Prevalence of risk factors for coronary atherosclerosis in a cross-sectional population of Andhra Pradesh.

BACKGROUND: The prevalence of risk factors for atherosclerosis is increasing in India due to changing socioeconomic factors and lifestyles. Data for the state of Andhra Pradesh are scanty in this regard. METHODS AND RESULTS: The prevalence of conventional risk factors for atherosclerosis was prospectively assessed in a unique sample of 3307 workers of a political party drawn from all over the state of Andhra Pradesh. Demographic, anthropometric, clinical and laboratory data were collected prospectively over a period of 6 months. The mean age of the subjects was 43.12+/-9.5 years, 2955 (88%) were males and 385 (12%) females. The prevalence of risk factors was as follows: diabetes in 810 (24%); hypertension in 924 (28%); lipid abnormality in 1908 (58%); smoking in 805 (24%) and positive family history in 555 (17%). Obesity was prevalent in 1178 (36%) of the population. All coronary risk factors, excepting family history, were significantly more prevalent in males [diabetes: 777 (26%) v. 34 (9%), p<0.001; hypertension: 833 (28%) v. 72 (19%), p<0.001; lipid abnormality: 1729 (59%) v. 172 (45%), p<0.001; smoking: 801 (27%) v. 7 (2%), p<0.001; and family history: 497 (17%) v. 60 (16%), p=0.54]. Region-wise analysis showed a high prevalence of diabetes in the Andhra and Rayalaseema regions, hypertension in the Andhra region, and smoking in the Rayalaseema region. Lipid disorders were equally prevalent in all the regions. CONCLUSIONS: The present report shows a disturbing burden of coronary risk factors in the study population. There is an urgent need to undertake population-based measures to reverse the trend.

A study of clinical efficacy of sildenafil in patients with primary pulmonary hypertension.

BACKGROUND: Primary pulmonary hypertension is a disorder with limited treatment options and poor outcome. Sildenafil, a pulmonary vasodilator, is likely to be beneficial in primary pulmonary hypertension. We studied the clinical efficacy of sildenafil in patients with primary pulmonary hypertension. METHODS AND RESULTS: A registry of patients with primary pulmonary hypertension has been maintained in our hospital since January 1999. Of a total of 60 patients. 29 (M:16, F:13) consented to try sildenafiL. New York Heart Association functional class, six-minute walk test and Doppler echocardiographic evaluation of pulmonary artery pressure was done before and after treatment with sildenafil. Sildenafil was initiated at a dose of 25 mg thrice a day and increased up to 100 mg thrice a day as tolerated. There was a significant improvement in the functional class. The six-minute walked distance increased from 297.07+/-130.69 m at baseline to 427.68+/-85.35 m after 3 months of sildenafil therapy (p<0.0003). The mean of the pulmonary artery systolic pressure before starting sildenaffil was 109.26+/-24.15 mmHg (mean+/-SD) and it decreased to 95.15+/-24.64 mmHg (p<0.008). While 19 of the 31 historical controls in whom sildenafil was not given died during follow-up (11-44 months), only 1 of the 29 patients given sildenafil died (in an accident) during follow-up (5-20 months). CONCLUSIONS: Sildenafil, a pulmonary vasodilator, has a beneficial effect in patients with primary pulmonary hypertension in improving the functional class, six-minute walked distance and in decreasing the pulmonary artery pressures.

Clinical evaluation of new balloon mountable coil stent: in-hospital and follow-up results.

The purpose of this study was to determine the feasibility, safety and efficacy of elective deployment of a new coil-stent (KR stent) in patients with coronary artery disease. KR stent deployment was attempted in 100 patients (135 lesions) enrolled prospectively at a single centre from December 1996 to March 1997. Ten, 15, 18, 24, and 32 mm long KR stents were manually crimped onto balloons and deployed in native coronary artery lesions. Majority of the patients had recent acute coronary syndromes (unstable angina 30% and post-myocardial infarction angina 56%). Diabetes was present in 34 percent of the patients. Fifty-six percent had single-vessel and 44 percent multi-vessel disease. In 38 percent, the lesions were located in proximal segments and 40 percent of lesions were long. KR stents were successfully deployed in 98 percent of patients. Mean minimal luminal diameter increased by 2.89 +/- 0.63 mm (from 0.57 +/- 0.38 mm before to 3.45 +/- 0.56 mm after the procedure). Mean percent diameter stenosis decreased from 83.33 +/- 10.84 percent before to 3.38 +/- 5.74 percent after the stent deployment. Mean reference vessel diameter was 3.45 +/- 0.56 mm. There were occasional technical complications including balloon rupture (1), stent migration (2) and distal embolisation of atheromatous material (1). One patient developed subacute stent thrombosis. There were no other major in-hospital cardiovascular events. At the end of six-month follow-up, there were no myocardial infarction or death. Six patients presented with recurrence of symptoms within six-months of the procedure, four of whom underwent target vessel revascularisation procedure. In conclusion, the in-hospital and six-month follow-up clinical results were highly encouraging with KR stent. Successful deployment rates were high despite unfavourable clinical and angiographic background. Low clinical events on follow-up will make it suitable for elective stenting.