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Saint Johns Academy Of Health Sciences now a free ART Centre

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Saint John's is now a free ART(anti retro viral treatment) Centre in treatment of HIV positive patients.

It will provide first line anti retroviral treatment to poor patients and will also offer OI (opportunistic infections) prophylaxis. The centre offers subsided labs and in patient care.The physcians involved with care of HIV patients are also looking for more  funding for the same and are hoping to receive it over a peroid of time.

It is targeted that five hundred patients will benefit by the end of the year .This is a significant accomplishment in the care of HIV patients at Saint John's. It is essentially comprehsive care for this group of patients.This centre at Saint Johns has been operating for one month. Saint Johns has been one of the institutions that has never refused care of HIV postive patients in the past.

 

 

 

Excellence in Research - Dr. Denis Xavier: Getting to the roots of stroke

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No matter where in the world you live, 90% of heart attacks are caused by some combination of the same nine risk factors, according to INTERHEART, a study that looked at 29,000 people in 52 countries. The risk factors for stroke, however, are a little more difficult to tease out and can vary according to the kind of stroke - ischemic, which makes up about 80% of strokes and is caused when a blood clot interferes with blood flow to the brain, and hemorrhagic, which accounts for the other 20% of strokes and is caused by uncontrolled bleeding in the brain.

Dr. Denis Xavier, along with colleagues at McMaster University, is examining people in eight countries - Argentina,Canada,China,Denmark, Germany, India, Nigeria,and South Africa - and five different ethnic groups to find out if there are regional or ethnic differences in the impact of different risk factors for stroke. The results of the INTERSTROKE study will mean that we will know as much about the risk factors for stroke as we do about those for heart attacks.

Dr. Xavier is undertaking the work at McMaster Univesity while on a two-year sabbatical from St. John's Medical College in Bangaolre, India, taking advantage of the opportunity to work with Dr. Salim Yusuf, the lead investigator on the INTERHEART study. He is one of the three inaugural recipients of the Canada-HOPE Scholarship Program. While in Canada, he is also completing a master's degree in clinical epidemiology and biostatistics, to supplement his extensive practical experience in the area. Upon his return to Bangalore, he hopes to design and run clinical research projects relevant to India and other developing countries. He also hopes to collaborate with his colleagues at McMaster and other universities to set up some informal training opportunities in clinical epidemiology for residents and young faculty at St. John's Medical College, the precursor, he hopes, to a more formal training program down the road.

http://www.cihr-irsc.gc.ca/e/35878.html

 

Large Research Grant awarded to Denis Xavier and cohorts

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Dr Denis Xavier from Saint Johns Research Institute has been awarded a grant of 3 million US dollars for cardiovascular prevention in India.It is an Ovations NLBHI grant.Out of 136 applicants from seventyone countries the research program at Saint Johns was one of the eight centres awarded this grant.

The program covers studies and community based initiatives in primary and secondary prevention in cardiovascular disease with an integrated health insurance component. At this time they colloborate with 3 other institutions in India and with Dr Salim Yusuf at McMaster university, Canada .

Denis is from batch 1987 graduated MBBS and MD from Saint Johns and is presently Associate Professor of Pharmacology at Saint Johns and and the Coordinator of the Division of Clinical Trials. From this division, along with Dr. Prem Pais, he coordinates large trials and cardiovascular epidemiological studies from  about 140 centers in India. This is one of the largest networks for clinical research in the Indiia.

Of his mentor Salim Yusuf, Denis cannot say enough."He has been my inspiration and has done a lot for research in India and has steered Saint Johns in a new direction where cardiovascukar research is concerned." Denis has also in the past received the award for Excellence in Research.

This Johnite has developed the Indian POLYCAP study(TIPS) with Salim Yusuf and a steering committee while in Canada and is the project director for the same. The recruitment for this study is almost done. Below is more information about the Polycap study.
 
The Indian POLYCAP Study (TIPS)
This study is currently recruiting participants.
Verified by St. John's Research Institute, January 2008

Sponsors and Collaborators: St. John's Research Institute
Cadila Pharnmaceuticals
Population Health Research Institute
Information provided by:St. John's Research Institute
ClinicalTrials.gov Identifier:NCT00443794

Purpose

STUDY TITLE A randomized double-blind controlled trial of the efficacy and safety of the POLYCAP® versus its components in subjects aged 45 to 80 years of age with at least one additional cardiovascular risk factor.

STUDY OBJECTIVES This study is designed to assess the efficacy and safety of the POLYCAP®, a fixed dose combinationcontaining 5 drugs (an antiplatelet drug; 3 blood pressure lowering agents, a beta blocker, an ACE inhibitor, a diuretic and a statin.

STUDY DESIGN

Randomized controlled double-blind trial of the POLYCAP® versus its components in eight formulations.

STUDY POPULATION Subjects between 45 and 80 years of age, with at least one additional CVD risk factor.

INVESTIGATIONAL PRODUCTS Composition POLYCAP® and its comparators FOLLOW UP The total duration of follow up will be 4 months, from the start of study medication.. Subjects will take study medication for 3 months. There will be a final follow up visit 1 month after stopping the study medication.

There will be five follow up visits, the first 7 - 10 days after starting study medication and thereafter monthly visits for 4 months. Subjects taking any of the study medications prior to enrolment will have one or more additional visits during a defined wash out and before enrolment.

OUTCOME MEASURES Mean difference of change in BP, LDL and urinary thromboxane at the end of the three month period.

STATISTICAL ISSUES Non-inferiority evaluation of the POLYCAP in modifying BP, lipids and platelet activity [as measured by urinary thromboxane] when compared with its different components in eight different formulations.


Condition Intervention
Cardiovascular Diseases
Drug: Thiazides
Drug: Ramipril with Thiazide
Drug: Thiazide plus atenolol
Drug: Ramipril plus atenolol
Drug: Ramipril plus atenolol plus thiazide
Drug: POLYCAP
Drug: Thiazide + Ramipril+Atenolol+Aspirin
Drug: Simvastatin
Drug: aspirin


MedlinePlus related topics:   Heart Diseases   Vascular Diseases  

Study Type:  Interventional
Study Design:  Prevention, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Active Control,
Parallel Assignment, Safety/Efficacy Study
 
Official Title:  A Randomized Double Blind Controlled Trial of the Efficacy and Safety of POLYCAP (Quintapill)Versus Its Components
in Subjects With at Least One Additional Cardiovascular Risk Factor

Further study details as provided by St. John's Research Institute:

Primary Outcome Measures:
  • Reduction in blood Pressure [ Time Frame: 12 weeks ] [ Designated as safety issue: Yes ]
  • reduction in Heart Rate [ Time Frame: 12 weeks ] [ Designated as safety issue: Yes ]
  • modify lipids [ Time Frame: 12 weeks ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Platelet aggregation [ Time Frame: 12 weks ] [ Designated as safety issue: No ]

Estimated Enrollment:  2000
Study Start Date:  March 2007
Estimated Study Completion Date:  June 2008
Estimated Primary Completion Date:  March 2008 (Final data collection date for primary outcome measure)

Arms Assigned Interventions
1, POLYCAP: Experimental
Combination of 3 anti hypertensives, lipid lowering agent and anti platelet agent
Drug: POLYCAP
Capsule for Oral Administration once daily for 12 weeks
2 B: Active Comparator
Diuretic antihypertensive
Drug: Thiazides
Capsule (blinded) oral administration once daily for 12 weeks
3 C: Active Comparator
Thiazide plus Angiotensis converting enzyme inhibitor - combination antihypertensive.
Drug: Ramipril with Thiazide
Capsule (blinded) oral administration 12 weeks
4 D: Active Comparator
Diuretic with Beta blocker combination antihypertensive
Drug: Thiazide plus atenolol
Caspule (blinded) for oral administration once daily for 12 weeks
5, E: Active Comparator
ACE inhibitor plus Beta blocker combination antihypertensive
Drug: Ramipril plus atenolol
Capsule ( blinded) for oral administration once daily for 12 weeks
6, F: Active Comparator
Combination antihypertensive of ACE inhibitor, diuretic and beta blocker
Drug: Ramipril plus atenolol plus thiazide
Capsule (blinded) for oral administration once daily for 12 weeeks
7,G: Active Comparator
Combination of ACE inhibitor, betablocker, diuretic and Antiplatelet
Drug: Thiazide + Ramipril+Atenolol+Aspirin
Capsule (Blinded) for oral administration once daily for 12 weeks
8,H: Active Comparator
Lipid lowering agent
Drug: Simvastatin
Capsule (Blinded) for oral administration once daily for 12 weeks
9,A: Active Comparator
Antiplatelet
Drug: aspirin
capsule (Blinded) for oral administration once daily for 12 weeks
  Eligibility
Ages Eligible for Study:   45 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

Inclusion Criteria:

  • Age between 45 and 80 years
  • At least any one of the following CVD risk factors:

    • Stable type 2 diabetes mellitus or
    • Hypertension or
    • Current smoker or
    • A waist to hip ratio > 0.85 for women and >0.9 for men or
    • Elevated lipids.
  • Informed consent.

Exclusion Criteria:

  • On any of the study medications,
  • Uncontrolled blood pressure,
  • Symptomatic hypotension,
  • Any clear indication or a contraindication to the use of any of the study medications,
  • History of coronary/cerebrovascular events,
  • Pregnancy or lactating or women of child-bearing potential with inadequate contraception and / or an inability to attend follow up visits.
  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00443794

Contacts

Locations
 
India, KARNATAKA
 St John's Medical College Hospital, Department of Medicine     Recruiting
       BANGALORE, KARNATAKA, India, 560034
       Contact: GANAPATHY BANTWAL, MBBS,MD            
       Contact: SUDHA SURESH, PhD            
       Principal Investigator: GANAPATHY BANTWAL, MBBS,MD            
 
India, Karnataka
 ST JOHN'S MEDICAL COLLEGE HOSPITAL, Dept of Cardiology     Recruiting
       Bangalore, Karnataka, India, 560 034
       Contact: Chandrakanth , MD, DM     +91 80 2206505324        
       Contact: Kiron Varghese, MD DM     9845014311     This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; This e-mail address is being protected from spambots. You need JavaScript enabled to view it    
       Principal Investigator: CHANDRAKANTH, MD DM            
 
India, TAMIL NADU
 Christian Medical College Hospital     Recruiting
       VELLORE, TAMIL NADU, India
       Contact: PRAKASH            
       Principal Investigator: NIHAL THOMAS, MBBS,MD            
 
India, Tamil Nadu
 KS Hospital     Not yet recruiting
       Chennai, Tamil Nadu, India
       Contact: Shanmuga Sundaram, MD, DM            
       Contact: Inyal , MBBS            
       Principal Investigator: Shanmuga Sundaram, MD,DM            

Sponsors and Collaborators
 
St. John's Research Institute
Cadila Pharmaceuticals
Population Health Research Institute
 
 

Investigators
 
Study Chair:Prem Pais, MD Medicinie     Dean, Professor of Medicine, St Johns Medical College, Head Division of Clinical Trials St John's Research Institute, Bangalore, India    
 
Study Director:Denis Xavier, MD Pharmac     HOPE Research Scholar, Department of Medicine, PHRI, McMaster University, Hamilton, ON, Canada,    
 
Study Chair:     Salim Yusuf, DPhil,FRCPC,FRSC     Director, Population Health Research Institute, Mc Master University, Hamilton, ON, CANADA    
  More Information

Division of Clinical Trials , St John's Research Institute, Website   
 
Cadila Pharmaceuticals   
 

Responsible Party:   Division of Clinical Trials, St. John's Research Institute ( Project Director, The Indian Polycap Study Steering Comittee. )
Study ID Numbers:   Rx-Medical-CVS-06-01
First Received:   February 14, 2007
Last Updated:   January 18, 2008
ClinicalTrials.gov Identifier:   NCT00443794
Health Authority:   India: Ministry of Health

Keywords provided by St. John's Research Institute:
POLYCAP, Primary Prevention,CVD  

Study placed in the following topic categories:
Aspirin
Simvastatin
Atenolol
Ramipril

Additional relevant MeSH terms:
Antimetabolites
Anti-Inflammatory Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Adrenergic Agents
Physiological Effects of Drugs
Hematologic Agents
Fibrinolytic Agents
Fibrin Modulating Agents
Sensory System Agents
 
Therapeutic Uses
Angiotensin-Converting Enzyme Inhibitors
Adrenergic beta-Antagonists
Anti-Inflammatory Agents, Non-Steroidal
Anti-Arrhythmia Agents
Analgesics
Sympatholytics
Antilipemic Agents
Cyclooxygenase Inhibitors
Enzyme Inhibitors

ClinicalTrials.gov processed this record on April 30, 2008
http://clinicaltrials.gov/ct2/show/NCT00443794

 

Johnite Role In "Vote Bengaluru"

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 Vote Bengaluru sounds the bell

MARCH 10TH 2008

The Election Commission and local government officials have been in the news recently on yet another effort (not unlike the past) to clean up the electoral rolls in the state. The upcoming assembly elections in May are a virtual deadline for this process. Civil society groups in Bangalore have pitched in to lend the EC a helping hand. Their goal is to make sure genuine voters are able to cast their votes, and fake voters weeded out.

How have these efforts fared? Though the task at hand is herculean, a beginning has been made.

For long, voters in Bangalore have had to put up with error ridden electoral lists hostage to the machinations of politicians of various hues. But finally, in January 2008, the Election Commission decided that it was time it stepped in to stem the rot. It ordered a revision of the electoral list in the state, after finding lakhs of bogus voters, dead voters, absentee voters and wrong addresses of voters.

Chief Electoral Officer R Ramaseshan (he retires this month end) has had his task cut out for him. His office is tasked with the mandate of preparing the electoral roll for the state. There are about 4.28 crore voters in Karnataka with 39.13 lakh voters in Bangalore, according to the Karnataka Election Commission. Preparing a new roll involves lakhs of inclusion and deletion of names and is a mammoth task.

In performing his job, he has to deal with the citizens’ apathy, the perceived obscurity of the voter registration offices in the city, increasing number of voters, lack of security for the verification team, and the nexus between booth level officers and political parties.

“The onus to see that his/her name is in the rolls falls on the citizen. The problem is that people don’t pay attention to including their names till the last minute. Voters’ apathy is a big challenge. Many among the upper and middle classes are not bothered about voting,” complains Chief Electoral Officer R Ramaseshan.

The EC has even attempted line registration in November 2007, says Ramaseshan. “We opened an online registration process but it received only 4,400 applications. It has been discontinued at the moment but may be made available in the future. The level of apathy seems to be directly proportionate to the citizen’s upward mobility,” he says, lashing out at the elite.

Ramaseshan makes it clear that while every citizen has the right to vote he or she must ensure that his or her name is on the list. If voters do not make arrangements during verification to ensure that their details are made available to the volunteers they will not be included in the list.

The Offices of municipal Assistant Revenue Officers (AROs) have been made the point of contact for citizens to include, delete or correct their names and addresses in the electoral roll. They have to use Form 6 to include their names, Form 7 for deletion and Form 8 for corrections. The entire list of these offices is available on the Chief Electoral Officer’s website.

The forms are also available on the same website. There is a search facility online for Bangalore voters, but the quality o the data and manner in which the results are displayed does not give the impression the search is functioning properly – which can turn off citizens looking for an effective system.

Make sure that you check with misspellings and variations of your name too,” cautions Dr Meenakshi Bharath, a volunteer with the Vote Bengaluru citizens’ campaign in Malleshwaram in Ward 7. She has been interacting frequently with the booth level officers in her ward.

“The fact is that the voters’ list is haphazard and a better system needs to be put in place to prevent confusion. We are working at telling them how exactly they need to go about getting the names and addresses of voters right so that there is no mix up. A few of the booth level officers we have interacted with are keen to get it right. The problem is that so far nobody has instructed them clearly on what exactly they should be doing,” she says.

Do you want help to register or check if your name is on the list?

Citizens' Action Forum (CAF) Padmanabhanagar Ph: 26699085

Citizens' Voluntary Initiative for the City (CIVIC) Shanthinagar Ph: 22110584

Karnataka Kolageri Nivasigala Samyukhtha Saghatane (KKNSS) Adugodi Ph: 22238739

Public Affairs Centre (PAC) Bommasandra Ph: 27834918

Swabhimana Koramangala Ph: 25538584

The Vote Bengaluru campaign is a joint initiative of Public Affairs and residents’ associations such as Citizens’ Action Forum (CAF), Citizens’ Voluntary Initiative for the City (CIVIC) and Swabhimana. The urban poor are represented through an NGO, the Karnataka Kolageri Nivasigala Samyuktha Sanghatane (KKNSS). Campaigners say they want to put an end to the elections of money power and muscle power and replace vote bank politics with issue based politics. It has begun by lending its mite to ensuring an error free electoral roll.

The campaign, however, is making a small start. Volunteers from VB will interact with booth level officers and citizens in around 100 polling booths in about half a dozen wards to ensure that the voters’ list is as error free as possible. (Bangalore has 135 wards). Reports have coming in from ward 50 (Basavanagudi), ward 53 (Srinagar), ward 70 (Shantinagar) and ward 55 (Banashankari) at the time of writing this report.

To complement the EC’s online voters list, VB is also making available the entire voters list for the city on a CD-ROM to make it easier for citizens to find out whether their names are on it. Says Poornima D G, coordinator for the campaign, “We need quality rolls for quality polls. Our aim is to create an accurate database for each polling booth.”

Mohammed Mardhan of Chandra Layout, in Ward 39, is enthusiastic about the exercise. He says, “After the last elections we conducted a survey and found that some 500 genuine voters were not able to cast their because of various errors. So this time let’s hope everybody can vote.” Lack of accountability in the system could be responsible for the proliferation of bogus voters. “We have seen for ourselves how the politics of money power and muscle power plays itself out during elections. There is indeed a high price for slum votes,” says Madhusudhan of KKNSS.

The campaign has highlighted a number of contradictions. For example, in Prashant Nagar in Ward 36 many postal addresses are not recognised by the revenue department. This may disenfranchise a number of voters. Says P L Rao, one of the campaign volunteers in the area, “Some 800 people may not be able to vote because of the conflicting views of the postal and revenue departments. At least 10 streets mandated by the revenue department cannot be located on the ground.”

Electoral rolls apart, VB says they will take things further. On the cards is evolving a citizens’ charter that will reflect real issues and encouraging people’s candidates to contest elections.

The final electoral roll is to be published on March 10, 2008. Requests for inclusion can be made till the last date of nomination, which will be known after the election dates are announced. Voters ID cars will be issued only to those whose names are on the final list.

An electoral roll which includes thousands of bogus voters makes a mockery of democracy. The logistics of preparing an error free electoral roll in Bangalore though is a herculean task, given the rapidly changing demographics of the city. The laborious processes employed by the Election Commission don’t make this task any easier. Only an overhaul of the methods employed together with the active participation of civil society groups and citizens can ensure that the electoral roll is error free.

 http://www.citizenmatters.in/articles/view/87-vote-bengaluru-sounds-the-bell

Rajeev Yeshwanth

 

ACS Patients In India Younger ,Poorer,Sicker and Dying

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Shelley Wood | Heartwire — a professional news service of WebMD

April 25, 2008 (London, UK) - A new analysis from the CREATE registry, published in the April 26, 2008 issue of the Lancet, provides a first true glimpse of the scope, treatments, and outcomes of acute coronary syndromes in India [1]. The picture is bleak: according to Dr Denis Xavier (St John's Medical College, Bangalore, India) and colleagues, people admitted for ACS in India are younger, poorer, sicker, and more likely to die than ACS patients in the developed world.

According to Dr Salim Yusuf (McMaster University, Hamilton, ON), senior author on the study, the findings should serve as a wake-up call to cardiologists and academics seemingly preoccupied with cardiovascular disease in Western countries, which accounts for just 20% of the world's CVD burden.

"This calls for much more awareness in developing countries," he told heartwire. "Very few scientists are working in this area, but if you really want to solve the problem of heart disease, you don't focus on new GP IIb/IIIa inhibitors or new stents that, in the full scheme of things, are actually quite unimportant. In a recent issue of JAMA there are two papers, both of which have no relevance whatsoever to beating the heart-disease burden in the world, yet these are the types of things being published in the major journals. Even if we made significant progress in these focused areas, which we're not even making any more, the real progress needs to be made in the low- and middle-income countries."

Slow to get help, dying young

Xavier et al's paper examined the incidence of STEMI and non-STEMI among almost 21 000 patients from 89 centers in 50 Indian cities. They found that more than 60% of these patients were diagnosed with STEMI, mean age was 57.5 years (although STEMI patients tended to be even younger), and the vast majority were from lower-middle-income or poor families.

Times from symptom onset to hospital admission were at least double that of Western countries, where patients typically take 130 to 170 minutes to get help: in Xavier et al's registry, STEMI patients took a median of 300 minutes from symptom onset to hospital admission, while non-STEMI and unstable-angina patients took a median of 420 minutes to get to the hospital. Authors of the study point to the lack of organized emergency transport systems and ambulance services.

"There is no real system in India for managing heart-attack patients, no education of patients to recognize symptoms and come to the hospital early, and no proper ambulance system--most people come by public transportation or taxi or some other mode of transportation," Yusuf explained. "All of this means that there is a delay in implementing effective therapies."

Once admitted, almost all STEMI and non-STEMI patients were treated with antiplatelet drugs (primarily aspirin, with clopidogrel used in just 15%), but use of ACE inhibitors or angiotensin-receptor blockers (ARBs), thrombolytics, beta blockers, statins, and PCI/CABG were all far lower than rates seen in the West.

Treatments and outcomes, STEMI vs non-STEMI

Treatment/outcome STEMI Non-STEMI p
Antiplatelet drugs 98.2 97.4 0.0001
Thrombolysis 58.5 3.4 <0.0001
Beta blockers 57.5 61.9 <0.0001
Anticoagulants 78.6 85.5 <0.0001
ACE inhibitors/ARBs 60.5 51.2 <0.0001
Lipid-lowering drugs 50.8 53.9 <0.0001
PCI 8 6.7 <0.0001
Death 8.6 3.8 <0.0001
Reinfarction 2.3 1.2 <0.0001

 

Not surprisingly, 30-day death, reinfarction, and stroke rates were higher for STEMI patients than non-STEMI, and mortality, notably, was significantly higher in poor patients than in rich patients, a difference eliminated when adjusted for treatment use.

Mortality rates, by socioeconomic status

Mortality Rich (%) Lower middle class (%) Poor (%) p
Unadjusted mortality 5.5 6.5 8.2 <0.0001
Mortality adjusted for risk factors, location of infarct, and treatments 7.2 6.4 6.6 0.97

 

"These are major, major issues that call for governmental action, a national health-insurance system, and education of patients about the signs and symptoms of a heart attack," Yusuf commented. "Government insurance that provides some sort of basic care in acute emergencies is urgently needed, so patients don't worry whether they can afford treatment. In India, often when a patient is first admitted with a heart attack and a thrombolytic is needed, the hospital will start to discuss with the patient's relatives whether it's worth doing, whether they can afford the cost."

While the number of health insurance companies is on the rise in India, plans are typically provided through larger employers, and a disproportionate number of Indian workers are actually self-employed, Yusuf noted.

Yusuf emphasized that this paper provides key information previously unknown about ACS in a country expected to account for 60% of the world's CVD by 2010 and where risk factors like obesity and diabetes are soaring.

"India has the largest percentage of heart disease in the world, and this is the first paper to clarify how people are being treated," he told heartwire. "The key thing is that the pattern of presentation of patients is similar to what we saw in the West 25 or 30 years ago: patients arrive late, they're younger (by about a decade compared with the West), and they have more ST-segment MI rather than non-STEMI. This is classical when disease is on the rise. And added to that, you have the burden of a healthcare system that's not geared toward dealing with these kinds of things."

Yusuf also stated that India may be "a good example for what is happening in most of the world."

"We are all very much focused on treatment as it applies to Western countries, but the problem with that is that only 20% of heart disease actually occurs in these countries," he said. "If you want to deal with the global problem, we have to find a way of paying attention to the developing countries. And this paper identifies the problems."

Treatment targets

In an editorial accompanying the study [2], Dr Kim Eagle (University of Michigan Medical Center, Ann Arbor) calls this registry analysis "a major milestone" that, by identifying the issues, provides opportunities for tackling them. He proposes efforts targeting tobacco use; policies and education to switch the emphasis from saturated to polyunsaturated fat in Indian diets; and screening for hyperlipidemia and hypertension--relatively cheap and simple strategies that have had an enormous impact in other parts of the world.

Eagle also observes that world-class medical care already exists in India but suggests that provision of this caliber of care to the minority who can afford it may be distracting from the goal of providing relatively inexpensive drugs on a much wider scale.

"On average, these strategies are not expensive," Eagle writes. "Most of the decline in coronary mortality in the US is believed to be secondary to improving risk-factor profiles and effective primary and secondary treatments of acute coronary syndrome with aspirin, beta blockers, statins, and, when appropriate, ACE inhibitors or angiotensin-receptor antagonists. Expensive interventions, such as revascularization, account for only 5% of this benefit. There is no reason why similar results cannot be achieved in India and elsewhere."

CREATE registry authors declared having no conflicts of interest; Eagle disclosed receiving research funding from Sanofi-Aventis, Pfizer, Bristol-Myers Squibb, and Merck. Sanofi-Aventis India was one of several funding sources for the study, via an unrestricted educational grant.

  1. Xavier D, Pais P, Devereaux PJ, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet 2008; 371:1435-1442.
  2. Eagle K. Coronary artery disease in India: challenges and opportunities. Lancet 2008; 371:1394-1395.

http://www.medscape.com/viewarticle/573493

 


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