Assessment of Demographics, Management and Outcomes of Acute Coronary Syndrome in Rural Population of India

Introduction: Acute coronary syndrome (ACS) comprise the majority of hospital admissions and encompass a high risk of inhospital mortality. This study aimed to understand and assess the characteristics of hospitalized ACS patients, trends in theirmanagement as per evidence based medicine, and its impact on outcome. Materials & Methods: This was a prospective,observational study conducted at a tertiary care hospital in India during January 2018 to December 2018. All consecutive patientssuspected of ACS having age ≥ 18 years were admitted. During hospitalization, a case report form was filled out for patients withdiagnosis of ACS. It included data on demographic, clinical and electrocardiographic characteristics of the patients, diagnosis &treatment modalities. Treatment outcome was mentioned in terms of TIMI grading & in hospital complications. Results: A total of112 consecutive patients admitted in cardiac ICU were enrolled. Out of them 72 (64.28%) were males and 40 (35.72%) werefemales. Mean age of study cohort was 55.98±10.68 years. Most commonly associated conventional risk factors wereHypertension and diabetes [65 (58.04%) hypertensives and 33 (29.46%) diabetics]. Medical management was offered to 78(69.64%) whereas, 34 (30.36%) underwent PTCA or CABG. TIMI flow grading assessment done in 62 patients of which 1/3rdpatients showed TIMI grade 3.Conclusion: The present study showed higher ACS prevalence among patients who were in sixth toseventh decade of life, most commonly males, and associated with conventional risk factors, hypertension and diabetes.

Ambulatory blood pressure pattern in overweight and obese subjects: a prospective, cross-sectional study

Background: Obesity is widely described as a leading cause of morbidity and mortality and is a known risk factor of many cardiovascular and non-cardiovascular diseases including hypertension. The aim of this study was to analyze the pattern of ambulatory blood pressure in overweight and obese subjects.Methods: This was a prospective, cross-sectional study performed over a period of 1 year in 95 subjects attending the Department of Medicine of tertiary care teaching institute. Anthropometric measures such as weight, height, body mass index (BMI), and waist circumference (WC) were recorded. Ambulatory blood pressure monitoring over a period of 24-hrs was performed in each individual and values were recorded. Comparison between normal subjects and overweight and/or obese subjects was done in terms of various ambulatory BP parameters.Results: Based on BMI, significantly higher proportion of females were obese (p-value = 0.020), as compared to males. Based on both BMI and WC, significant proportion of overweight and obese subjects had higher 24-hr SBP (p-value < 0.001) and 24-hr DBP (p-value = 0.001); higher day-time SBP (p-value < 0.001); higher night-time SBP (p-value < 0.001); and widening of 24-hr pulse pressure (> 50 mmHg) (p-value < 0.001) as compared to normal subjects. However, among various abnormal ABPM parameters, majority of the parameters revealed more incidence of BP abnormalities with increased BMI than with increased WC. Thus, BMI appeared to be a better anthropometric parameter than WC.Conclusions: The findings of the present study confirm that obesity in apparently non-hypertensive subjects leads to rise in both SBP and DBP. Moreover, it is the systolic part of ABPM which probably predicts the cardiovascular morbidity in overweight and obese subjects.

Prevalence of cardiac autonomic dysfunction in patients with metabolic syndrome: a cross-sectional, observational study

Background: Cardiovascular autonomic neuropathy (CAN) is a distinguished disorder associated with diabetes mellitus and metabolic syndrome. The pathogenesis of CAN in patients with metabolic syndrome still remains unclear. This study was undertaken to assess the prevalence of cardiac autonomic dysfunction in patients with metabolic syndrome and to correlate different parameters of metabolic syndrome with cardiac autonomic dysfunction.Methods: In this cross-sectional observational study, total 100 consecutive cases meeting the inclusion criteria and attending the Department of Medicine in Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi were enrolled. 50 subjects who satisfied the IDF criteria of metabolic syndrome were taken as cases and remaining 50 subjects (age and gender matched) who did not satisfy the IDF criteria were taken as controls. Comparison of categorical variables was made using chi-square or Fisher’s exact test. P-value <0.05 was considered as statistically significant.Results: Majority of study population (i.e., 42%) belonged to the age group of 41-50 years. Overall prevalence of cardiac autonomic dysfunction (CAD) was 25%. Prevalence of CAD among cases and controls was 38% and 12%, respectively. Overall distribution of various parameters like waist circumference, fasting blood glucose, blood pressure, HDL-C and serum triglycerides was assessed in all subjects with respect to CAD. Statistically significant association of these parameters was seen with CAD (p-value ≤0.01).Conclusions: In this study, strong association was found between CAD and central obesity, impaired fasting glucose, high blood pressure and dyslipidemia. Thus, the metabolic disorders are good predictors of CAD.