Relationship between Left Ventricular Mass Index and Insulin Resistance in Obese Subjects

Obesity is an underestimated condition of clinical and public health importance across the world. Obesity has been associated with Left ventricular hypertrophy and insulin resistance, both of which are associated with cardiovascular morbidity and mortality. The aim of present study to determine relationship between left ventricular mass index and Insulin resistance in obese subjects. Methods: The present study is a observational study conducted in Guru Nanak Dev Hospital attached to Govt. Medical college Amritsar. Total 50 normotensive nondiabetic obese subjects of both genders were included in the study. Results: There was strong positive correlation of Left Ventricular Mass Index (LVMI) with HOMA-IR. Pearson’s correlation coefficient (r) = 0.298 and P value was < 0.05. Left ventricular hypertrophy was present in 38% and 70% of obese subjects when left ventricular mass was indexed to body surface area and height respectively. Conclusion: The present study concludes that left ventricular mass index is strongly related with insulin resistance in normotensive nondiabetic obese subjects. So their earlier detection will reduce cardiovascular morbidity and mortality.

The impact of three combinations vildagliptin/metformin, vildagliptin/pioglitazone, and metformin/pioglitazone on glycemic control and atherogenic dyslipidemia in patients with Type 2 diabetes mellitus.

Background: There are limitations of currently recommended stepwise treatment for Type 2 diabetes, especially failure with monotherapies to achieve the strict glycemic control. This has prompted the intensification of therapy with such combinations which have additive efficacy and complimentary mechanisms of action. Vildagliptin is one such agent with the above potential which does not increase the risk of hypoglycemia and does not promote weight gain. Methods: It was a prospective, open-label, randomized, and parallel group study involving 90 patients, divided into three Groups A, B, and C. Group A given vildagliptin/metformin (50/500 mg), Group B vildagliptin/pioglitazone (50/15 mg)and Group C metformin/pioglitazone (500/15 mg) combinations twice daily for 12 weeks. Fasting blood glucose (FBG) was estimated biweekly while hemoglobin A1c (HbA1c), lipid profile, insulin, and C-peptide levels at 0 and 12th week. Statistical analysis was done using ANOVA and Student’s t-test. Results: At the end, mean percentage of age fall in HbA1c and FBG from baseline was maximum in Group B, which was found out to be more efficacious than Group A and C (p<0.001) on glycemic parameters. Mean percentage of age decrease in triglyceride from baseline was maximum in Group C, which was found out to be more efficacious than Group A and B (p<0.001) on lipid parameters. The adverse effects were low in all the groups. However, the incidence of peripheral edema and weight gain was more with the use of Group C while nausea, vomiting, and nasopharyngitis was more with the use of Group A. Conclusion: Vildagliptin/pioglitazone combination is of choice in patients with uncontrolled hyperglycemia but normal lipid profile while metformin/pioglitazone combination in diabetic patients with dyslipidemia.

Apolipoprotein modifying effects of statins and fibrate in various age groups of coronary artery disease patients.

These days apolipoproteins especially apo B and apo A I are thought to be better predictors of risk of coronary artery disease as compared to lipids and lipoprotein cholesterol. Lifestyle modification and use of lipid modifying drugs such as statins and fibrates have proven effective in reducing the risk of coronary artery disease. Statins and fibrates are known to possess anti-atherosclerotic properties in addition to lipid modifying effects. Extensive data is available regarding lipid modification especially lowering of low density lipoprotein-cholesterol levels by these drugs. But the data regarding the effect of statins and fibrates, on apolipoprotein levels is scanty. Hence the present study was aimed at assessing the effect of statins (atorvastatin, simvastatin) and fenofibrate on serum apo B and apo A I levels in addition to their lipid modifying effects in various age groups of coronary artery disease patients. One hundred patients suffering from coronary artery disease were randomly assigned to 10 mg atorvastatin, 10 mg simvastatin and 200 mg fenofibrate, separately (without any combination). All the patients were divided into three age groups; group I (35-45 years), group II (46-55 years) and group III (> 55 years). Significant modification was observed in lipid and lipoprotein profile of coronary artery disease patients when treated with these drugs (statins and fibrates). A significant increase in serum apo A I (p < 0.01) and decline in serum apo B levels (p < 0.01) was observed in case of coronary artery disease patients after 16 weeks treatment, though the effect started after 1 month. All the three drugs reduced serum apo B levels in a comparable manner. Fenofibrate increased serum high density lipoprotein-cholesterol and apo A I levels more as compared to statins. It had nearly, proportionate effect in increasing high density lipoprotein-cholesterol and apo A I levels and reducing serum low density lipoprotein-cholesterol and apo B levels while the effect was disproportionate in case of atorvastatin and simvastatin. All the three drugs not only corrected lipid and lipoprotein cholesterol levels but also modified, apolipoprotein levels in a positive direction in coronary artery disease patients. Advancing age had no appreciable effect on the efficacy of these drugs.

Epidemiology of HIV infection among brothel-based sex workers in Kolkata, India.

A cross-sectional study was carried out during January-June 2004 to assess the status of HIV infection among brothel-based sex workers in Kolkata city, India. Six hundred and twenty-two sex workers, selected from six brothels, were included in the study to assess their HIV status, and 362 sex workers, a subset of the above population, were interviewed to study their risk behaviour and practices. Blood samples were collected from each sex worker for testing HIV by an unlinked anonymous method. The prevalence of HIV infection was 9.6%, but was much higher among younger sex workers aged 20 years or less (27.7%) compared to the older age group (8.4%). This difference was statistically significant, indicating an association of younger ages with HIV infection [p = 0.006 and odds ratio (OR) = 4.18; (95% confidence interval (CI) 1.2-13.8)]. HIV was not associated with duration of sex work, average number of clients entertained per day, condom use, practice of sex during menstruation, pre-coital examination of penis for visible ulcer/discharge, suffering from sexually transmitted infections, and entertaining clients outside the brothel. There was a big gap between the reported and the evaluated condom use by sex workers. The results suggest that there is a need to develop suitable HIV intervention strategies, considering the socioeconomic and cultural aspects of city sex workers, with a provision for continuous monitoring and evaluation.