Browsing by Author "Dayasagar Rao"

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Do gender differences matter in Acute Heart Failure? Insights from Indian College of Cardiology – National Heart Failure Registry, India
(Elsevier B.V., 2025) Pathiyil Balagopalan Jayagopal; Chollenahally Nanjappa Manjunath; Jabir Abdullakutty; Sridhar Lakshmana Sastry; Veena Nanjappa; Peruvamba Raman Vaidyanathan; Johny Kutty Joseph; Soma Sekhar Ghanta; Panchanatham Manokar; Nitin Kabra; Dharmendra Jain; Vinod Kumar Sharma; Trinath Kumar Mishra; R. Badri Narayanan; Narendra Jathappa; Gautam M. Rege; Sunil Kumar Modi; S. N. Routray; Thagachagere Ramegowda Raghu; Rabin Chakraborty; Dayasagar Rao; Shantanu P. Sengupta; Khandenahally Shankarappa Ravindranath; Budanuru Chikkaswamy Srinivas; Vijay Kumar Chopra
Background: Real-world investigations focused on gender-associated characteristics of Acute Heart failure (AHF) are lacking. The current study, from a national heart failure registry, aims to investigate gender-based patterns and outcomes among AHF patients in India. Methods: This prospective Indian College of Cardiology National Heart Failure Registry enrolled patients admitted with AHF in 17 centres from 2019 to 2021. Demographics, aetiology, co-morbidities, laboratory investigations, electrocardiogram, and echo parameters were captured. In-hospital 30-day and one-year mortality rates were recorded. The prescription and adherence to the three Guideline Directed Medical Therapy (GDMT) prescription in 2019–2021 were also captured at discharge. Mortality rate Gender-based comparisons were tested at a 5 % level of significance. Results: The study enrolled 5182 AHF patients, 66.7 % male (M) and 33.3 % female (F). The mean age of the male (M) population was 60.9 ± 13.3, and the female (F) population was 62.8 ± 14 years. Women had a higher prevalence of heart failure with preserved ejection fraction (HFpEF)(F:12.9 %, M:7.3 %;P < 0.0001), hypertension (F: 57.2 %, M: 52.4 %; P = 0.0011) and arrhythmia (F:15.2 %, M:11.7 %;P = 0.0005). Men had a higher incidence of ischemic heart disease (M:76.2 %, F:67.5 %; P < 0.001). Adherence to Renin-angiotensin-aldosterone system (RAAS) inhibitors, Beta-blockers and Mineralocorticoid receptor antagonists (MRAs) was low (18.8 % (M); 15.9 % (F)). The mortality rate, in-hospital mortality was 6.9 % (M:6.5 %, F:7.7 %), up to one-month was 11.8 % (M:11.6 %, F:12.3 %) or one-year was 18.1 % (M:17.8 %, F:18.6 %). Conclusion: Women represent one-third of the population with AHF. Hypertension and HFpEF were more common in women, while ischemic heart disease was more prevalent in men. No gender-based differences were observed in the mortality outcomes. Both groups had low GDMT adherence. This calls for effective strategies to improve HF care in the country. © 2025 The Authors
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).
Reply to “Letter to the Editor: Comments on gender differences in acute heart failure study”
(Elsevier B.V., 2025) Pathiyil Balagopalan Jayagopal; Chollenahally Nanjappa Manjunath; Jabir Abdullakutty; Sridhar Lakshmana Sastry; Veena Nanjappa; Peruvamba Raman Vaidyanathan; Johny Kutty Joseph; Soma Sekhar Ghanta; Panchanatham Manokar; Nitin Kabra; Dharmendra Jain; Vinod Kumar Sharma; Trinath Kumar Mishra; R. Badri Narayanan; Narendra Jathappa; Gautam M. Rege; Sunil Kumar Modi; S. N. Routray; Thagachagere Ramegowda Raghu; Rabin Chakraborty; Dayasagar Rao; Shantanu P. Sengupta; Khandenahally Shankarappa Ravindranath; Budanuru Chikkaswamy Srinivas; Vijay Kumar Chopra
[No abstract available]