Prevalence of peripheral arterial disease by ankle-brachial index and its correlation with carotid intimal thickness and coronary risk factors in Nepalese population over the age of forty years.

OBJECTIVES: Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) and common carotid artery intima-media thickness (CCA IMT) could improve risk prediction and provide more focused primary prevention strategies. This report describes the prevalence of subclinical atherosclerotic vascular disease in a Nepalese population over the age of forty years as measured by ABI and CCA IMT and their association with established cardiovascular risk factors. MATERIALS AND METHODS: Ultrasonic evaluation of ABI and CCA IMT was done in 195 individuals of age 40 years and above who had presented to an outpatient department. Patients with established diagnosis of coronary artery disease or symptomatic for peripheral arterial disease were excluded from the study. RESULTS: The prevalence of atherosclerotic disease as measured by ABI was 18.5% and there was a statistically significant correlation between ABI and CCA IMT and other established cardiovascular risk factors such as smoking, diabetes mellitus and hypertension. CONCLUSIONS: We recommend that ABI as measured by sphygmomanometer be incorporated into routine cardiovascular screening and when found to be abnormal further confirmed by Doppler assessment of ABI and CCA IMT as surrogate markers of atherosclerotic vascular disease.

An echocardiographic study of cardiac changes in hypothyroidism and the response to treatment.

INTRODUCTION: Thyroid Hormones exert a direct cellular effect on almost all the tissues of the body including heart. Limited studies are available in the country to assess the various CVS parameters in hypothyroid patients and none have defined the impact of treatment on these parameters. AIM AND OBJECTIVES: To do an echocardiographic study of the cardiac changes in hypothyroidism and response to treatment. METHODOLOGY: 20 overt hypothyroid patients were selected , 12 males and 8 females and subdivided into 4 groups : untreated patients-A (14) , patients on L-thyroxin >=4 months-B6 , control subjects matched by age and sex-C10 , patient after treatment-D6-a subset of group A. Total T3 T4 was measured by RIA and TSH by IRMA. Echocardiography was done according to the standard protocols. RESULTS: With replacement therapy hypothyroid patients showed a decrease in wall thickness, decrease or disappearance of pericardial effusion and improvement in cardiac output. However no change in systolic function or size of various chambers were noted. Decreased cardiac output seen in untreated patients was mainly due to decreased heart rate. DISCUSSION: Present study showed relatively increased thickness of IVS and LVPW in untreated patients with marked difference in older patients consistent with other studies. There is a striking correlation between severity of disease and pericardial effusion. Following thyroid hormone replacement it was reported to resolve within few months. CONCLUSION: All patients with unexplained PE should be screened for hypothyroidism. Echocardiography is useful in assessing the response to replacement therapy. With replacement therapy hypothyroid patients showed a decrease in wall thickness.