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Humans, Cardiovascular Diseases, Prevalence, Risk Assessment, Risk Factors, Retrospective Studies, Awareness, Forecasting, Adult, Aged, Middle Aged, Urban Population, India, Female, Male, Hypertension epidemiology, Lower-middle income countries, Non-communicable diseases, Sustainable development goals, and Cardiovascular System & Hematology

ObjectivesWe evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets.MethodsAdult participants (n=7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991-93 (n=2212), 1999-01 (n=1123), 2003-04 (n=458), 2006-07 (n=1127), 2009-10 (n=739) and 2012-15 (n=1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control.ResultsThe age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2=0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2=0.63); treatment in all (9, 22, 38, 34, 41, 36; R2=0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2=0.46); and control in all (2, 14, 13, 18, 21, 21; R2=0.82), aware (12, 33, 27, 46, 37, 37; R2=0.54) and treated (9, 20, 21, 48, 36, 49; R2=0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43-45), awareness to 82% (81-83), treatment to 62% (61-63), and control to 36% (35-37).ConclusionHypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.

Biomedical and Clinical Sciences, Clinical Sciences, Cardiovascular, Kidney Disease, Atherosclerosis, Clinical Trials and Supportive Activities, Clinical Research, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Renal and urogenital, Aged, Aged, 80 and over, Atorvastatin, Cholesterol, LDL, Coronary Disease, Double-Blind Method, Dyslipidemias, Female, Glomerular Filtration Rate, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Kidney, Male, Pravastatin, Renal Insufficiency, Chronic, Uric Acid, Pharmacology and Pharmaceutical Sciences, Geriatrics, Clinical sciences, and Pharmacology and pharmaceutical sciences

BackgroundImprovement in renal function and decreases in serum uric acid (SUA) have been reported following prolonged high-intensity statin (HMG-CoA reductase inhibitor) therapy. This post hoc analysis of the SAGE trial examined the effect of intensive versus less intensive statin therapy on renal function, safety, and laboratory parameters, including SUA, in elderly coronary artery disease (CAD) patients (65-85 years) with or without chronic kidney disease (CKD).MethodsPatients were randomized to atorvastatin 80 mg/day or pravastatin 40 mg/day and treated for 12 months. Patients were stratified using Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rates (eGFRs) in CKD (eGFR 3 times the upper limit of normal occurred in 4.4% of atorvastatin- and 0.2% of pravastatin-treated patients.ConclusionIntensive management of dyslipidemia in older patients with stable coronary heart disease may have beneficial effects on renal function and SUA.

Biomedical and Clinical Sciences, Clinical Sciences, Diabetes, Heart Disease, Clinical Research, Heart Disease - Coronary Heart Disease, Transplantation, Cardiovascular, Kidney Disease, Bioengineering, Assistive Technology, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, end-stage renal disease, statin, survival, hemodialysis, diabetes, and Cardiovascular System & Hematology

End-stage renal disease (ESRD) patients have extraordinarily high cardiovascular risk and mortality, yet the benefit of statins in this population remains unclear based on the randomized trials. We investigated the prognostic value of statins in a large, pure cohort of prospectively recruited patients with ESRD awaiting renal transplantation, and being followed up in a dedicated cardiac clinic. We prospectively collected demographic, clinical, laboratory, and pharmacological data on 423 consecutive ESRD patients on hemodialysis awaiting renal transplantation. Survival analysis was performed as a function of statin therapy. The baseline characteristics were as follows: age 57 ± 11 years, males 64%, diabetes mellitus in 68%, known coronary artery disease in 30%, left ventricular (LV) ejection fraction 61 ± 11%. Over a mean follow-up of 2 years, there were 43 deaths. Adjusted for age, gender, hypertension, body mass index, diabetes mellitus, coronary artery disease, smoking, and treatment with angiotensin converting enzyme inhibitor, β blocker, and antiplatelet medications, statin use was a predictor of lower mortality (hazard ratio 0.30, 95% confidence interval 0.11-0.79, p = 0.01). This beneficial effect of statin was supported by propensity score analysis (p = 0.02) and was consistent across all clinical subgroups. The benefit of statins seemed to be greater in those with LV hypertrophy and smoking. Statin therapy in hemodialysis patients awaiting renal transplant is independently associated with better survival supporting its use in this high-risk population.

Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Tobacco Smoke and Health, Substance Misuse, Clinical Research, Tobacco, Diabetes, Prevention, Cardiovascular, Good Health and Well Being, Cardiorespiratory Medicine and Haematology, and Cardiovascular medicine and haematology

ObjectiveTo determine association of socioeconomic status, defined by educational status (ES), with awareness, treatment and control of cardiovascular risk factors.MethodsWe performed an epidemiological study at 11 cities in India using cluster sampling. 6198 subjects (3426 men, 2772 women, response 62%, age 48±10 years) were evaluated for sociodemographic, lifestyle, anthropometric and biochemical factors. ES was categorised according to years of schooling into low (≤10 years), medium (11-15 years) and high (>15 years). Risk factors were diagnosed according to current guidelines. Awareness, treatment and control status were determined for hypertension, diabetes and hypercholesterolaemia. For smoking/tobacco use, quit rate was determined. Descriptive statistics are reported.ResultsAge-adjusted and sex-adjusted prevalence (%) of various risk factors in low, medium and high ES subjects was hypertension 31.8, 29.5 and 34.1, diabetes 14.5, 15.3 and 14.3, hypercholesterolaemia 24.0, 23.9 and 27.3, and smoking/tobacco use 24.3, 14.4 and 19.0. Significantly increasing trends with low, medium and high ES were observed for hypertension awareness (30.7, 37.8, 47.0), treatment (24.3, 29.2, 35.5) and control (7.8, 11.6, 15.5); diabetes awareness (47.2, 51.5, 56.4), treatment (38.3, 41.3, 46.0) and control (18.3, 15.3, 22.8); hypercholesterolaemia awareness (8.9, 22.4, 18.4), treatment (4.1, 6.2, 7.9) and control (2.8, 3.2, 6.9), as well as for smoking/tobacco quit rates (1.6, 2.8, 5.5) (χ(2) for trend, p

TNT Investigators, Humans, Pyrroles, Heptanoic Acids, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Glomerular Filtration Rate, Hospitalization, Proportional Hazards Models, Retrospective Studies, Follow-Up Studies, Double-Blind Method, Adult, Aged, Middle Aged, Female, Male, Heart Failure, Atorvastatin, Cardiovascular, Kidney Disease, Clinical Research, Heart Disease, Cardiovascular System & Hematology, and Cardiorespiratory Medicine and Haematology

Impaired kidney function often accompanies heart failure (HF) and is associated with a worse prognosis. This post hoc analysis of the Treating to New Targets (TNT) trial examined whether the observed decrease in HF hospitalizations with high- compared to low-dose atorvastatin could be related to improvements in kidney function. Of 10,001 TNT participants, 9,376 had estimated glomerular filtration rate (eGFR) measurements at baseline and 1 year and were included in this analysis. The association of change in year-1 eGFR and subsequent HF hospitalization was examined using Cox regression models. In total 218 participants developed subsequent HF hospitalization. Little change in eGFR occurred over 1 year in the atorvastatin 10-mg group, whereas eGFR improved in the 80-mg group by 1.48 ml/min/1.73 m(2) (95% confidence interval 1.29 to 1.67, p

Heart Disease - Coronary Heart Disease, Atherosclerosis, Heart Disease, Cardiovascular, Development of treatments and therapeutic interventions, 5.1 Pharmaceuticals, Angina Pectoris, Animals, Clinical Trials as Topic, Coronary Vessels, Endothelium, Vascular, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Inflammation, Lipoproteins, LDL, Myocardial Ischemia, Plaque, Atherosclerotic, Reperfusion Injury, Treatment Outcome, Vasodilation, Lipid-lowering, Statin, Cardiovascular disease, Coronary heart disease, Myocardial ischemia, Angina pectoris, Cardiorespiratory Medicine and Haematology, and Cardiovascular System & Hematology

Angina pectoris resulting from myocardial ischemia afflicts half of all patients with coronary heart disease (CHD). Chronic angina remains a major public health burden despite state-of-the-art therapies, and improvement in survival from myocardial infarction and CHD has only increased its prevalence. There is growing experimental and clinical evidence pointing to the anti-ischemic and anti-anginal properties of statins. Some data suggest that the degree of anti-ischemic efficacy of statins may be comparable to the current standard pharmacologic and mechanical strategies. The pleiotropic effects of statins are postulated to be primarily responsible for their anti-ischemic and anti-anginal properties. These include improvement of endothelial function, enhancement of the ischemic vasodilatory response, modulation of inflammation, and protection from ischemia-reperfusion injury. The anti-ischemic effects of statins further strengthen their role as a crucial component of the optimal medical therapy for CHD.

Medicine & Public Health, Pathology, Epidemiology, Cardiology, Type 2 diabetes mellitus, Diabetes natural history, Angiotensin-converting enzyme inhibitor, Angiotensin receptor blocker, Renin-angiotensin system, Impaired fasting glucose, Impaired glucose tolerance, and Insulin resistance

Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease (CVD) morbidity and mortality worldwide. Renin-angiotensin system (RAS) blockers have been indispensable in diminishing the macrovascular and microvascular complications of diabetes. In addition, cumulative evidence from retrospective studies pointed toward a beneficial effect of RAS agents in preventing the development and progression of T2DM. This disease-modifying potential of RAS blockers has been substantiated by recent prospective trials. Contemporary concepts regarding the natural history of T2DM and the pathophysiologic processes involved have increased our understanding of the mechanisms underlying the therapeutic potential of these agents in diabetes management. In addition to their established roles in the primary prevention of CVD in patients with diabetes, RAS blockers might be considered a suitable therapeutic choice for preventing the development of frank diabetes in high-risk patients.

Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Heart Disease - Coronary Heart Disease, Clinical Research, Cardiovascular, Health Services, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Adrenergic beta-Antagonists, Adult, Aged, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Coronary Disease, Drug Prescriptions, Drug Therapy, Combination, Drug Utilization, Evidence-Based Medicine, Female, Guideline Adherence, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, India, Male, Middle Aged, Platelet Aggregation Inhibitors, Practice Guidelines as Topic, Practice Patterns, Physicians', Primary Health Care, Secondary Prevention, statins, coronary heart disease, aspirin, beta blockers, angiotensin-converting enzyme inhibitor, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, and Clinical sciences

ObjectiveTo determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India.MethodsPhysicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.ResultsWe evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care.ConclusionsThere is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.