachycardia, metabolic derangement and importantly, did not produce any serious side effects.