Background: Coronary Artery Disease (CAD) is the foremost single cause of mortality and loss of Disability Adjusted Life Years (DALYs) globally. A large percentage of this burden is found in low and middle income countries. This accounts for nearly 7 million deaths and 129 million DALYs annually and is a huge global economic burden.

Objective: To review epidemiological data of coronary artery disease and acute coronary syndrome in low, middle and high income countries.

Methods: Keyword searches of Medline, ISI, IBSS and Google Scholar databases. Manual search of other relevant journals and reference lists of primary articles.

Results: Review of the results of studies reveals the absolute global and regional trends of the CAD and the importance and contribution of CAD for global health. Data demonstrates which region or countries have the highest and lowest age-standardized DALY rates and what factors might explain these patterns. Results also show differences among the determinants of CAD, government policies, clinical practice and public health measures across the various regions of world.

Conclusion: CAD mortality and prevalence vary among countries. Estimation of the true prevalence of CAD in the population is complex. A significant number of countries have not provided data, the estimation of the exact figures for epidemiological data is a barrier. The incidence of CAD continues to fall in developed countries over the last few decades and this may be due to both effective treatment of the acute phase and improved primary and secondary preventive measures. Developing countries show considerable variability in the incidence of CAD. The globalization of the Western diet and increased sedentary lifestyle will have a dramatic influence on the progressive increase in the incidence of CAD in these countries.

Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review

Chapter-09 Abdominal Obesity, Visceral Fat and Type 2 Diabetes-"Asian Indian Phenotype"

Myeloid sarcoma usually involves lymph nodes, and head and neck regions. Uncommon sites like testis and ovary are rarely involved and pose a diagnostic challenge. Nonspecific findings, difficulty in retrieving biopsy specimens, and associated infertility are few of the hurdles faced during diagnosis and treatment of testicular myeloid sarcoma. Our review is an attempt to study myeloid sarcoma involving testis.

Testicular Myeloid Sarcoma: A Systematic Review of the Literature

BACKGROUND & OBJECTIVES Ischemic heart disease (IHD) is one of the most important causes of death and disability in the world and diabetes is an important risk factor. This review was performed to describe the mortality and morbidity burden from this twin epidemic in South Asian countries. METHODS Country-level data on the epidemiology of IHD and diabetes were obtained from the Global Burden of Disease (GBD) study. Sub-national data were available only for India. We also retrieved epidemiological studies from published reviews on IHD and diabetes in India. These were supplemented with MEDLINE search. RESULTS GBD study and regional epidemiological studies have reported that there are significant regional variations in IHD mortality and disease burden within South Asian countries. IHD burden has increased significantly from 2000 to 2017. Prospective Urban Rural Epidemiology study has reported that diabetes is an important IHD risk factor in the South Asian region. GBD Study and International Diabetes Federation have reported increasing diabetes-related mortality and disease burden in South Asian countries, especially India. There are regional variations in diabetes-related mortality, disease burden, and prevalence in South Asia. At the macrolevel, rapid food and nutrition transition along with increasing physical inactivity is responsible for this twin epidemic. CONCLUSION Increasing trends in IHD and diabetes-related mortality and disease burden with regional variations are observed in South Asian countries.

Epidemiology of Ischemic Heart Disease and Diabetes in South Asia: An Overview of the Twin Epidemic.

Objectives We aimed to measure the change in prevalence of Coronary Heart Disease (CHD) and Cardiovascular Diseases (CVDs) risk among those aged 35–64 years in urban and rural areas of National Capital Region (NCR) of Delhi, between 1991-1994 (survey 1) and 2010–2012 (survey 2). Methods Both surveys used similar sampling methodology and mean ages of participants were similar. A total of 3048 and 2052 subjects were studied in urban Delhi and 2487 and 1917 participants recruited from rural Ballabgarh in survey 1 and in survey 2 respectively. CHD was diagnosed based on a Minnesota coded ECG and Rose angina questionnaire. Data on behavioural, physical, clinical and biochemical parameters were collected using standard methods. CVD Risk of participants was calculated using the gender specific Framingham risk equation. Results The age and sex standardised prevalence of CHD in urban Delhi increased from 10.3% (95% CI: 9.2–11.4) to 14.1% (95% CI: 12.6–15.6) between the two surveys as compared to an increase from 6.0% (95% CI: 5.0–6.9) to 7.4% (95% CI: 6.3–8.6) in rural Ballabgarh. The highest increase in the prevalence of CHD was reported among urban women (10.1% to 16.6%).The proportion of population with high 10-year CVD risk increased to 4.1% from 1.2% in rural areas as compared to 4.8% from 2.5% in urban areas. Conclusions The CHD and CVD risk has increased over 20 years period in and around Delhi and the increase was more in rural population and women, traditionally considered to be at low risk.

Change in prevalence of Coronary Heart Disease and its risk between 1991-94 to 2010-12 among rural and urban population of National Capital Region, Delhi.

Background Three-fifths of total deaths in India are attributed to noncommunicable diseases, and coronary heart disease (CHD) is one of the dominant causes. There are only few studies available in India to find confirmed CHD by pragmatic approach. This study aims to find prevalence of confirmed CHD and its risk factors in rural community of central India. Materials and methods This was a community-based cross-sectional study during 2013–2014 involving adults ≥60 years from 13 villages in rural central India. We screened CHD on the basis of history and standard 12-lead ECG. Apart from the past documentation of CHD, we diagnosed confirmed CHD in symptomatic patients or with resting ECG changes by means of echocardiography, exercise ECG test or coronary angiography whenever needed. Results We screened 1190 of 1415 individuals ≥60 years for CHD. Five hundred eighty were men and 610 were women. Diagnosis of CHD was confirmed in 61 individuals (29 men and 32 women). The prevalence of CHD in individuals older than 60 years was 51.3 per 1000 population. Hypertension was the only independent risk factor associated with CHD, whereas association of diabetes mellitus, obesity, socioeconomic status and smoking with CHD was not significant. Conclusion Prevalence of confirmed CHD has increased in agrarian rural community in central India, which requires further studies to find out causative factors.

Epidemiology of confirmed coronary heart disease among population older than 60 years in rural central India-A community-based cross-sectional study.

Acute leukemia generally present with nonspecific symptoms such as fatigue, weakness, malaise, anorexia, weight loss, fever, bone pains, bruising, or bleeding that begin gradually and are the consequence of associated cytopenias. Polyserositis with predominant pericardial effusion clinically manifested as heart failure as the presenting feature of acute myeloid leukemias (AMLs) has been rarely described. In this report, we describe a case of a 21-year-old male, who presented with symptomatic serositis and leukemia cutis and was subsequently diagnosed as AML-myelomonocytic type (AML-M4).

Acute myeloid leukemia presenting as polyserositis and leukemia cutis

Background & objectives: Coronary Heart Disease (CHD) is the disease of urbanisation. However, the recent evidence suggests that CHD is becoming more prevalent in low socioeconomic group, including rural areas. The role of lipids and lipoproteins in pathogenesis of CHD factors is well established. Methods: We performed a case-control study to determine association of dyslipidaemia with CHD in individuals above 60 years residing in the rural community of central India. Successive consenting nondiabetic subjects who are diagnosed to have definite CHD (electrocardiographically defined; exercise test and echocardiographically/angiographically confirmed) but are not on statins were enrolled (cases n=41). Subjects with matched age group, gender and socioeconomic status, with no evidence of CHD, nondiabetic and not on statin, were recruited as controls (n=164). Results: Isolated low HDL level was the most common finding (80% in male, 90% in female cases and 74% in male and 95% in female controls). No statistically significant difference was found in cases and controls in total cholesterol (p=0.3342), HDLCholesterol (p=0.4864), TG (p=0.997), LDL cholesterol (p=0.1945) and VLDL cholesterol (p=0.5943) and lipid ratios i.e. total cholesterol: HDL (p=0.075), TG: HDL (0.65) and LDL: HDL (0.05). The correlation coefficient between serum HDL and waist circumference, serum HDL and BMI indicated no association. There was no difference in the distribution of S. HDL-C among subjects who belonged to different socioeconomic strata. Conclusion: Overall prevalence of lipid abnormalities is low in our population except isolated low HDL level. We found that isolated low HDL level was not associated with CHD in our rural community.

/pdf/low-hdl-is-not-associated-with-coronary-heart-disease-in-non-4hari9hbfs.pdf

Low HDL is not associated with Coronary Heart Disease in Non-diabetic Agrarian Rural Community in Central India

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Epidemiology of confirmed coronary heart disease among population older than 60 years in rural central India-A community-based cross-sectional study.

Acute myeloid leukemia presenting as polyserositis and leukemia cutis

Low HDL is not associated with Coronary Heart Disease in Non-diabetic Agrarian Rural Community in Central India