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Survival outcomes of patients with heart failure (HF) based on their disease etiology are not well described. Here, we provide one-year mortality outcomes of 10850 patients with HF (mean age = 59.9 years, 31% women) in India. Ischemic heart disease (71.9%), dilated cardiomyopathy (17.3), rheumatic heart disease (5.4), non-rheumatic valvular heart disease (1.9), hypertrophic cardiomyopathy (0.8), congenital heart disease (0.7), peri-partum cardiomyopathy (0.5), restrictive cardiomyopathy (0.4), and infective endocarditis (0.1) were the main disease etiologies. Mortality rate per 100-person years of follow-up varied from 13.8 (95% CI: 6.2–30.7) in peri-partum cardiomyopathy to 92.9 (46.5–185.9) in infective endocarditis. Compared to ischemic heart disease, the mortality was two to five times higher in rheumatic heart disease (HR = 2.0; 95% CI: 1.6–2.4), congenital heart disease (2.9; 1.9–4.2), and infective endocarditis (4.8; 2.4–9.8). The wide variations in mortality rate in HF patients may bring possible clinical applicability of risk stratification. The NHFR is India’s first nationally representative heart failure (HF) registry. Here the authors studied the survival outcomes of 10,850 HF patients and found wide variations in mortality rates based on HF etiologies.

Background Calcium-channel blockers (CCB) are a mainstay in the management of hypertension (HTN), and amlodipine is the preferred CCB due to its longer half-life and better safety. Patients and methods This practice-based, observational, real-world evidence study assessed the 24-hour ambulatory blood pressure (ABP) control in mild-to-moderate essential hypertensive patients (treatment naïve receiving amlodipine monotherapy, or as add-on therapy) in inadequately controlled blood pressure (BP goal not met after one month of existing therapy). One hundred four (62M/42F) patients between 18 and 65 years of age who received amlodipine 5/10 mg/day for >8 weeks were included after obtaining informed written consent. The primary outcome was a change from baseline in the mean 24-h SBP and DBP on ABP monitoring at eight (±1) weeks. Secondary outcomes were different from baseline in the mean morning, day-time, night-time, and last six-hour dosing interval period. Other outcomes assessed BP variability (dippers and non-dippers), and responder rates based on ABP monitoring and in-clinic trough cuff measurements. Safety outcomes included adverse effects reported, electrocardiogram, and laboratory abnormalities (hepatic and renal function). Changes in BP parameters in different sub-groups (age, gender, BMI, physical activity, occupation, duration of hypertension, the total daily dose of amlodipine, type of amlodipine therapy, and hypertension severity at baseline) were estimated. Results Of the 104 patients, 49 patients (completed eight weeks) were included in the per-protocol (PP) data for efficacy analysis. Safety analysis was done on the intent-to-treat (ITT) dataset. Significant reductions (p<0.0001) from baseline in all BP measurements on ABPM were observed at the end of eight weeks. Similar improvements were observed in office BP recordings. There was a marginal but non-significant (p>0.05) increase in the proportion of dippers and extreme dippers with amlodipine at the end of the eight-week treatment period. Conclusions Amlodipine 5/10 mg/day therapy used as monotherapy or adjuvant therapy provided significant reductions in both office BP and ambulatory BP over eight weeks.

Background Unhealthy eating and lack of exercise during adolescence culminated into earlier onset and increasing burden of atherosclerotic cardiovascular diseases (CVDs) worldwide. Among urban Indian adolescents, prevalence of these risk factors of CVD seemed to be high, but data regarding their pattern and predictors was limited. To address this dearth of information, a survey was conducted among urban adolescent school-students in Kolkata, a highly populated metro city in eastern India. Methods During January–June, 2014, 1755 students of 9th-grade were recruited through cluster (schools) random sampling. Informed consents from parents and assents from adolescents were collected. Information on socio-demographics, CVD-related knowledge and perception along with eating and exercise patterns were collected with an internally validated structured questionnaire. Descriptive and regression analyses were performed in SAS-9.3.2. Results Among 1652 participants (response rate = 94.1%), about 44% had poor overall knowledge about CVD, 24% perceived themselves as overweight and 60% considered their general health as good. Only 18% perceived their future CVD-risk and 29% were engaged in regular moderate-to-vigorous exercise. While 55% skipped meals regularly, 90% frequently consumed street-foods and 54% demonstrated overall poor eating habits. Males were more likely to engage in moderate-to-vigorous exercise [adjusted odds ratio (AOR) = 3.40(95% confidence interval = 2.55–4.54)] while students of higher SES were less likely [AOR = 0.59(0.37–0.94)]. Males and those having good CVD-related knowledge were more likely to exercise at least 1 h/day [AOR = 7.77(4.61–13.07) and 2.90(1.46–5.78) respectively]. Those who perceived their future CVD-risk, skipped meals more [2.04(1.28–3.25)] while Males skipped them less [AOR = 0.62(0.42–0.93)]. Subjects from middle class ate street-foods less frequently [AOR = 0.45(0.24–0.85)]. Relatively older students and those belonging to higher SES were less likely to demonstrate good eating habits [AOR = 0.70(0.56–0.89) and 0.23(0.11–0.47) respectively]. A large knowledge-practice gap was evident as students with good CVD-related knowledge were less likely to have good eating habits [AOR = 0.55(0.32–0.94)]. Conclusions CVD-related knowledge as well as eating and exercise habits were quite poor among adolescent school-students of Kolkata. Additionally, there was a large knowledge-practice gap. Multi-component educational interventions targeting behavioral betterment seemed necessary for these adolescents to improve their CVD-related knowledge, along with appropriate translation of knowledge into exercise and eating practices to minimize future risk of CVDs.

Background Handful studies report the prevalence of cardiovascular disease (CVD) risk factors among medical students from India and none from the eastern part of the country. Aim To estimate the prevalence of risk factors of CVD and their correlation with CVD risk ratio among the MBBS students from eastern India. Methods 433 students were studied. International Physical Activity Questionnaire-long form was used for assessment of physical activity and Perceived Stress Scale (PSS) to elicit psychological stress levels. Waist-to-height ratio (WHtR) was calculated. Total cholesterol to high-density lipoprotein ratio was calculated as the CVD risk ratio. Results 39.3% were women and 68.6% of the subjects were in junior classes. 22.4% subjects had high PSS while 30% performed low physical activity. Tobacco and alcohol intake was prevalent in 29.3% and 21.0% respectively. High CVD risk ratio was found in 14.3%. Most risk factors were more prevalent among juniors except diabetes. Among the non-overweight and non-obese subjects there was a significant positive correlation between WHtR and CVD risk score ( R  = 0.33, p  < 0.001). 82.7% of the variance in CVD risk ratio could be explained by WHtR, Body mass index, Triglycerides and Low-density lipoprotein ( F (7, 425) = 296.085), of which LDL ( β  = 0.755) contributed the most. Conclusions High prevalence of different modifiable CVD risk factors revealed among the subjects in this study is concerning. WHtR appears promising as an independent early predictor of CVD risk in Indian population. A dedicated CVD risk assessment tool for the young population is necessary.

Uncontrolled hypertension is an important cardiovascular risk factor and therefore requires effective approaches to patient management. This study assessed approaches to the management of patients with Stage 2 hypertension by cardiologists in India. This was a retrospective, multicenter, observational, case-based questionnaire study. Data on demographic characteristics, risk factors associated with Stage 2 hypertension, use of antihypertensive medications, side effects, and approaches to education for 2,540 patients were extracted from questionnaire responses provided by 508 cardiologists. The study population of patients with Stage 2 hypertension had a mean age of 55.0 years. Most of the patients (62.6%) were aged 30 to 60 years and diabetes mellitus was the most prevalent comorbidity (48.9%). Triple antihypertensive therapy was being used by 760 patients, and 634 and 1,146 patients were receiving 4 and 5 different antihypertensive medications, respectively. Telmisartan, amlodipine, chlorthalidone, hydrochlorothiazide, spironolactone, metoprolol, and prazosin were the commonly prescribed drugs. Ankle edema (27.7%) was the most frequent side effect of therapy. Pharmacotherapy was supported by patient education and lifestyle modifications for better blood pressure control. The standardized approach to the collection and assessment of these contemporary data provides useful insights into the characteristics and treatment of patients with Stage 2 hypertension in India.

Uday Jadhav,1 Santanu Guha,2 Harsh Mittal,3 Chinmoy Barik,4 Chandrashekhar S Gillurkar,5 Sandeep Kumar Gupta,6 Mukulesh Gupta,7 Santosh Saklecha,8 Mayur Jadhav,9 Sanjay Y Choudhari,9 Saiprasad Patil,9 Sumit Bhushan,9 Divakar A,9 Hanmant Barkate9 1Department of Cardiology and Cardiac CT, MGM New Bombay Hospital, Mumbai, Maharashtra, India; 2Department of Cardiology, Narayan Medical College, Jamuhar, Bihar, India; 3Department of General Medicine, Panchsheel Hospital, Delhi, India; 4Department of Medicine, College of Medicine & J.N.M. Hospital, Kalyani, West Bengal, India; 5Department of Internal Medicine, Gillurkar Multispeciality Hospital, Nagpur, Maharashtra, India; 6Department of General Medicine, MV Hospital & Research Center, Lucknow, Uttar Pradesh, India; 7Department of General Medicine, Udyan Health Care Pvt. Ltd, Lucknow, Uttar Pradesh, India; 8Department of General Medicine, Santosh Hospital, Bengaluru, Karnataka, India; 9Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, IndiaCorrespondence: Sanjay Y Choudhari, Global Medical Affairs, Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India, Email Sanjay.Choudhari@glenmarkpharma.comPurpose: To assess the effectiveness and safety of telmisartan-amlodipine (TA) versus telmisartan-cilnidipine (TC) fixed-dose combinations (FDCs) in patients with hypertension and renal impairment.Patients and Methods: This open label, randomized, multicentric, post-marketing study was conducted in India. Adult patients with hypertension and renal impairment, receiving a stable dose of telmisartan and not on calcium channel blockers, were enrolled. Participants were randomized (1:1) to receive the TA or TC FDC for 12 months. The primary endpoint was change in the urine albumin-creatinine ratio (UACR) from baseline to 12 months. Secondary endpoints included changes in estimated glomerular filtration rate (eGFR), serum creatinine, and serum uric acid at 6 and 12 months, and office systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 3, 6, 9, and 12 months. Similar parameters were assessed in the diabetic subpopulation. Adverse events were recorded and classified using system organ classification.Results: At 12 months, the TA and TC groups showed significant reductions in UACR by 119± 157.7 mg/g and 97.5± 128.6 mg/g, respectively (p< 0.0001 for both). Improvements in eGFR and serum creatinine were comparable between groups (p> 0.05). SBP reduction was significantly greater with TA at both 9 months (20.74± 12.75 vs. 16.9± 13.66) mmHg, (p=0.0430)] and 12 months (25.4± 14.25 vs. 20.6± 10.94) mmHg, (p=0.0397)], while DBP reductions were similar. The diabetic subgroup showed a superior SBP reduction favoring the TA group − 24.5 (± 13.75) mmHg (p≤ .0001) Vs − 18.9 (± 10.68) mmHg (p≤ .0001) while the renal parameters were similar between the two groups. A total of 17 mild drug-related adverse events were reported (TA: 8; TC: 9), with no serious events.Conclusion: Both the TA and TC FDCs were effective and well tolerated when treating hypertension with renal impairment. The TA FDC may provide better BP reduction with similar reno-protective benefits than the TC FDC.Keywords: amlodipine, cilnidipine, telmisartan, CCB, renoprotection

The aggregation of platelets on the plaque rupture site on the coronary artery is reported to cause both acute coronary syndromes (ACS) and acute myocardial infarction (AMI). While the inhibition of platelet aggregation by acetyl salicylic acid was reported to produce beneficial effects in ACS, it failed to do in AMI. The concentration of a stress induced protein (dermcidin isoform-2) was much higher in AMI than that in ACS. Incubation of normal platelet rich plasma (PRP) with dermcidin showed one high affinity (K d = 40 nM) and one low affinity binding sites (K d = 333 nM). When normal PRP was incubated with 0.4 μM dermcidin, the platelets became resistant to the inhibitory effect of aspirin similar to that in the case of AMI. Incubation of PRP from AMI with dermcidin antibody restored the sensitivity of the platelets to the aspirin effect. Incubation of AMI PRP pretreated with 15 μM aspirin, a stimulator of the NO synthesis, resulted in the increased production of NO in the platelets that removed the bound dermcidin by 40% from the high affinity binding sites of AMI platelets. When the same AMI PRP was retreated with 10 μM aspirin, the aggregation of platelets was completely inhibited by NO synthesis.

Alkaloid extracts from the plant Aconitum species have been used in various forms of herbal remedies predominantly as anti-inflammatory and analgesic agents. Many of these alkaloids are extremely potent cardiotoxins and documented cases of various arrhythmias with fatal outcomes have been reported. We report a case of self-medication with ‘tincture of aconite’ resulting in severe bradycardia, reversible panconduction defect evidenced by sinus inactivity, atrioventricular dissociation with idiojunctional rhythm and left bundle branch block pattern resulting in hypotension and syncope. Complete reversal of ECG findings with marked improvement in symptoms was noted within a few hours. Herbal medicines containing aconite alkaloids may result in severe cardiotoxicity, and strict regulatory measures are warranted to curb unsupervised use for therapeutic purposes.

Reliance, India's biggest company by market value, said gross refining margin in the fourth quarter was $15.50 a barrel, higher than $13 a barrel a year earlier, and marginally more than $15.40 a barrel in the third quarter. Gross refining margin is the difference in the cost of the refined product and the cost of buying the crude for refining. Total expenses in the fourth quarter increased 39% to 326.48 billion rupees. Reliance's spending on raw materials rose 41% during the quarter to 256.64 billion rupees because of higher prices of crude oil and naphtha, the company said.