Browsing by Author "Banshi Saboo"

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Does Adopting Western Low-density Lipoprotein Cholesterol Targets Expose Indians to a Higher Risk of Cardiovascular Events? Expert Opinion From the Lipid Association of India
(Journal of Association of Physicians of India, 2024) Raman Puri; Vimal Mehta; Manish Bansal; P. Barton Duell; S.S. Iyengar; Sadanand Shetty; Ian Graham; J.C. Mohan; Upendra Kaul; Dayasagar Rao; Rajeev Agarwala; Gurpreet Singh Wander; Prakash Hazra; Soumitra Kumar; S.K. Wangnoo; Abdul Hamid Zargar; Banshi Saboo; Jamal Yusuf; Vinod M. Vijan; Prem Aggarwal; Sarat Chandra; Ravi R. Kasliwal; P.C. Manoria; M.U. Rabbani; Milan C. Chag; D. Prabhakar; Aziz Khan; Neil Bordoloi; Saravanan Palanippan; Kunal Mahajan; Akshay Pradhan; Dharmender Jain; A. Murugnathan; Pradeep Kumar Dabla; Nagaraj Desai; Mangesh H. Tiwaskar; Devaki R. Nair; Charanjeet Singh; Jayant Panda; Vitull Gupta; Prashant Sahoo; Nathan D. Wong
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. In the US, mean low-density lipoprotein cholesterol (LDL-C) levels have markedly declined over the last 2 decades, correlating with a proportional reduction in CV events. Conversely, poor risk factor control and dyslipidemia management have led to increased CV and coronary artery disease (CAD) mortality rates in India. The population-attributable risk of dyslipidemia is about 50% for myocardial infarction, signifying its major role in CV events. In addition, the pattern of dyslipidemia in Indians differs considerably from that in Western populations, requiring unique strategies for lipid management in Indians and modified treatment targets. The Lipid Association of India (LAI) recognized the need for tailored LDL-C targets for Indians and recommended lower targets compared to Western guidelines. For individuals with established ASCVD or diabetes with additional risk factors, an LDL-C target of <50 mg/dL was recommended, with an optional target of ≤30 mg/dL for individuals at extremely high risk. There are several reasons that necessitate these lower targets. In Indian subjects, CAD develops 10 years earlier than in Western populations and is more malignant. Additionally, Indians experience higher CAD mortality despite having lower basal LDL-C levels, requiring greater LDL-C reduction to achieve a comparable CV event reduction. The Indian Council for Medical Research—India Diabetes study described a high prevalence of dyslipidemia among Indians, characterized by relatively lower LDL-C levels, higher triglyceride levels, and lower high-density lipoprotein cholesterol (HDL-C) levels compared to Western populations. About 30% of Indians have hypertriglyceridemia, aggravating ASCVD risk and complicating dyslipidemia management. The levels of atherogenic triglyceride-rich lipoproteins, including remnant lipoproteins, are increased in hypertriglyceridemia and are predictive of CV events. Hypertriglyceridemia is also associated with higher levels of small, dense LDL particles, which are more atherogenic, and higher levels of apolipoprotein B (Apo B), reflecting a higher burden of circulating atherogenic lipoprotein particles. A high prevalence of low HDL-C, which is often dysfunctional, and elevated lipoprotein(a) [Lp(a)] levels further contribute to the heightened atherogenicity and premature CAD in Indians. Considering the unique characteristics of atherogenic dyslipidemia in Indians, lower LDL-C, non-HDL-C, and Apo B goals compared to Western guidelines are required for effective control of ASCVD risk in Indians. South Asian ancestry is identified as a risk enhancer in the American lipid management guidelines, highlighting the elevated ASCVD risk of Indian and other South Asian individuals, suggesting a need for more aggressive LDL-C lowering in such individuals. Hence, the LDL-C goals recommended by the Western guidelines may be excessively high for Indians and could result in significant residual ASCVD risk attributable to inadequate LDL-C lowering. Further, the results of Mendelian randomization studies have shown that lowering LDL-C by 5–10 mg/dL reduces CV risk by 8–18%. The lower LDL-C targets proposed by LAI can yield these incremental benefits. In conclusion, Western LDL-C targets may not be suitable for Indian subjects, given the earlier presentation of ASCVD at lower LDL-C levels. They may result in greater CV events that could otherwise be prevented with lower LDL-C targets. The atherogenic dyslipidemia in Indian individuals necessitates more aggressive LDL-C and non-HDL-C lowering, as recommended by the LAI, in order to stem the epidemic of ASCVD in India. © The Author(s).
Effects of Indo-Mediterranean style diet and low fat diet on incidence of diabetes in acute coronary syndromes
(Nova Science Publishers, Inc., 2017) R.B. Singh; Banshi Saboo; Anuj Mahashwari; Kshitij Bharatdwaj; Narsingh Verma; Krasimira Hristova; S. Ghosh; M.A. Niaz; Jaipaul Singh; Ernest A. Adeghate; K.A. Bidasee; Mukta Singh; Anubha Mishra; Surbhi Tripathi; Diksha Singh; Smita Pandey; Swarnika Srivastava; Poonam Jaglan
Introduction: Obesity and diabetes are known to increase the risk of mortality due to acute coronary syndromes (ACSs). Effect of ACSs on risk of diabetes is unknown. This study examined the effect of the Mediterranean-style diet compared to a low-fat diet on incidence of obesity, diabetes and prediabetes in patients with ACSs. Subjects and Methods: A randomized, single-blind, controlled trial was carried out on 406 patients with ACSs diagnosed by WHO criteria. The intervention group received a low-energy Indo-Mediterranean diet and the control group received a fat-modified diet, according to the NCEP Step 1 diet. The main outcome measures were compliance with diets and weight loss at one year and frequency of obesity and diabetes and all-cause mortality after two years. Results: The intervention group received significantly greater amounts of Mediterranean-style foods and lower amounts of Western foods compared to the control group at one year of follow-up. The frequency of obesity and known diabetes, as well as prediabetes, was comparable in the two groups at the inception of the study. However, after 2 years, the incidence of obesity, known diabetes, as well as prediabetes (n = 55, 26.9%. vs. 11, 5.4%, P < 0.001) was significantly lower in the intervention group, compared to the reference. In contrast, the incidence of prediabetes was significantly increased in the control group compared to reference (n = 50, 20.2, vs. 58, 28.7%, P < 0.01). The incidence of prediabetes after 2 years was significantly higher in the control group compared to the intervention group (28.7% vs. 5.4%, P < 0.001). These findings were associated with a significantly greater adherence score for the Indo-Mediterranean diet in the intervention group compared to that for the diet of the control group. A greater weight loss of >0.5 kg was associated with significantly (p < 0.001) fewer cardiovascular events and less mortality, more so in the intervention group than in the control group. The total mortality was 14.7% in the intervention group and 25.2% in the control group (p < 0.01) after two years. Conclusions: The Indo-Mediterranean-style diet is effective in decreasing the incidence of known diabetes and prediabetes. However, in the control group, there is no decline in known diabetes but a significant increase in the incidence of prediabetes, compared to the reference indicating that ACSs may have predisposed subjects to prediabetes without any beneficial effect of the low-fat control diet. © 2017 Nova Science Publishers, Inc.
Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes
(Elsevier Ltd, 2017) Sujoy Ghosh; A.G. Unnikrishnan; Banshi Saboo; Jothydev Kesavadev; S.R. Aravind; Sarita Bajaj; Rajesh Rajput; Krishna Seshadri; Narsingh Verma; Arvind Gupta; Brij Mohan Makkar; Mihir Saikia; Shailaja Kale; Suresh Damodaran; Ashish Dengra; T.K.M. Eashwar; Anuj Maheshwari; Sharad Pendsey; Sanjeev R. Phatak; Surendra Kumar Sharma; Surya Kumar Singh; A. Ramachandran; Abdul H. Zargar; Shashank R. Joshi; Shaukat M. Sadikot
Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients’ exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy. © 2017 Diabetes India
Insulin Glargine in Type 1 Diabetes Mellitus: A Review of Clinical Trials and Real-world Evidence Across Two Decades
(Bentham Science Publishers, 2024) Banshi Saboo; Hemraj Chandalia; Sujoy Ghosh; Jothydev Kesavadev; I.P.S. Kochar; K.M. Prasannakumar; Archana Sarda; Ganapathi Bantwal; R.N. Mehrotra; Madhukar Rai
Background: Over the past two decades, insulin glargine 100 U/mL (Gla-100) has emerged as the “standard of care” basal insulin for the management of type 1 diabetes mellitus (T1DM). Both formulations, insulin glargine 100 U/mL (Gla-100) and glargine 300 U/mL (Gla300) have been extensively studied against various comparator basal insulins across various clinical and real-world studies. In this comprehensive article, we reviewed the evidence on both insulin glargine formulations in T1DM across clinical trials and real-world studies. Methods: Evidence in T1DM for Gla-100 and Gla-300 since their approvals in 2000 and 2015, respectively, were reviewed. Results: Gla-100 when compared to the second-generation basal insulins, Gla-300 and IDeg-100, demonstrated a comparable risk of overall hypoglycemia, but the risk of nocturnal hypoglycemia was higher with Gla-100. Additional benefits of Gla-300 over Gla-100 include a prolonged (>24hours) duration of action, a more stable glucose-lowering profile, improved treatment satisfaction, and greater flexibility in the dose administration timing. Conclusion: Both glargine formulations are largely comparable to other basal insulins in terms of glucose-lowering properties in T1DM. Further, risk of hypoglycemia is lower with Gla-100 than Neutral Protamine Hagedorn but comparable to insulin detemir. © 2024 Bentham Science Publishers.