Abstract:The increasing pressure on health resources has led to the emergence of risk assessment as an essential tool in the management of cardiovascular disease (CVD). Concern exists regarding the validity of their generalization to all populations. Existing risk scoring models do not incorporate emerging 'novel' risk factors. In this context, the aim of the study was to examine the relevance of British, European, and Framingham predictive CVD risk scores to the asymptomatic high risk Indian population. Blood samples drawn from the participants were analyzed for various 'traditional' and 'novel' biomarkers, and their CVD risk factor profi ling was also done. The Framingham model defi ned only 5% of the study cohort to be at high risk, which appears to be an underestimation of CVD risk in this genetically predisposed population. These subjects at high risk had signifi cantly elevated levels of lipid, pro-infl ammatory, pro-thrombotic, and serological markers. It is more relevant to develop risk predictive scores for application to the Indian population. This study substantiates the argument that alternative approaches to risk stratifi cation are required in order to make them more adaptable and applicable to different populations with varying risk factor and disease patterns.
Asian Indians have a high predisposition to metabolic syndrome (MS) and coronary artery disease (CAD). The present study aimed to estimate MS prevalence in 531 Asian Indian families comprising of 2318 individuals. Anthropometrics and lipid profi le were assessed. MS prevalence was estimated using standard Adult Treatment Panel III (ATP-III) and World Health Organisation (WHO) criteria and modifi ed defi nitions which included lowered cut-offs for waist circumference (WC) (Ն90 cm for men and Ն80 cm for women], body mass index (BMI) (Ն23 kg/m 2 ) and impaired fasting glucose (IFG) levels. ATP-III criteria identifi ed a signifi cantly higher proportion of people with MS (N = 933; 40.3%) compared with WHO (N = 708; 30.6%; p Ͻ 0.0001) while modifi ed ATP-III showed maximum gain in percent prevalence among the revised criteria (17.3%; p = 0.0056). The IDF criteria identifi ed similar proportion of subjects with MS (N = 809; 34.9%) as the revised WHO criteria (N = 792; 34.2%). The number of MS subjects was highest in the 50-59 years age group. MS was diagnosed a decade earlier in unaffected subjects compared with those with CAD/diabetes using the modifi ed MS criteria. WC correlated signifi cantly with BMI and waist-hip ratio (WHR) (p = 0.000). Among MS components, high density lipoprotein cholesterol and BMI contributed signifi cantly in males (71.4% and 85.9%) and females (86.8% and 88.8%), respectively. The higher percentage contribution of WC among males and WHR among females indicates the infl uence of gynecoid/android pelvis on WHR measures. In conclusion, the revision of defi nition criteria for MS with lowered cut-offs for WC and BMI is critical for the accurate assessment of MS among Asian Indians.
Coronary artery disease (CAD) is a multifactorial disease, and family history is the best available tool to assess gene-environment interaction. This study addressed the heritability of quantitative traits, namely lipid, coagulation/fibrinolysis and pro-inflammatory markers in the ongoing family-based Indian Atherosclerosis Research Study and assessed the effect of the type/lineage of CAD family history on inheritance patterns in the high-risk Indian population. A total of 518 families comprising 2,305 individuals were recruited in phase I of the IARS; of these, 1,195 individuals from 220 families were included in the heritability analysis. With the exception of leptin, all phenotypes exhibited significant age- and sex-adjusted heritability (p < 0.0001). Amongst all the phenotypes analysed after adjustment for confounding factors, the significantly higher heritability estimates of triglycerides (0.53, p < 0.0001), lipoprotein (a) (0.83, p < 0.0001) and interleukin-6 (0.46, p < 0.0001) with low spouse pair correlations identifies them as possible CAD risk factors. Families with parental history of CAD had onset of CAD symptoms at much younger ages with significantly higher heritability of proinflammatory markers, whereas in families with sibling history of CAD, more risk factors were present at significantly higher levels. Triglycerides, lipoprotein (a) and interleukin-6 appear to be promising atherothrombotic candidate phenotypes in this population. Genes controlling these phenotypes are possible candidate genes linked with CAD. An informed understanding and incorporation of 'family history' as a screening tool may help in the prevention and pre-emption of CAD.
Objective To formulate a consensus statement for utilisation combination of DAPT and statin combination based on evidence and real-world experiences. Methods A virtual collaborative educational initiative was convened in June 2022 through a series of nationwide (n = 16) meetings with 275 cardiologists (cumulative experience of 2,200-man years) at forefront of ACS management, who rated their level of agreement for 10 questions (6 Likert scale, 4 objective choice). This was preceded by evidence-based discussion of combination of DAPT and statin. Consensus was predefined as > 60% agreeing/disagreeing on any given item. Results Highest agreement was for the concurrence for clinical relevance of concept of stratified treatment of ACS (95.4%). Agreement score (%) for that DAPT- statin combination is underutilised was 83.8%, followed by the need for optimal management of ACS (75.5%), relevance of BATTLE AMI hypothesis (74.6%), clopidogrel preferred for de-escalated DAPT approach (72.1%), De-escalation therapy is part of optimisation approach (61.8%) (P < 0.0001). Participants opined that: ischemic risk is the most important factor to choose DAPT (67.6%), other ongoing therapy is an important determinant of DAPT adherence (59.5%), patients with high CV risk are the best suited for prolonged DAPT therapy (46.5%), DAPT should be continued for atleast 1 year (50%). Conclusions There was a high preference for combination of DAPT and statin for stratified treatment of ACS, associated with a high level of perceived effectiveness based on the recent clinical trials. Combination of DAPT and high potent statin, like rosuvastatin is distinctive in the therapeutic armamentarium for optimal management of ACS.
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