Publications by authors named "Vinod Mittal"
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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- * 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.
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.
View Article and Find Full Text PDFCurrent Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India.
J Assoc Physicians India
January 2024
Article Synopsis
- * 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.
Role of Bisoprolol in Heart Failure Management: A Consensus Statement from India.
J Assoc Physicians India
December 2023
Article Synopsis
- - 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.
Article Synopsis
- 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.
Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), β-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile.
View Article and Find Full Text PDFRole of Iron Therapy in Heart Failure: A Consensus Statement from India.
J Assoc Physicians India
March 2023
Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF.
View Article and Find Full Text PDFIn 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations.
View Article and Find Full Text PDFIntroduction: In this ORION study subgroup analysis, the safety and effectiveness of insulin glargine 300 U/mL (Gla-300) was evaluated in people from the South Asia region with type 2 diabetes mellitus (T2DM) before, during, and after Ramadan, in a real-world setting.
Methods: The ORION study was a real-world, prospective, observational, non-comparative study conducted across 11 countries. The current subgroup analysis included participants from the South Asia region (India and Pakistan) who fasted during Ramadan.
Article Synopsis
- Type 2 Diabetes Mellitus (T2DM) is increasingly becoming a major public health issue, and tailored treatment approaches are recommended for patients, especially those newly diagnosed in India with an HbA1c level above 7.5%.
- A committee of seventeen diabetes experts assessed three key statements regarding the treatment of these patients using a 9-point Likert scale to gauge consensus.
- The consensus was that dual therapy combining Dipeptidyl Peptidase-4 inhibitors (DPP4Is) and Metformin should be the first-line treatment for newly diagnosed Indian T2DM patients with HbA1c levels over 7.5%, as it is both effective and cost-efficient.
Objective To evaluate the usage of various strengths of glimepiride and metformin fixed-dose combinations in the management of type 2 diabetes mellitus (T2DM) patients with comorbidities and complications. Methods A retrospective, non-randomized, non-comparative, multi-centric real-world study included T2DM patients (age > 18 years) taking glimepiride and metformin fixed-dose combinations. Age, duration of diabetes, diabetes complications, comorbidities (hypertension and dyslipidemia), dosage frequency, and concomitant medications were analyzed from medical charts.
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