Chronic infections & coronary artery disease with special reference to Chalmydia pneumoniae.

BACKGROUND & OBJECTIVES: Studies on cardiovascular diseases (CVD) in India have shown about 10-20 per cent of cases with no obvious risk factors, raising a suspicion of infections as a cause. There is a paucity of data on this possible role of infections. This study was, therefore, undertaken to find out the association between infection due to Chlamydia pneumoniae and other organisms and coronary artery disease (CAD). METHODS: Patients with CAD were selected in group I (acute myocardial infarction, AMI) and group III (patients undergoing coronary artery bypass graft (CABG) surgery), and normal controls in group II. Routine biochemical, haematological and inflammatory tests [C-reactive protein (CRP), total leucocyte count (TLC), fibrinogen, ESR], serodiagnostic tests for IgA and IgG antibodies to C. pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), Mycoplasma pneumoniae and Parvovirus B-19 by ELISA kits, C. pneumoniae antigen by microimmunofluorescence and PCR from endothelial tissue obtained at CABG were carried out. Aortic punch biopsies were done in patients who underwent CABG. RESULTS: Acute MI patients had a significantly higher association with accepted cardiac risk factors, lipid profile, inflammatory and thrombogenic tests. IgG and IgA antibodies levels against C. pneumoniae were not significantly different in the controls as against the AMI group. However, C. pneumoniae antigen seropositive group had significant association with HDL cholesterol, lipid tetrad index (P<0.001) and with triglycerides. Parvovirus B antigen was detected in 8.3 per cent of tissue specimens by PCR and of 44 patients with AMI (6.8%) were also positive for parvovirus B-19 IgG antibodies. INTERPRETATION & CONCLUSIONS: There was no direct evidence of the involvement of C. pneumoniae and other infective agents and viruses in CAD. It is possible that such infections produce an indirect adverse effect on the lipid profile.

Risk factors for ischemic heart disease in Delhi. (A prospective study of 7000 cases).

BACKGROUND: A prospective study of 7000 consecutive patients with IHD was carried out for "traditional" risk factors at the National Heart Institute (NHI) of the All India Heart Foundation (AIHF) and compared with 1000 "normal" controls. A specially designed proforma was used. STUDY GROUP: There were 5334 men (76%) and 1666 women (24%). The ages ranged from 24 to 92 years; above 60 (35%), between 51-60 (23%), 41-50 (22%) and below 40 (21.7%). The risk factor profile for the whole group was positive family history 38%, sedentary lifestyle 56%, overweight & obesity 21%, hypertension 64%, smoking 43% diabetes 39%, hypercholesterolemia 21% with no obvious risk factor in 15%. Those with no obvious risk factors could have had some of the "new" ones, which were not addressed. 2 & 3 risk factors were present in the majority (5618 patients 80%) and multiple risk factors in 96%. Hypertension was dominant in all groups. WOMEN: Significant differences were more, sedentary lifestyle, little or no smoking, higher cholesterol and more with no obvious risk factors. PRECOCIOUS IHD: In the 22% below 40 years, there was a significantly higher family history and smoking with significant prevalence of smoking, hypertension and diabetes. EXECUTIVE GROUP: The ages ranged from 24 to 59 with none above 60. There was no obvious risk factor in 55%. Here was a positive family history in 30.8%, sedentary lifestyle in 34%, smoking in 24.7%, hypertension in 16.5%, diabetes 11.8% and high cholesterol only in 5.6%. CONCLUSION: Multiple traditional risk factors were dominant in all the groups, with hypertension heading the list. Control of these, should be the target for all preventive programmes, targeting the general population and high risk groups.

Cardiovascular disease incidence in some asian-pacific countries

A cooperative survey of general hospitals in Australia, India and the Philippines during 1954-1956 showed that the cardiovascular incidence and distribution pattern in the Philippines was intermediate between those of Australia and India in a similar manner as the Philippines is, culturally speaking, intermediate between the two. However, no good correlation was observed between the cardiovascular incidence of hypertensive and arteriosclerotic heart diseases with the reported values of serum cholesterol and dietary fats in these countries. (Summary and Conclusions)

Treatment and prevention of target organ damage.

Target organ damage to the brain, heart or kidneys due to hypertension appears to differ in various ethnic groups. Prevention of such damage is by early recognition of mild hypertension and institution of treatment primarily by non-pharmacologic and if required drugs. Treatment of established damage is by both these methods. In the choice of drugs 24-hour control of blood pressure is essential as is regression of left ventricular hypertrophy. Other desirable qualities of the drugs are their anti-ischaemic and anti-atherogenic effects.

Present status of rheumatic fever and rheumatic heart disease in India.

This paper examines the present status of Rheumatic fever (RF) and Rheumatic heart disease (RHD) in India with reference to both prevalence and incidence, and evaluates the currently available methods of control. Data available over the last 10 years shows that the prevalence of RF/RHD in the most vulnerable group i.e. school children between 5 to 15 years of age is still unacceptably high. RHD is encountered in 1 to 5.4 per 1,000 in large samples of school children and RF in 0.3 to 0.5 per 1,000 children. There appears to be no obvious decline in its prevalence in school children over a 20 year period. Because of preoccupation with adult cardiac diseases specially ischemic heart disease (IHD), the problem of RF/RHD has been sidelined and studies on prevalence, treatment and prevention receive scant attention. Only exotic palliative methods such as balloon mitral valvotomy (BMV) have become the centre stage. Studies are needed on the lines of WHO recommendations for the regional prevalence of RF/RHD in school children throughout the country to detect regional variations. The most effective method for control is primary prevention by treating streptococcal sore throat and secondary prevention by early detection and continuous penicillin prophylaxis. This could be done most effectively by general physicians (GP's) who need motivation and education and through school health services. The latter needs to be organised on a state-wise basis throughout the country as it is available in only a few cities. Public health education by all available media specially, through video films is also recommended. The lacunae in our knowledge of RF/RHD calls for further research.

Thrombolytic therapy in clotted prosthetic mitral valve.

Thrombosis of a Bjork-Shiley valve in the mitral position was suspected clinically and confirmed by echocardiography and cine fluoroscopy. Streptokinase therapy followed by intravenous heparin infusion was given and the clot lysed successfully. The patient was asymptomatic upto two years of follow-up.

An evaluation of cardiac function in malnourished children by non-invasive methods.

Forty-six malnourished children between 3-48 mo with varying grades of malnutrition (PEM) were evaluated for left ventricular function by echocardiography. None of these children had any pre-existing cardiac disease, chronic illness or significant anemia. Children with Grades III and IV PEM had significantly smaller cardiac chamber size and ventricular wall thickness as compared to normally nourished children. Cardiac output as well as other indices of left ventricular function (percentage fractional shortening, mean rate of circumferential fibre shortening and ejection fraction) were also significantly decreased in severe PEM. The atrophic PEM heart does appear to show left ventricular dysfunction in moderately severe malnutrition.

The community control of rheumatic fever and rheumatic heart disease: report of a WHO international cooperative project.

The feasibility and effectiveness of a programme for the community control of rheumatic fever and rheumatic heart disease were studied in a cooperative multicentre project initiated and coordinated by the World Health Organization. The programme was carried out in seven centres in various developing countries of Africa, America, and Asia according to a common protocol, and is under way in a further eight countries in Latin America. Pilot community programmes were shown to be practicable and effective in reducing the burden of rheumatic heart disease in developing countries and their extension to cover entire populations should be encouraged.