C ardiovascular diseases (CVDs) are the leading cause of death in many regions of the world (1). Elevated blood pressure, blood sugar, serum cholesterol, body mass index, and tobacco use, all established risk factors for CVD, have a direct and linear relationship with CVD (2-7). All of these risk factors are linked to lifestyle changes (4).Although reasonable evidence exists for the beneficial role of risk factor reduction in decreasing CVD risk among individuals at high risk, primary or primordial prevention programs that use populationbased approaches have yielded equivocal results (8,9). For example, a meta-analysis of all population-based studies conducted largely in developed countries has suggested that health promotion (involving health education, mass media, and community organization) does not reduce mortality significantly but leads to small yet potentially beneficial reduction in risk factor levels (10). Several reasons have been attributed to this equivocal result of health promotion. These include shorter duration of intervention, improper design to evaluate the benefits, contamination (adoption of components of health intervention by the control community), and a declining trend of CVD in developed countries during the intervention period. However, by contrast, in developing countries the current prevailing secular trend seems to be a rapidly increasing burden of CVD and its risk factors. Therefore it is likely that a community-based approach may show the desired results of reducing CVD risk factors in developing country settings. For example, a primary prevention and health promotion initiative in Mauritius showed a pronounced decrease in the population level total cholesterol concentrations after 5 years of the intervention program (11).India is experiencing an accelerated epidemiological transition with a consequent increase in the burden of CVD risk factors both in community-based studies and in industrial populations (12)(13)(14)(15)(16). Given this background, we hypothesized that a comprehensive CVD risk factor reduction program comprising of a multipronged strategy of health promotion, high-

The usefulness of a reduction in ST segment elevation to predict coronary reperfusion in myocardial infarction remains uncertain. ST segment changes and angiographic findings were compared in 45 patients soon after thrombolysis. The percentage ST segment change 3 hours after treatment (in the lead showing the greatest initial ST elevation) was compared with the TIMI perfusion grade (thrombolysis in myocardial infarction trial) obtained between 90 minutes and 3 hours after treatment. Global ejection fraction and regional wall motion were assessed by cineventriculography (11 (5) days (mean (SD))) and by gated blood pool imaging (44 (11) days). Prediction of coronary patency by a reduction of greater than 25% in ST segment elevation 3 hours after thrombolytic treatment had a sensitivity of 97% but a specificity of only 43%. Where the ST segment elevation was reduced by greater than 25% the global ejection fraction was well maintained whether or not the infarct vessel was patent. In patients with a reduction of less than 25% in ST elevation, the ejection fraction was significantly lower and regional wall motion abnormality more severe. Reduction in ST elevation of greater than 25% within 3 hours of thrombolysis indicates either a patent infarct artery or preservation of left ventricular function. When the ST segment elevation does not fall by greater than 25% persistent coronary occlusion is likely (predictive accuracy 86%) and is associated with a lower ejection fraction. These patients may benefit from further treatment or additional interventions.

Cardio Vascular disease (CVD) as well as depression are both highly prevalent disorders and both of them cause a significant decrease in quality of life and increase the economic burden for the patient. Depressed individuals are more likely to develop angina, fatal or non-fatal myocardial infarction, than those who are not depressed. Over the past decade, evidence has accumulated to suggest that depression may be a risk factor for cardiac mortality in patients with established coronary artery disease (CAD). The 'vicious cycle' linking CVD to major depression and depression to CVD, deserves greater attention from both cardio-vascular and psychiatric investigators.(1).

Idiopathic aneurysmal dilatations of the right atrium are rare anomalies. We report one such case of a young man presenting with fatigue, abdominal distension, pedal oedema, unremarkable cardiac examination except for raised jugular venous pressure, an electrocardiogram showing normal sinus rhythm with right bundle-branch block, and an radiograph of the chest showing cardiomegaly. The echocardiographic examination revealed a giant right atrium with low pressure tricuspid regurgitation. The computed tomography confirmed the findings of two-dimensional echocardiography. He was put on medical treatment and remained symptomatically controlled on follow-up.

ObjectivesWe describe the clinical characteristics, prevalence and control of coronary artery disease (CAD) risk factors of the Indian cohort enrolled in the CLARIFY registry and compare them with data from rest of the world (ROW).MethodsCLARIFY is an international, prospective, observational, longitudinal cohort study in stable CAD outpatients. The baseline data of Indian cohort (n = 709) were compared to ROW (n = 31994).ResultsThe CLARIFY India patients were significantly younger than the ROW (59.6 ± 10.9 vs 64.3 ± 10.4). Indian patients were more likely than those in ROW to have diabetes (42.9% vs 28.8%) and angina (27.8% vs 21.9%). Mean heart rate was significantly greater in Indians measured by either palpatory method (76.1 ± 10.4 vs 68.0 ± 10.5) or ECG (74.9 ± 12.9 vs 67.0 ± 11.3). The use of aspirin (85.6% vs 87.8%), β-blockers (69.4% vs 75.4%), and lipid-lowering agents (90% vs 92.4%) was lower in India. A significantly greater proportion of patients in India exhibited low HDL cholesterol (41.6% vs 31.2%), and heart rate ≥70 bpm (82.2% vs 48.5%). The risk factors control was poor in India with heart rate goal of ≤60 bpm achieved in 2.5%; HbA1c <7% in 9.9%; and HbA1c <6.5% in 4.6% patients.ConclusionThe CLARIFY registry demonstrates a high prevalence and poor control of cardiovascular risk factors in Indian patients. Systematic efforts to improve risk factor control are required.