Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. Prevalence of metabolic risk factors including diabetes mellitus, obesity, etc. is rapidly increasing in India putting this population at risk for NAFLD. Patients with NAFLD are at increased risk for liver-related morbidity and mortality and also cardiovascular disease risk and increased incidence of diabetes mellitus on long-term follow-up. Management of patients with NAFLD may require a multi-disciplinary approach involving not only the hepatologists but also the internists, cardiologists, and endocrinologists. This position paper which is a combined effort of the Indian National Association for Study of the Liver (INASL), Endocrine Society of India (ESI), Indian College of Cardiology (ICC) and the Indian Society of Gastroenterology (ISG) defines the spectrum of NAFLD and the association of NAFLD with insulin resistance and metabolic syndrome besides suggesting preferred approaches for the diagnosis and management of patients with NAFLD in the Indian context.
"A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India" was organized as a pre-conference symposium of the 2 nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24 th August. This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of World Health Organization, National Accreditation Board of Hospitals, Medical Council of India, Drug Controller General of India, and Indian Council of Medical Research along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and range of opinions to guide formation of the road map. The ethos of the meeting was very much not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance. The Chennai Declaration will be submitted to all stake holders.
| INTRODUC TI ONCardiovascular disease (CVD) is the world's leading cause of death, killing 18 million people per year-about one-third of all deaths. 1 Hypertension is the leading cause of CVD and contributes to 10 million deaths per year-the same number of people killed by all infectious diseases combined. 2 Whereas the burden of hypertension and CVD afflict predominantly older aged persons in high-income countries, younger populations are disproportionately affected in lowand middle-income countries. 1 It is estimated that CVD costs 2%-4% of gross national income in these countries. 3 Hypertension is amenable to treatment with generic, oncedaily, low-cost medications that are safe and effective, yet currently, fewer than 15% of adults with hypertension worldwide have their blood pressure controlled to 140/90 or lower. 4 Some countries and health systems have achieved control rates approaching 70%; 5,6 accomplishing this on a global basis could save millions of lives. The Resolve to Save Lives Cardiovascular Health Initiative has been established to help improve hypertension management. Resolve to Save Lives -a 5-year, $225 million initiative based at Vital Strategies, a global health nonprofit organization, is supporting key organizations and engaging new partners to help low-and middle-income countries accelerate and scale-up implementation of proven tools and strategies to prevent CVD. 7 These tools, together with the elimination of artificial trans-fats and a reduction of sodium consumption, could improve hypertension management and save 100 million lives over the next 30 years.
BACKGROUND: Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India compared to Western countries and are increasing. Moreover, ASCVD events occur at a younger age with only modest hypercholesterolemia, most commonly with low levels of high-density lipoprotein cholesterol. The course of ASCVD also appears to be more fulminant with higher mortality.OBJECTIVE: In light of these issues, the Lipid Association of India (LAI) endeavored to develop revised guidelines with more aggressive low-density lipoprotein cholesterol (LDL-C) goals in secondary prevention and for patients with familial hypercholesterolemia compared to guidelines in the United States and other countries.METHODS: Owing to the paucity of clinical outcomes data in India, it was necessary to place major emphasis on expert opinion as a complement to randomized placebo-controlled data generated mostly in non-Indian cohorts. To facilitate this process, the LAI conducted a series of 19 meetings among 162 lipid specialists in 13 cities throughout India over a period of 11 months before formulating this expert consensus statement.RESULTS: The LAI recommends an LDL-C goal ,50 mg/dL in all patients in secondary prevention or very high-risk primary prevention but proposes an optional goal #30 mg/dL in category A extreme-risk patients (eg, coronary artery disease 1 familial hypercholesterolemia) and a recommended goal #30 mg/dL in category B extreme-risk patients [coronary artery disease 1 (1) diabetes and polyvascular disease/$3 major ASCVD risk factors/end organ damage, or (2) recurrent acute coronary syndrome within 12 months despite LDL-C ,50 mg/dL, or (3) homozygous familial hypercholesterolemia].CONCLUSIONS: More aggressive LDL-C goals are needed for prevention of ASCVD in India, as described in this expert consensus statement. Use of statins and ezetimibe needs to increase in India in combination with improved control of other ASCVD risk factors. Proprotein convertase subtilisin kexin type 9 inhibitors can improve LDL-C goal achievement in patients with refractory hypercholesterolemia.
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