Publications by authors named "Gs Wander"

Background: Various studies have documented gender differences in the management and outcomes of acute myocardial infarction (AMI) in developed countries. Gender differences in the management of AMI in India is not known.

Objectives: To document the gender differences in the management and outcomes of AMI in India.

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  • The study investigates home blood pressure monitoring (HBPM) practices and knowledge among people with hypertension (HTN) and their caregivers in North India, revealing low training and usage rates.
  • Out of 2750 screened participants, only 18.1% utilized HBPM, with a significant urban-rural disparity (20.5% vs. 8.5%).
  • Most participants learned HBPM informally, resulting in better practice scores compared to knowledge, highlighting a need for structured training to improve effective BP management.
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In heart failure, sympathetic overdrive is evidenced by norepinephrine spillover, receptor level changes, etc. Beta-blockers continue to be the cornerstone of treatment in patients with chronic heart failure due to their ability to counteract sympathetic overdrive. Extensive clinical research has demonstrated that long-term beta-blocker treatment with metoprolol succinate, carvedilol, or bisoprolol enhances left ventricular function and reverses left ventricular remodeling, decreases hospitalization risk, and increases survival.

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  • The study aims to examine the incidence and types of drug abuse among individuals under 30 years old who have experienced acute coronary syndrome (ACS).
  • The research involved 153 patients, with 17 patients (11.1%) identified as drug abusers; common substances included opium, energy drinks, whey protein, inhaled marijuana, and heroin.
  • Results indicate a significant increase in drug abuse trends over time, signaling a need for strict regulations to address this growing issue as it is a modifiable risk factor for ACS in young adults.
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Adverse cardiovascular (CV) events have declined in Western countries due at least in part to aggressive risk factor control, including dyslipidemia management. The American and European (Western) dyslipidemia treatment guidelines have contributed significantly to the reduction in atherosclerotic cardiovascular disease (ASCVD) incidence in the respective populations. However, their direct extrapolation to Indian patients does not seem appropriate for the reasons described below.

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Background: The efficacy and safety of the ultrathin BioMime sirolimus-eluting coronary stent (SES) system in treating single or multiple native coronary lesions, in-stent restenosis, and bifurcation lesions have been evidenced at 1 year.

Aims: We sought to investigate the long-term safety and efficacy of the BioMime SES in a real-world population with obstructive coronary artery disease (CAD).

Methods: The prospective, single-arm, multicentre meriT-2 trial enrolled 250 patients from 11 sites across India.

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  • * Current guidelines recommend early combination therapy using four drug classes, especially ARNI, which significantly reduces morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF).
  • * A national consensus by Indian cardiology experts emphasizes that ARNI should be initiated early in HFrEF patients, including those hospitalized, and can also benefit patients with preserved and mildly reduced ejection fractions.
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In India and the Southeast Asian population, hypertension and type 2 diabetes mellitus (T2DM) are the leading lifestyle-related diseases, responsible for a majority burden of morbidity and mortality. Multiple population-spanning studies have revealed the staggering prevalence of both diseases in India, and the prevalence of both will only increase further due to factors such as an aging population, rapid urbanization, increased obesity, and sedentary lifestyles. More than 50 percent of hypertensive patients in India are also diagnosed with T2DM, and a detailed management protocol for the same is required, especially when a major portion of the disease is managed at the primary care level.

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The index study aimed to investigate the clinical impact of initial high-sensitivity C-reactive protein (hs-CRP) on outcomes in nonvalvular atrial fibrillation (AF). Single-center, prospective, observational study recruiting all recently diagnosed treatment-naive AF patients. Hs-CRP was measured at baseline and patients were followed for 24 months.

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The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications.

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Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment.

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Aim: The present study compared the safety, efficacy, and tolerability of the new fixed-dose combination (FDC) of telmisartan 40 mg + bisoprolol 5 mg (TBP) tablets with the existing comparator FDC telmisartan 40 mg + metoprolol succinate ER 50 mg (TMS) tablets in patients with stage 1 and stage 2 hypertension.

Methodology: The multicentric, double-blind, parallel-group, comparative, prospective, phase-III clinical study involved 264 subjects with stage 1 and stage 2 hypertension from 10 centres across India. The selected subjects were randomized into two groups: group A received the TMS and group B received the new FDC TBP.

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The rapidly increasing burden of hypertension is responsible for premature deaths from cardiovascular disease (CVD), renal disease, and stroke, with a tremendous public health and financial burden. Hypertension detection, treatment, and control vary worldwide; it is still low, particularly in low- and middle-income countries (LMICs). High blood pressure (BP) and CVD risk have a strong, linear, and independent association.

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  • * Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are new medications that not only help control blood sugar in T2DM but also provide significant cardiovascular benefits for HF patients.
  • * Evidence shows that SGLT2i can enhance heart function and improve outcomes in HF whether patients have diabetes or not, making them valuable for a wide range of HF patients, especially in India.
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  • - In India, heart failure (HF) is a significant health issue, impacting younger individuals compared to Western countries, but many patients do not receive proper medical treatment.
  • - Selective β-1 blockers, like bisoprolol, are important in treating HF because they help lower heart rate and reverse negative heart and blood vessel changes associated with the condition.
  • - Despite the benefits of bisoprolol for various HF cases and comorbid conditions, its use in India remains suboptimal, prompting a consensus on its effectiveness and recommending it for better patient care.
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We evaluated the performance of various polygenic risk score (PRS) models derived from European (EU), South Asian (SA), and Punjabi Asian Indians (AI) studies on 13,974 subjects from AI ancestry. While all models successfully predicted Coronary artery disease (CAD) risk, the AI, SA, and EU + AI were superior predictors and more transportable than the EU model; the predictive performance in training and test sets was 18% and 22% higher in AI and EU + AI models, respectively than in EU. Comparing individuals with extreme PRS quartiles, the AI and EU + AI captured individuals with high CAD risk showed 2.

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  • The Lipid Association of India updated its cardiovascular risk assessment algorithm to address the unique challenges of atherosclerotic cardiovascular disease (ASCVD) in Indians, focusing on early intervention.
  • A series of expert meetings were held to review current evidence and refine treatment guidelines, emphasizing the need for aggressive preventive measures due to the young age of onset for ASCVD in the Indian population.
  • The updated recommendations aim to enhance LDL-C-lowering therapy and improve risk management strategies for individuals at high risk of ASCVD, ultimately striving to reduce its prevalence in India and beyond.
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  • Genome-wide polygenic risk scores (PRS) are effective in predicting type 2 diabetes (T2D) risk, particularly in Europeans, but their utility in non-European populations, such as Asian Indians, is less understood.
  • The study analyzed PRS models using data from 13,974 Asian Indian individuals, comparing their predictive power against European-derived PRS models and found significant efficacy in identifying T2D risk.
  • Results indicated that the Asian Indian PRS outperformed the European PRS in predicting risk, highlighting the importance of including diverse ethnic groups in genetic and clinical research for more accurate risk assessment.
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  • * The review examines the links between IBD and ASCVD, discussing mechanisms, the effects of IBD treatments on cardiovascular risk, and the adverse cardiovascular effects of some new IBD medications.
  • * A thorough search of PubMed from its beginning until August 2023 was conducted to gather literature on IBD and ASCVD, aiming to provide a comprehensive understanding of their relationship and related health risks.
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Multisystem inflammatory syndrome in children (MIS-C) can cause significant morbidity and mortality in children. This study was conducted to assess the pattern and outcome of cardiac abnormalities in MIS-C. This retrospective study was conducted in children with MIS-C between 1 month and 18 years.

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Objectives: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019.

Methods: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study.

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Background: Diabetes mellitus (DM), chronic kidney disease (CKD), and heart failure (HF) are pathophysiologically linked and increasing in prevalence in Asian populations, but little is known about the interplay of DM and CKD on outcomes in HF.

Objectives: This study sought to investigate outcomes in patients with heart failure with preserved ejection fraction (HFpEF) vs heart failure with reduced ejection fraction (HFrEF) in relation to the presence of DM and CKD.

Methods: Using the multinational ASIAN-HF registry, we investigated associations between DM only, CKD only, and DM+CKD with: 1) composite of 1-year mortality or HF hospitalization; and 2) Kansas City Cardiomyopathy Questionnaire scores, according to HF subtype.

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Background: Structural valve dysfunction in bioprosthetic heart valves necessitates redo replacement procedure that are associated with high mortality and morbidity. The transcatheter valve-in-valve (VIV) approach has emerged as a preferred option for patients requiring redo procedures due to structural valve degeneration. We report from India the first case of the simultaneous transcatheter dual VIV implantation (mitral valve and tricuspid valves) in a high-surgical-risk patient.

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