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Background: In Chronic kidney Disease (CKD) a significant risk factor for mortality is Cardiovascular disease (CVD) and the most prevalent cardiovascular risk factor is left ventricular hypertrophy (LVH). Anemia, hypertension and volume overload are risk factors for LVH in CKD. So, the present was aimed at comparing the risk factors between CKD with and without LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh. A total of 120 patients are included in this study and divided in to CKD stage III to V based on estimated GFR. Based on 2D echocardiography data CKD cases are further divided in to CKD with LVH and CKD without LVH.Results: The Left ventricular mass index was significant higher in CKD with LVH (128.89±19.28) when compared with CKD without LVH (108.20±10.28). The left ventricular mass index was noted in more number in stage V of CKD. It is also observed that the left ventricular mass index was negatively correlated with haemoglobin and eGFR and was positively correlated with systolic blood pressure and serum NT-proBNP.Conclusions: Present study finding suggested that the incidence of LVH is higher in CKD patients. LVH was positively correlated with hypertension and NT-proBNP and negatively correlated with anemia and estimated GFR.
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Background: Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.Methods: This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.Results: A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.Conclusions: Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins
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Background: The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.Methods: An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.Results: Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).Conclusions: The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD.
ABSTRACT
Background: Nephropathy is responsible for an End Stage Renal Disease (ESRD) in type 2 diabetics if uncontrolled. The monotherapy/combination of Angiotensin Converting Enzyme inhibitor (ACEi) and Angiotensin II Receptor Blockers (ARBs) can retard the progression of urine albumin to creatinine ratio in diabetic nephropathy but, the data shows an inconsistency in the efficacy of these drugs. So, the present study was aimed at comparing the reno-protective effect of ACEi/ARBs in type 2 diabetics.Methods: A prospective, randomized study is conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India with 100 patients, who are randomly categorised and equally distributed among the two groups and treated with Enalapril (ACEi) and Losartan (ARBs) for 6 months. 24-hour urine albumin to creatinine ratio and HbA1c are recorded before and after the treatment.Results: Enalapril and losartan showed a non-significant reduction in urine albumin to creatinine ratio from 196.2±17.5 to 185.9±15.2 (p=0.66) and 236.8±16.3 to 193.7±20.6 (p=0.11) respectively. A strict glycemic control has shown a reduction in HbA1c in both the groups.Conclusions: Present findings suggested that losartan is relatively more effective than enalapril in reducing the 24-hour urine albumin to creatinine ratio of diabetic nephropathy patients. Along with these drugs, regulation of blood glucose will assist in retarding the progression of nephropathy in type 2 diabetics.