A case-control study of risk factors for coronary heart disease in urban Indian middle-aged males.

OBJECTIVE: There are few case-control studies on native Indians to explore the reasons for the growing prevalence of coronary heart disease (CHD) in Indians. The present study was undertaken to identify the conventional coronary risk factors in angiographically proven CHD cases by comparing their prevalence in age-and gender-matched healthy controls. METHODOLOGY: A hospital-based case-control study was performed on 197 middle-aged urban males (age 40-64 years) with angiographically proven CHD and 197 age (32 years) and gender-matched healthy controls in a tertiary cardiac care center of New Delhi. Prevalence of coronary risk factors with special emphasis on diet was determined by administration of a pre-tested questionnaire, physical examination, and biochemical estimation of blood lipids and glucose. Odds ratios (OR) and their 95% confidence intervals (CI) for the association of risk factors with CHD and their population attributable risks (PAR) were calculated. RESULTS: Logistic regression analysis showed that history of diabetes mellitus (OR 4.934, 95% CI 2.320-10.494), low education (OR 2.410, 95% CI 1.261-4.608), full cream milk consumption (OR 2.113 95% CI 1.176-3.798), and family history of premature cardiovascular disease (CVD) (OR 1.810, 95% CI 1.064-3.079) were independent risk factors for CHD. High HDL-C (OR 1.055 95% CI 1.025-1.086) and fruit intake (OR 1.473, 95% CI 1.020-2.128) emerged as anti-risk factors. 44.1% of PAR was attributable to low HDL-C (.3%), low education status (6.6%), history of diabetes mellitus (6.0%), family history of premature CVD (4.4%), low fruit consumption (4.3%), tobacco abuse (4.2%), full cream milk consumption (3.6%) or milk intake (3.4%), high fasting blood glucose (2.3%), and history of hypertension (2.07 percent;). CONCLUSIONS: Conventional risk factors are not enough to explain the high prevalence of CHD among native Indians. While efforts must go on to reduce the risk attributable to them, the role of emerging risk factors should be investigated.

Reducing the burden of coronary artery disease in India: challenges and opportunities.

Asian Indians--living both in India and abroad--have one of the highest rates of coronary artery disease (CAD) in the world, three times higher than the rates among Caucasians in the United States. The CAD among Indians is usually more aggressive at the time of presentation compared with whites or East Asians. The overall impact is much greater because the CAD in Asian Indians affects the "younger" working population. This kind of disproportionate epidemic among the young Indians is causing tremendous number of work days lost at a time when India is experiencing a dizzying economic boom and needs a healthy populace to sustain this boom. While the mortality and morbidity from CAD has been falling in the western world, it has been climbing to epidemic proportions among the Indian population. Various factors that are thought to contribute to this rising epidemic include urbanization of rural areas, large-scale migration of rural population to urban areas, increase in sedentary lifestyle, abdominal obesity, metabolic syndrome, diabetes, inadequate consumption of fruits and vegetables, increased use of fried, processed and fast foods, tobacco abuse, poor awareness and control of CAD risk factors, unique dyslipidemia (high triglycerides, low HDL-cholesterol levels), and possible genetic predisposition due to lipoprotein (a) [Lp(a)] excess. The effect of established, as well as novel, risk factors is multiplicative, not just additive (total effect>sum of parts). The management would require aggressive individual, societal, and governmental (policy and regulatory) interventions. Indians will require specific lower cut-offs and stricter goals for treatment of various risk factors than is currently recommended for western populations. To this end, the First Indo-US Healthcare Summit was held in New Delhi, India on December 14 and 15, 2007. The participants included representatives from several professional entities including the American Association of Physicians of Indian origin (AAPI), Indian Medical Association (IMA), Medical Council of India (MCI), and Government of India (GOI) with their main objective to address specific issues and provide precise recommendations to implement the prevention of CAD among Indians. The summary of the deliberations by the committee on "CAD among Asian Indians" and the recommendations are presented in this document. OBJECTIVES: Discussion of demographics of CAD in Indians-both in India and abroad, current treatment strategies, primordial, primary, and secondary prevention. Development of specific recommendations for screening, evaluation and management for the prevention of CAD disease epidemic among Asian Indians. Recommendations for improving quality of care through professional, public and private initiatives.

Valvular heart disease: diagnosis and management.

Valvular heart disease is a leading cause of morbidity and mortality in India. Advances in both surgical and percutaneous techniques and a better understanding of timing for intervention accounts for the current increased rates of survival. Echocardiography remains the gold standard for diagnosis and periodic assessment of patients with valvular heart disease. Generally, patients with stenotic valvular lesions can be monitored clinically until symptoms appear and most can now benefit from percutaneous techniques. In contrast, patients with regurgitant valvular lesions require careful echocardiographic monitoring for left ventricular function and may require surgery even if no symptoms are present. Percutaneous therapy of valvular regurgitant lesions is yet to evolve fully.