Saumitra Ray

Polymorphism of ACE gene as the genetic predisposition of coronary artery disease in Eastern India

AIM A case control study was designed to assess whether the prevalence of ACE gene polymorphism has any role in the development of CAD. METHODS The study included unrelated 217 cases with CAD and 255 healthy controls. PCR was done using primers followed by agarose gel electrophoresis for study of different ACE gene polymorphisms. Multiple logistic regression analysis was carried out to find association between studied genotypes and lifestyle as well as biochemical risk factors. RESULTS Both DD [OR: 2.16; 95%CI: (60.60-67.40)] and ID [OR: 1.48; 95%CI: (93.28-97.72)] genotypes of the ACE gene showed significant associations in the development of CAD. Coexistence of diabetes and hypertension found to be risk modifier of the disease. Tobacco intake in various forms elevates the risk of the disease among the cases with risk genotypes. CONCLUSION ID and DD genotypes of ACE gene came out to be predisposing factors for the CAD cases in our study population.

Polymorphisms of methylenetetrahydrofolate reductase gene as the genetic predispositions of coronary artery diseases in eastern India

Background: Gene–environment interaction is an important aspect in the development of coronary artery disease (CAD). The mutation (677C-T) of methylenetetrahydrofolate reductase (MTHFR) gene results in a decrease of the enzyme activity that leads to mild hyperhomocysteinemia. Elevated plasma level of homocysteine has been recognized as an independent risk factor for cardiovascular disease. A case–control study was designed to assess whether the prevalence of some MTHFR gene polymorphisms have any role in the development of CAD. Materials and Methods: The study included unrelated 217 cases with CAD and 255 healthy controls. DNA was extracted from peripheral blood. MTHFR genotypes were identified by seeing the presence or absence of 677C→T mutation obtained by PCR followed by Hinf1 restriction digestion. Multiple logistic regression analysis was carried out to find association between studied genotypes and lifestyle as well as biochemical risk factors. Results: The T allele was found to be associated with the disease. Significant associations were found with smoking, hypertension, diabetes, and family history of CAD. Conclusion: The results indicate that MTHFR 677C-T polymorphism has significant association with CADs in the population of eastern India.

Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India

Santanu Guha*, Rishi Sethi, Saumitra Ray, Vinay K. Bahl, S. Shanmugasundaram, Prafula Kerkar, Sivasubramanian Ramakrishnan, Rakesh Yadav, Gaurav Chaudhary, Aditya Kapoor, Ajay Mahajan, Ajay Kumar Sinha, Ajit Mullasari, Akshyaya Pradhan, Amal Kumar Banerjee, B.P. Singh, J. Balachander, Brian Pinto, C.N. Manjunath, Chandrashekhar Makhale, Debabrata Roy, Dhiman Kahali, Geevar Zachariah, G.S. Wander, H.C. Kalita, H.K. Chopra, A. Jabir, JagMohan Tharakan, Justin Paul, K. Venogopal, K.B. Baksi, Kajal Ganguly, Kewal C. Goswami, M. Somasundaram, M.K. Chhetri, M.S. Hiremath, M.S. Ravi, Mrinal Kanti Das, N.N. Khanna, P.B. Jayagopal, P.K. Asokan, P.K. Deb, P.P. Mohanan, Praveen Chandra, (Col.) R. Girish, O. Rabindra Nath, Rakesh Gupta, C. Raghu, Sameer Dani, Sandeep Bansal, Sanjay Tyagi, Satyanarayan Routray, Satyendra Tewari, Sarat Chandra, Shishu Shankar Mishra, Sibananda Datta, S.S. Chaterjee, Soumitra Kumar, Soura Mookerjee, Suma M. Victor, Sundeep Mishra, Thomas Alexander, Umesh Chandra Samal, Vijay Trehan

Management standards for stable coronary artery disease in India

Coronary artery disease (CAD) is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. An increasing burden of CAD in India is a major cause of concern with angina being the leading manifestation. Stable coronary artery disease (SCAD) is characterised by episodes of transient central chest pain (angina pectoris), often triggered by exercise, emotion or other forms of stress, generally triggered by a reversible mismatch between myocardial oxygen demand and supply resulting in myocardial ischemia or hypoxia. A stabilised, frequently asymptomatic phase following an acute coronary syndrome (ACS) is also classified as SCAD. This definition of SCAD also encompasses vasospastic and microvascular angina under the common umbrella.

Management Protocols of stable coronary artery disease in India: Executive summary

Sundeep Mishra *, Saumitra Ray , Jamshed J. Dalal , J.P.S. Sawhney , S. Ramakrishnan , Tiny Nair , S.S. Iyengar , Vinay K. Bahl a a Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India b AMRI Hospital, Kolkata, India c Kokilaben Dhirubhai Ambani Hospital, Mumbai, India d Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India e PRS Hospital, Trivandrum, India f Consultant Cardiologist, Manipal Hospital, Bangalore, India

The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants.

The last ten years have seen rapid strides in the evolution of nonvitamin K oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). For the preparation of this consensus, a comprehensive literature search was performed and data on available trials, subpopulation analyses, and case reports were analyzed. This Indian consensus document intends to provide guidance on selecting the right NOAC for the right patients by formulating expert opinions based on the available trials and Asian/Indian subpopulation analyses of these trials. A section has been dedicated to the current evidence of NOACs in the Asian population. Practical suggestions have been formulated in the following clinical situations: (i) Dose recommendations of the NOACs in different clinical scenarios; (ii) NOACs in patients with rheumatic heart disease (RHD); (iii) Monitoring anticoagulant effect of the NOACs; (iv) Overdose of NOACs; (v) Antidotes to NOACs; (vi) Treatment of hypertrophic cardiomyopathy (HCM) with AF using NOACs; (vii) NOACs dose in elderly, (viii) Switching between NOACs and vitamin K antagonists (VKA); (ix) Cardioversion or ablation in NOAC-treated patients; (x) Planned/emergency surgical interventions in patients currently on NOACs; (xi) Management of bleeding complications of NOACs; (xii) Management of acute coronary syndrome (ACS) in AF with NOACs; (xiii) Management of acute ischemic stroke while on NOACs.

CSI position statement on management of heart failure in India

Santanu Guha, S. Harikrishnan*, Saumitra Ray, Rishi Sethi, S. Ramakrishnan, Suvro Banerjee, V.K. Bahl, K.C. Goswami, Amal Kumar Banerjee, S. Shanmugasundaram, P.G. Kerkar, Sandeep Seth, Rakesh Yadav, Aditya Kapoor, Ajaykumar U. Mahajan, P.P. Mohanan, Sundeep Mishra, P.K. Deb, C. Narasimhan, A.K. Pancholia, Ajay Sinha, Akshyaya Pradhan, R Alagesan, Ambuj Roy, Amit Vora, Anita Saxena, Arup Dasbiswas, B.C. Srinivas, B.P. Chattopadhyay, B.P. Singh, J. Balachandar, K.R. Balakrishnan, Brian Pinto, C.N. Manjunath, Charan P. Lanjewar, Dharmendra Jain, Dipak Sarma, G. Justin Paul, Geevar A. Zachariah, H.K. Chopra, I.B. Vijayalakshmi, J.A. Tharakan, J.J. Dalal, J.P.S. Sawhney, Jayanta Saha, Johann Christopher, K.K. Talwar, K. Sarat Chandra, K. Venugopal, Kajal Ganguly, M.S. Hiremath, Milind Hot, Mrinal Kanti Das, Neil Bardolui, Niteen V. Deshpande, O.P. Yadava, Prashant Bhardwaj, Pravesh Vishwakarma, Rajeeve Kumar Rajput, Rakesh Gupta, S. Somasundaram, S.N. Routray, S.S. Iyengar, G. Sanjay, Satyendra Tewari, Sengottuvelu G., Soumitra Kumar, Soura Mookerjee, Tiny Nair, Trinath Mishra, U.C. Samal, U. Kaul, V.K. Chopra, V.S. Narain, Vimal Raj, Yash Lokhandwala

Adaptation of 2016 European Society of Cardiology/European Atherosclerosis Society guideline for lipid management to Indian patients – A consensus document

In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia.

Management protocols for chronic heart failure in India.

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Vascular Disease in Young Indians (20-40 years): Role of Hypertension.

Hypertension (HTN) being one of the important risk factors for cardiovascular disease (CVD) is a significant health concern, especially in India. With age, prevalence of HTN, especially systolic HTN increases. Special attention needs to be directed to HTN in young ages (20-40 years) due to lower awareness, need for early treatment and better control of HTN. HTN in the age group of 20-40 years needs critical reappraisal. Given the high prevalence of HTN in the general population in India, in this review we attempt to provide current evidence and expert opinion on epidemiology, aetiopathogenesis and treatment of HTN in young (20-40 years) Indians.