Consensus statement for the management of dyslipidemia and hypertension in the Indian population with diabetes

The mortality rate from cardiovascular disease (CVD) in India is higher than the global figures (272 per 100,000 persons vs. 235 per 100,000 persons, respectively). Smoking, obesity, hypertension, diabetes and dyslipidemia are the known risk factors for atherosclerotic cardiovascular disease (ASCVD). The treatment of either condition aims to reduce the risk of ASCVD. This goal is achievable only when a holistic, simultaneous treatment is initiated and is monitored to reduce the blood glucose, blood cholesterol, and BP. India heralds a huge population of nearly 73 million people with diabetes. Diabetes is one of the major contributors of ASCVD, dyslipidemia and hypertension often coexist with diabetes. Patients diagnosed with either condition need risk stratification, followed by defining the treatment target for each risk category and developing appropriate treatment strategies based on the risk category. Unfortunately, there is no clear guideline that defines the treatment targets and subsequent management. This statement has been created based on the vast experience and an extensive literature review conducted by experts from multidisciplinary teams to address several treatment dilemmas that are routinely faced by clinicians when treating their patients with diabetes. An attempt is made to provide well-defined answers to these quandaries. This statement discusses screening, diagnosis, risk stratification, treatment targets, and management of dyslipidemia and/or hypertension in patients with diabetes and provides a roadmap for the treatment of Indian patients to curtail the risk of ASCVD.

Percutaneous treatment of bifurcation coronary stenosis: a long-term follow-up.

BACKGROUND: The treatment of bifurcation coronary stenosis involved several techniques in the last few years, with the use of one stent, two stents, kissing balloon, crush stenting. Basic objective was to reduce MACE rate and improve event-free survival. OBJECTIVE: To examine the performance of some techniques of stent placement adopted in the last few years by evaluating MACE (major adverse cardiac events) and TLR (target lesion revascularization). METHODS: Between 1999 and 2003, 74 consecutive patients with bifurcation lesions were treated with either stenting two vessels (type A, n = 8) or single vessels (type B, n = 66) and were followed for 30 days, 6 months, with a mean follow-up of 23 months for clinically driven MACE and TLR. RESULTS, The mean reference diameters of the main and side branches were 2.97 +/- 0.27 mm and 2.28 +/- 0.49 mm, respectively. The side branch was stented in 11% cases. Less than 30% residual stenosis in the main branch was achieved in 100% cases, <50% in the side branch in 94.5% of the cases. In-hospital major adverse cardiac events were non-Q-wave MI in 5% patients. During follow-up, death was 1.35%, subacute stent thrombosis (SAT) was 4%, and TLR (CABG) was 10.8%. Multivariate analysis showed type 1 lesion, and STEMI was associated with more MACE than others. There was 4.35-fold greater odds of MACE, associated with stenting both vessels in bifurcation lesion. CONCLUSION, Stenting of the main branch along with kissing balloon dilatation or provisional stenting of the side branch is a safe and effective treatment of coronary bifurcation lesions with acceptable TLR rates.

Inadvertent transvenous left ventricular pacing through an unsuspected atrial septal defect.

A 65-year-old male patient with a long standing history of chronic obstructive lung disease had permanent pacemaker implantation for symptomatic atrioventricular nodal blocks. Preoperative echocardiography showed dilated right heart chambers and moderate pulmonary arterial hypertension without any demonstrable intracardiac shunt. Postoperative twelve-lead ECG showed right bundle branch block configuration of paced complexes. This suggested left ventricular pacing which was confirmed by transthoracic echocardiography. Later, transoesophageal echocardiography showed the lead entering into left atrium from right atrium through a sinus venosus type of atrial septal defect. The patient refused any further intervention and continues to remain asymptomatic with stable pacing on aspirin-anticoagulant therapy at end of four years.

Lipid profile of Indian children and adolescents.

Dyslipidaemia when diagnosed in childhood predicts the development of clinical atherosclerotic disease in adulthood. Ever since we became aware of the abnormally high incidence of coronary artery disease amongst Indians, there always has been an ever-growing need for study of lipid values amongst Indian children and adolescents. Five hundred and eighty-six children (352 boys and 234 girls) from a public school aged between 8 and 18 years (mean age: 12.86 for boys and 12.15 for girls) were included in the study for assessment of lipid profile during the period from April, 1999 to March, 2000. Fasting venous blood was drawn from each child and total cholesterol and triglyceride levels were measured by enzymatic method, high-density lipoportein (HDL)-cholesterol was measured using specific precipitation method and lipoprotein (a) [Lp (a)] was measured by immunoturbidimetric method. After biochemical estimation was completed reference values and percentiles were calculated for each lipid component. Mean cholesterol and triglyceride values were higher amongst girls compared to boys. HDL-cholesterol values were lower amongst Indian boys compared to girls. Mean Lp (a) values were higher amongst both Indian boys and girls and more so amongst girls compared to boys. Since Lp(a) values remain unchanged through ages, these values should represent corresponding values in adult Indian males and females. It is being expected that data presented in this study should form guidelines with regard to dietary and pharmacological intervention for dyslipidaemia amongst children and adolescents.