Objective-Virtually all adults with Down syndrome (DS) have neuropathological manifestations of Alzheimer's disease (AD) but not all develop the condition. The effect of allelic variants of Apolipoprotein (APOE) gene in the development and progression of AD and mortality in people with DS is examined.Methods-Participants with DS recruited through local clinical services and voluntary organizations underwent 2 to 14 sequential assessments over a follow up period of 5 years on average. Blood samples were collected for determination of the APOE genotype. Dementia status of each participant was confirmed as recommended by the Working Group for the Establishment of Criteria for the Diagnosis of Dementia in Individuals with Intellectual Disability.Results-At the end of the study APOE genotype results were available for 252 individuals and thus included in the analysis. Participants with APOE ε4 allele had a significantly higher risk of developing AD (Hazard ratio = 1.8, 95% CI: 1.12-2.79), had an earlier onset of AD (55.0 vs. 57.0 years; p = .0027) and a more rapid progression to death compared with participants with ε3 allele. In those who did not have AD, presence of ε4 allele was associated with early mortality (Hazard ratio = 5.9, 95% CI: 1.7-21.3).Conclusions-This study highlights the relationship of APOE genotype to morbidity and mortality in people with DS which may have important clinical implications in terms of early identification of individuals at risk. We recommend screening for APOE genotype for individuals with DS early in their life.

ObjectiveThe accuracy of various 10-year cardiovascular disease (CVD) risk calculators in Indians may not be the same as in other populations. Present study was conducted to compare the various calculators for CVD risk assessment and statin eligibility according to different guidelines.MethodsConsecutive 1110 patients who presented after their first myocardial infarction were included. Their CVD risk was calculated using Framingham Risk score- Coronary heart disease (FRS-CHD), Framingham Risk Score- Cardiovascular Disease (FRS-CVD), QRISK2, Joint British Society risk calculator 3 (JBS3), American College of Cardiology/American Heart Association (ACC/AHA), atherosclerotic cardiovascular disease (ASCVD) and WHO risk charts, assuming that they had presented one day before cardiac event for risk assessment. Eligibility for statin uses was also looked into using ACC/AHA, NICE and Canadian guidelines.ResultsFRS-CVD risk assessment model has performed the best as it could identify the highest number of patients (51.9%) to be at high CVD risk while WHO and ASCVD calculators have performed the worst (only 16.2% and 28.3% patients respectively were stratified into high CVD risk) considering 20% as cut off for high risk definition. QRISK2, JBS3 and FRS-CHD have performed intermediately. Using NICE, ACC/AHA and Canadian guidelines; 76%, 69% and 44.6% patients respectively were found to be eligible for statin use.ConclusionFRS-CVD appears to be the most useful for CVD risk assessment in Indians, but the difference may be because FRS-CVD estimates risk for several additional outcomes as compared with other risk scores. For statin eligibility, however, NICE guideline use is the most appropriate.

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Introduction Erectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients. Aim To study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD. Methods In all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function-5 questionnaire. Main Outcome Measures and Results Among 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21-fold higher risk of having triple-vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41–141.09, P = 0.001) and an 18-fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11–111.09, P = 0.001). Conclusion Asian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.

The number of percutaneous transradial procedures have increased significantly with reduced complication rates and comparable success rate to transfemoral approach, along with the additional benefits to patient in terms of patient comfort, preference and reduced cost of health delivery.

Patients with CKD have endothelial dysfunction as evidenced by reduced FMD. Decreased FMD indicating worsening endothelial function was noted with increasing severity of CKD. Within three months of RT, there was significant improvement in FMD, while NMD values did not change.