Browsing by Author "Madan, Kushal"

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    Ambulatory blood pressure monitoring in clinical practice
    (Cardiological Society of India, 2019-01) Dadlani, Apaar; Madan, Kushal; Sawhney, J.P.S.
    Being one of the most widely prevalent diseases throughout the world, hypertension has emerged as one of the leading causes of global premature morbidity and mortality. Hence, blood pressure (BP) measurements are essential for physicians in the diagnosis and management of hypertension. Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend initiating antihypertensive medications on the basis of office BP readings. However, office BP readings provide a snapshot evaluation of the patient's BP, which might not reflect patient's true BP, with the possibility of being falsely elevated or falsely low. Recently, there is ample evidence to show that ambulatory blood pressure monitoring (ABPM) is a better predictor of major cardiovascular events than BP measurements at clinic settings. ABPM helps in reducing the number of possible false readings, along with the added benefit of understanding the dynamic variability of BP. This article will focus on the significance of ambulatory BP, its advantages and limitations compared with the standard office BP measurement and a brief outlook on its use and interpretation to diagnose and treat hypertension.
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    Comparison of straight sternotomy and interlocking sternotomy in open heart surgery.
    (2006-07-24) Madan, Kushal; Gupta, Vishwa Prakash; Singh, Rajvir; Talwar, Sachin; Choudhary, Shiv Kumar; Airan, Balram; Sampath Kumar, A
    BACKGROUND AND OBJECTIVES: Stable sternal approximation is an important factor to avoid respiratory complications after open heart surgery. The present study is designed to compare interlocking sternotomy and straight sternotomy in terms of sternal stability, pain and respiratory function. METHODS: Sixty patients scheduled for open heart surgery underwent a standard midline sternotomy (n=30) or an interlocking sternotomy (n=30). The features assessed were pain on visual analogue scale during rest and during cough, peak expiratory flow rate and sternal instability. Evaluation was performed on the first, fourth post-operative days, on discharge and one month and three month follow up. RESULTS: Analysis of the peak expiratory flow rates, visual analogue ratings of pain intensity at rest and on coughing were carried out for each group only for those patients who completed the study. Postoperatively, in all patients there was significant reduction in peak expiratory flow rates. In the straight sternotomy group resting pain intensity was higher on discharge (2.6+/- 2 vs 1.6 +/- 2.3, P= 0.005). In the interlocking sternotomy group pain on coughing was significantly less than straight sternotomy group (median 0.5 vs 2.8, P=0.005) at 1 month follow up and at 3 months (median 0 vs 1.6, P=0.003). INTERPRETATION AND CONCLUSION: Interlocking sternotomy can be performed with good functional results and offers a less painful alternative to straight sternotomy.
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    CSI clinical practice guidelines for dyslipidemia management: Executive summary
    (Elsevier, 2024-03) Sawhney, Jitendra PS.; Ramakrishnan, Sivasubramanian; Madan, Kushal; Ray, Saumitra; Jayagopal, P Balagopalan; Prabhakaran, Dorairaj; Nair, Tiny; Zachariah, Geevar; Jain, Peeyush; Dalal, Jamshed; Radhakrishnan, Sitaraman; Chopra, Arun; Kalra, Sanjay; Mehta, Ashwani; Pancholia, Arvind K.; Kabra, Nitin K.; Kahali, Dhiman; Ghose, Tapan; Yadav, Satyavir; Kerkar, Prafulla; Yadav, Ajay; Roy, Debabrata; Das, Mrinal Kanti; Bang, Vijay H.; Rath, Pratap Chandra; Sinha, Dhurjati Prasad; Banerjee, P.S.; Yadav, Rakesh; Gupta, Rajeev
    Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the CSI: Clinical Practice Guidelines for Dyslipidemia Management published in this issue of the Indian Heart Journal. The summary is focused onthe busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttrans- plant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also pre- sented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the indi- vidual clinician judgement who remains the sole arbiter in management of the patient.
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    Exercise and lipids
    (Elsevier, 2024-03) Madan, Kushal; Sawhney, J.P.S.
    Evidence from the existing literature suggests that exercise has positive effects for prevention and treatment of cardiovascular diseases by reducing risk factors such as elevated blood lipids. Based on clinical and observational clinical trials, it is well established that increased physical activity and regular exercise has a favourable impact on blood lipids and lipoprotein profiles. Exercise training significantly decreases blood triglycerides concen- tration and increases high density lipoprotein cholesterol levels. Though the Indian data depicting the effect of exercise on lipids is scarce, exercise directly improves atherogenic dyslipidaemia which is frequently present among Indians i.e. HDL-C is increased, TG is reduced and LDL-C particle size is improved. While drug therapy is key to the treatment of dyslipidaemia, lifestyle alterations such as exercise should continue to be actively pro- moted and encouraged by clinicians. Exercise is a low cost, non pharmacological therapeutic lifestyle change that is of value to lipid metabolism and cardiovascular fitness.
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    Familial hypercholesterolemia
    (Elsevier, 2024-03) Sawhney, J.P.S.; Madan, Kushal
    Familial hypercholesterolemia is a common genetic disorder of autosomal inheritance associated with elevated LDL-cholesterol. It is estimated to affect 1:250 individuals in general population roughly estimated to be 5 million in India. The prevalence of FH is higher in young CAD patients (<55 years in men; <60 years in women). FH is underdiagnosed and undertreated. Screening during childhood and Cascade screening of family members of known FH patients is of utmost importance in order to prevent the burden of CAD. Early identification of FH patients and early initiation of the lifelong lipid lowering therapy is the most effective strategy for managing FH. FH management includes pharmaceutical agents (statins and non statin drugs) and lifestyle modification. Inspite of maximum dose of statin with or without Ezetimibe, if target levels of LDL-C are not achieved, Bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9) Inhibitors/Inclisiran can be added.
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    Prevalence of familial hypercholesterolemia in premature coronary artery disease patients admitted to a tertiary care hospital in North India
    (Cardiological Society of India, 2019-03) Sawhney, J.P.S.; Prasad, Shashi Ranjan; Sharma, Manish; Madan, Kushal; Mohanty, A.; Passey, Rajiv; Mehta, Ashwani; Kandpal, B.; Makhija, Aman; Jain, Rajneesh; Mantri, R.R.; Vivek, Bhola Shankar; Manchanda, S.C.; Verma, I.C.
    Aims The prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown. Methods A total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded. Results Of total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%). Conclusion FH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used.