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Background: The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families., Methods and Results: A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above. The mean age of the study group was 43.3 ± 9.5 years. There was a high prevalence of major cardiovascular risk factors - current smoking 58 (12.8%), tobacco consumption 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus 25 (5.8%), hypertension 94 (20.7%), hypercholesterolemia 110 (25.7%), hypertriglyceridemia 148 (34.5%), physical inactivity 180 (39.7%), body mass index ≥23 kg/m(2) 350 (77.3%), central obesity 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption 387 (85.4%), heavy drinking 12 (2.6%), and stress 58 (12.7%)., Conclusion: This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level., (Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Background: Cardiovascular diseases have become the leading cause of mortality and morbidity in most countries of the world. The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families., Methods and Results: A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above (N1 = 453 for the questionnaire, anthropometric and clinical parameters; N2 = 429 for biochemical investigations). Evaluation for cardiovascular risk factors, anthropometric measurements, blood pressure, fasting blood glucose and serum lipids were performed using standard definitions. The mean age of the study group was 43.3 +/- 9.5 years. There was a high prevalence of major cardiovascular risk factors--current smoking in 58 (12.8%), tobacco consumption in 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus in 25 (5.8%), hypertension in 94 (20.7%), hyperlipidemia--hypercholesterolemia in 110 (25.7%) & hypertriglyceridemia in 148 (34.5%), physical inactivity in 180 (39.7%), body mass index e" 23 kg/m2 in 350 (77.3%), central obesity i.e. waist circumference > 90 cm for males and > 80 cm for females -in 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption in 387 (85.4%), heavy drinking in 12 (2.6%), and stress in 58 (12.7%)., Conclusion: The study demonstrated an overall high prevalence of cardiovascular risk factors even amongst employees at a tertiary hospital and their families. This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.

Background: Brain natriureticpeptide (BNP) levels are elevated in patients with rheumatic mitral stenosis (MS) and decrease after a successful percutaneous transvenous mitral commissurotomy (PTMC)., Methods: In 37 consecutive patients of symptomatic MS (mean age 30 +/- 8.6 years) NTpro BNP levels were determined pre and 24-hours post PTMC. We seek to determine whether NT-pro-BNP levels be used as a marker of success of PTMC., Results: PTMC was successful orpartial successful in 33 (89 %) cases. The mean NT-pro- BNP levels decreasedfrom 771 +/- 456 pg/ml to 700 +/- 595 pg/ml (p < 0.05) following PTMC. The mean NT-pro-BNP levels decreased by 20.6% in patients with a successful PTMC and decreased by 10.8% in patients with a partially successful PTMC, while the levels increased by 33.4% in patients with an unsuccessful procedure. Patients with associated aortic regurgitation failed to show a decline in NT-pro-BNP levels despite a successful procedure., Conclusion: NT-pro-BNP levels fall significantly after a successful PTMC, and a significant decrease in levels is a good marker of success of PTMC. It may not decrease in patients with associated aortic regurgitation despite a successfiul PTMC.

Objective: Provide preliminary data on prevalence and functional significance (association with atherosclerotic risk factors and stress test positivity) of fluoroscopically detected CAC (Coronary Artery Calcification) in asymptomatic elderly Indian-Asian., Design: Prospective observational study., Setting: Outpatient services at 1000-bed tertiary care hospital in Northern India., Patients: 100 sedentary elderly (>60 years) Asian-Indian subjects (70 males, 30 females, age 65.9 +/- 5.1 years) with no history of CAD (asymptomatic)., Methods: CAC assessment was done using high intensity cine fluoroscopy and semi quantitative CAC scoring (scores 0-3) in all subjects (n = 100). Risk factor profile (diabetes, hypertension, smoking, serum lipids, body-mass index, waist-hip ratio) documented for all subjects. In 50 (the latter half of 100) consecutive subjects (29 males and 21 females, age 64.2 +/- 4.9 years), exercise stress test (treadmill test, TMT) was also done using standard Bruce protocol., Results: 92% (84.8-96.1, 95% CI) had fluoroscopic calcification and there was no significant association of higher CAC scores and risk factors, except for a positive trend with serum total cholesterol (p = 0.086). 20% (11-33.2, 95% CI) tested positive on exercise stress test and a positive trend (OR = 7.2, 95% CI = 0.8-63, p value = 0.067) with higher CAC scores was seen., Conclusion: High prevalence of fluoroscopic CAC and stress test positivity was observed in asymptomatic elderly Asian-Indians. The newly observed positive trend with increasing total cholesterol levels and stress test positivity highlights the importance of fluoroscopic CAC in asymptomatic elderly and should be corroborated with larger studies.

Background: The association between Chlamydia pneumoniae infection and atherosclerosis has gained recognition. However, the nature of this association is controversial. The infective link may not be specific for atherosclerosis and may also exist in other nonatherosclerotic arterial diseases. We investigated patients with nonspecific aortoarteritis for serological evidence of prior Chlamydia pneumoniae infection., Methods and Results: Fifty patients each of nonspecific aortoarteritis and coronary artery disease with angiographic evidence of significant (>70%) coronary artery lesions were tested for the presence of IgG antibodies against Chlamydia pneumoniae by micro-immunofluorescence assay and compared with 50 age- and sex-matched normal healthy controls. The number of patients with nonspecific aortoarteritis who tested positive for Chlamydia pneumoniae antibodies (IgG) was not significantly different from controls (8 v. 7, p=ns). The mean titer amongst positive subjects in the two groups was also similar (1:40+/-40 v. 1:50+/-25; p=ns). Patients with coronary artery disease were significantly older than patients with nonspecific aortoarteritis and controls (53.2+/-5.8 v. 21.2+/-9.9 years and 24.5+/-5.2 years, p<0.01 for both) and showed a higher seroprevalence of prior Chlamydia pneumoniae infection (18 v. 8 and 7, p < 0.05 for both). The mean IgG titers of patients with coronary artery disease who tested positive were also significantly higher than the other two groups (1:98+/-34 v. 1:40+/-40, p<0.001 and 1:98+/-34 v. 1:50+/-25, p<0.01, respectively)., Conclusions: In patients with nonspecific aortoarteritis, the seroprevalence of prior Chlamydia pneumnoniae infection is not more than that in healthy individuals of the same age group, but is significantly lesser than that in patients with coronary artery disease. Thus Chlamydia pneumoniae infection may not be associated with all forms of chronic inflammatory arterial lesions.

Background: Percutaneous transseptal mitral commissurotomy has been successfully performed in selected pregnant patients with severe symptomatic mitral stenosis. Its safety and efficacy needs to be evaluated in a large number of cases., Methods and Results: Percutaneous transseptal mitral commissurotomy was performed in 85 severely symptomatic (New York Heart Association functional class III or IV) pregnant women aged 22.7+/-4.1 years (range 18-39 years) with critical mitral stenosis at 24.8+/-4.7 weeks (range 20-34 weeks) of gestation. Percutaneous valvotomy was performed using a flow-guided Inoue balloon in all the patients. The procedure was considered successful in 80 (94%) patients. The hemodynamic mean end-diastolic gradient decreased from 26.7+/-6.8 mm Hg (range 16-35 mmHg) to 4.5+/-3.8 mmHg (range 0-14 mmHg) (p<0.001). The mean diastolic gradient decreased from 29.1+/-9.1 mmHg (range 18-38 mmHg) to 7.2+/-4.1 mmHg (range 4.1-18 mmHg) (p<0.001). The mean mitral valve area assessed by echocardiography increased from 0.75+/-0.5 cm2 (range 0.4-1.0 cm2) to 2.0+/-0.5 (range 1.0-2.7 cm2) (p<0.001). The mean fluoroscopy time was 3.6+/-3.2 minutes. The results of the mitral valvotomy were considered suboptimal in 4 patients. Mitral regurgitation increased by 1 grade in 16 patients and more than 2 grades in 2 patients. One patient developed pericardial tamponade during the procedure and was managed by catheter drainage. Percutaneous mitral valve dilatation was then successfully performed in this patient. No fetal abortion occurred after the procedure., Conclusions: The results of this study indicate that percutaneous transseptal mitral commissurotomy is a safe and effective procedure for severe symptomatic mitral stenosis in pregnancy.

Elevated levels of lipoprotein(a) has been regarded as an independent risk factor for coronary, peripheral and cerebral atherosclerosis. The enormous intra-personal variation in the plasma concentration of lipoprotein(a) is almost entirely controlled by the apolipoprotein(a) i.e. gene locus on the chromosome 6q 26-27. The apolipoprotein(a) molecule is highly polymorphic and is known to exist in multiple, genetically determined isoforms. These polymorphisms may be responsible for difference in promoter activity, variable size of apolipoprotein(a) and thereby variation in plasma lipoprotein(a) concentration. We studied the effect of two types of polymorphisms, (i) variation in length of the pentanucleotide repeat in the 5' flanking region starting -1373 bp upstream of AUG codon, and (ii) the Kringle-4 type 2 size polymorphism, on plasma lipoprotein(a) levels in North Indian population. The study group consisted of 88 angiographically assessed male coronary artery disease patients (age range 30-70 years) and 83 age- and sex-matched healthy controls. The pentanucleotide repeat polymorphism was analysed using polymerase chain reaction. In all, 8/11 pentanucleotide repeat isoforms were observed. Using SDS-agarose gel electrophoresis and immunoblotting isoforms having 12-50 Kringle-4 type 2 repeats were detected. Our study indicates a strong association of elevated plasma lipoprotein(a) concentration with coronary artery disease. An inverse correlation was seen between lipoprotein concentration and isoform size for both the pentanucleotide repeat polymorphism and the Kringle-4 type 2 polymorphisms; statistically significant difference (p = 0.001) was, however, observed only for the later.

The haemodynamic effects of nicorandil, a new balanced vasodilator exhibiting nitrate-like as well as potassium-channel opening activity in patients with chronic severe valvular lesions have not been reported. We studied the acute effect of nicorandil on haemodynamics in 12 stable patients (6 males, 6 females; mean age 23.5 +/- 4.6 years) with chronic severe valvular regurgitation (8 mitral, 4 aortic). All patients were studied in resting, supine and fasting states. All cardioactive drugs were withdrawn five days prior to the study. Intra-arterial line was placed and thermodilution catheter was positioned in the pulmonary artery. Haemodynamic parameters recorded at baseline and at 30, 60, 90 and 120 minutes following a single oral dose of 20 mg nicorandil revealed no significant change in the heart rate while systemic pressures showed a small decline (p < 0.05). There was significant reduction in systolic, diastolic and mean pulmonary artery pressures (p < 0.001). The mean cardiac index increased from 3.16 L/min/m2 at baseline to 3.77 L/min/m2 at 60 minutes. Both the pulmonary and systemic vascular resistance indices reduced significantly, the peak fall being 18 percent and 29 percent, respectively. Maximal changes were observed at 60 to 90 minutes following administration of nicorandil. No adverse effect of nicorandil occurred during the study. We conclude that nicorandil has a favourable acute haemodynamic effect in patients with chronic severe valve regurgitation. Its long-term use in valvular lesions should be explored further.