Relation of anthropometric variables to coronary artery disease risk factors.

BACKGROUND AND OBJECTIVES: Anthropometric variables and their relation to conventional coronary artery disease (CAD) risk factors in railway employees have been inadequately studied in India. This cross-sectional survey was carried out in the Solapur division of the Central railway in the year 2004, to assess the anthropometric variables in railway employees and their relation to conventional CAD risk factors. MATERIALS AND METHODS: A total of 995 railway employees, with 872 males and 123 females participated in this cross-sectional study. All subjects underwent anthropometric measurements, fasting lipid profile, and blood sugar level. Various anthropometric indices were calculated for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and abdominal volume index (AVI). Statistical analysis was done by EPI Info 6 statistical software. RESULTS: Compared to all other obesity indices, WHtR was most prevalent in both genders. High WHtR was present in 699 (80.16%) males and 103 (83.73%) females. Age ≥45 years, high systolic BP, high diastolic BP, low HDL, high triglyceride, and diabetes mellitus were positively correlated with high BMI, high WC, high WHR, high WHtR, and high AVI. High BMI, high WC, high WHR, high WHtR, and high AVI were negatively associated with physical inactivity. CONCLUSIONS: Over all, anthropometric variables in both genders were significantly deranged in subjects with coronary risk factors. Compared to all other anthropometric variables, WHtR was statistically significantly associated with a majority of coronary artery risk factors. Hence we recommend inclusion of WHtR as a parameter of obesity to predict coronary artery disease risk factor along with WC, WHR, and BMI in epidemiologic studies.

Metabolic syndrome in railway employees and its relation to lifestyle factors.

BACKGROUND: Limited information is available about the prevalence of the metabolic syndrome(MeTS) in India. Railway employees provided a unique opportunity to study the prevalence of MeTS in a variety of jobs. METHODS: A total of 995 railway employees, 872 males (mean age 42.96 +/- 7.91) and 123 females (mean age 44.28 +/- 7.91), underwent physical examination and anthropometric measurement for waist circumference; 605 males and 95 females also underwent biochemical examination. MeTS was diagnosed using ATP III criteria modified for Indians. RESULTS: The prevalence of MeTs in males was 162/605 (26.77%) and in females 26/95 (27.36%). Amongst all components of MeTS, high waist circumference was most prevalent in females (89.83%) and systolic hypertension in males (61.12%). In multivariate analysis, waist circumference in both genders had good association with sedentary job (P < 0.02), high fasting blood sugar (P < 0.02), age 45 years or older (P < 0.001), high systolic blood pressure (P < 0.001), high diastolic blood pressure (P < 0.001), physical inactivity (P < 0.001), while the correlation of dyslipidemia (low HDL and high triglycerides) with high waist circumference was not statistically significant. CONCLUSION: These results from a representative sample of Solapur division railway employees show that the MeTs is highly prevalent mainly in sedentary workers aged 45 years or older. The large numbers of Indian Railway employees with the MeTs may carry important implications for the health care sector.

Adult type anomalous left coronary artery from pulmonary artery.

Anomalous origin of Left Coronary Artery from Pulmonary Artery (ALCAPA) is a rare congenital anomaly. Its survival into adulthood is further rare. Clinical manifestations result from evolving morphological - functional alterations in pulmonary circulation that occur after the birth. We report a case of 43 year old adult patient with effort angina and without any ECG or Echo abnormalities. On coronary angiography, typical anatomy of ALCAPA was revealed.

Effects of atorvastatin on higher functions.

OBJECTIVE: This study was undertaken to assess the effects of atorvastatin on cognition and higher mental functions. METHODS: In this before and after comparison study with controls, group one included 55 subjects aged > or =40 years requiring statins for cardiovascular indications who were started on atorvastatin (10 mg/day). Group two assigned to receive placebo were men and women chosen from the same geographical area and matched for age, sex, education and presence of hypertension and diabetes mellitus. Assessment was done with the Mini-Mental State Examination, Digit Span, Picture Test (average and delayed), Trail Making Test, Controlled Oral Word Association Test, Digit Symbol Substitution Test and Auditory Vigilance and Digit Vigilance Test at baseline and after 6 months. Changes between baseline and 6 months in the above parameters of mental function were compared using suitable statistical tests in the atorvastatin and placebo groups. To limit experiment-wise error, performance scores were grouped into five cognitive domains, which were labeled as attention, psychomotor speed, mental flexibility, working memory and memory retrieval. Summary effect sizes were estimated as z-scores. RESULTS: Both subjects on atorvastatin and placebo showed improvement in the majority of scales consistent with a learning effect on test performance. However, subjects treated with atorvastatin scored significantly over the placebo group in all domains, i.e. tests of attention [z-score=0.54, 95% confidence interval (CI): 0.38-0.64, p=0.001], psychomotor speed (z-score=0.28, 95% CI: O.09-0.47, p<0.001), mental flexibility (z-score=0.27, 95% CI: 0.22-0.32, p=0.01), working memory (z-score=1.22, 95% CI: 0.93-1.50, p<0.001) and memory retrieval (z-score=0.59, 95% CI: 0.36-0.82, p<0.05). CONCLUSION: The present study concludes that there are significant beneficial effects of atorvastatin in a dose of 10 mg/day for a period of 6 months on higher functions as measured by the above standard neurocognitive tests.

Importance of reciprocal leads in acute myocardial infarction.

OBJECTIVES: To study the relevance of the ECG changes in the reciprocal leads in patients with acute anterior and inferior wall myocardial infarction, with regard to culprit artery localization and left ventricular (LV) function. METHODS: Three hundred patients of acute myocardial infarction (AMI) (180 anterior, 120 inferior) aged between 30-90 years (mean age - 60 yrs; M:F - 220:80) were studied with regard to the reciprocal lead changes which were correlated with the culprit coronary artery and LV function. 285/300 (95%) patients underwent echocardiography and 62/300 (20.67%) underwent coronary angiography (CAG). RESULTS: In patients with acute anterior wall MI (AWMI), Q wave in inferior leads was found in 38.8% (70/180) patients. Nineteen patients underwent (CAG) and all 70 patients underwent 2D echocardiography. CAG revealed 10/19 and 9/19 patients to have single vessel disease (SVD) and multivessel disease (MVD), respectively. In presence of SVD, 80% (8/10) patients were found to have a distal/mid LAD occlusion. The echocardiogrpahy of these 19 patients showed that 15/19 (78.94%) of these had LV ejection fraction (EF) > 40% as against only 4/19 (21.05%) patients with LVEF < 40%. The echocardiographic study of patients with and without reciprocal ST depression in inferior leads more than or equal to the ST elevation in anterior leads, showed higher incidence of LV dysfunction i.e. LVEF < 40% in patients with reciprocal changes (72.05%) as compared to patients without the reciprocal changes (27.94%). In patients with acute inferior wall MI (IWMI), anterior and lateral ST depression more than or equal to ST elevation in inferior leads was found in 80% (96/120) patients. 27/96 patients underwent coronary angiography and all 96 underwent echocardiography. Patients with ST depression in I, a VL, V4-V6 (apicolateral leads) > or = ST elevation in inferior leads were found to have more occurrence of multivessel disease (21/27) with LVEF < 40% (50/64 i.e. 78.12%, P < 0.001). 12.5% (4/32) patients with reciprocal changes in anterior i.e. VI-V3 leads and 15% (3/20) patients without significant reciprocal changes in anterior and lateral leads had LVEF < 40%. Also, patients with ST depression in I, aVL showed higher incidence of right coronary artery (RCA) lesion (23/27) (P < 0.001). CONCLUSIONS: Patients of acute AWMI with Q waves in inferior leads indicate a smaller infarct with higher incidence of mid/distal LAD occlusion and a relatively preserved LV function. AWMI patients without reciprocal changes in inferior leads have a better LVEF. Patients of acute IWMI with ST depression in apicolateral leads have more occurrence of multivessel disease with significant LV dysfunction. Reciprocal ST depression in I, aVL suggests a possibility of RCA lesion.