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Biomedical subjects

S Vythilingum

Publications and source records attributed to S Vythilingum.

At least 19 recordsLinked to original sources
PubMed1991

Coronary risk factors in newly diagnosed and previously diagnosed type 2 diabetic men with myocardial infarction.

Risk factors for coronary artery disease in 131 known non-insulin-dependent (type 2) diabetic patients is compared to that in 115 newly diagnosed type 2 diabetic subjects and in 316 non-diabetic patients. The subjects, all Indian men aged 21-60 years, represent consecutive survivors of myocardial infarction and were investigated 3-4 months after their acute episode. A group of 524 healthy Indian men aged 21-60 years were included as controls. Significant differences in parameters measured were noted when all diabetic and non-diabetic patients were compared to the control group. Diabetic patients were older than the non-diabetic patients and with significantly higher frequency of hypertension and hypertriglyceridaemia, whilst smoking and family history of coronary artery disease were elicited more frequently in the non-diabetic patients. Mean concentrations of serum total cholesterol and lipoproteins in the diabetic and non-diabetic men were similar, whereas serum triglyceride concentrations were significantly higher in the diabetic patients. Newly diagnosed and known diabetic patients did not differ with respect to the risk factors examined. Clusters of various combinations of hypertension, obesity, hypertriglyceridaemia and low HDL-cholesterol values were encountered more frequently in diabetic patients when compared to non-diabetic patients, whilst no significant differences were observed when the two groups of diabetic subjects were compared. In conclusion, this study has demonstrated that in men with myocardial infarction there are significant differences between diabetic and non-diabetic patients with respect to certain risk factors. However, newly diagnosed diabetic men have similar risk profiles to their known diabetic counterparts.

Adult↗
PubMed1991

Serum lipoproteins and apolipoproteins in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction.

Serum total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and apolipoprotein B were evaluated as potential indicators of the risk of coronary artery disease in young (less than 46 years) normocholesterolaemic, non-diabetic men who had previously sustained a myocardial infarction (n = 50) and in healthy age and sex matched controls (n = 122) with a similar socioeconomic background. Significant differences were observed between patients and controls in the mean concentrations of serum total cholesterol, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and apolipoprotein B, as well as in the ratios of total cholesterol to high density lipoprotein cholesterol and apolipoprotein A-I to apolipoprotein B. No significant difference was demonstrated in the concentration of apolipoprotein A-I between the two groups. Stepwise discriminant analysis indicated that apolipoprotein B was the best discriminant between patients and controls. The percentage of exact classification was 74% in patients and 66% in controls. When the patients were compared to a subset of controls (n = 50) matched for age and total cholesterol, significant differences were demonstrated only in the mean concentrations of apolipoprotein B. Discriminant analysis confirmed that the best single discriminating variable was apolipoprotein B. The results therefore indicate that in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction, apolipoprotein B is superior to other lipid parameters studied, as a marker for coronary artery disease.

Adult↗
PubMed1991

Lipid and lipoprotein abnormalities in South African Indian men with myocardial infarction.

The Indian (Asian) population in South Africa has a high rate of coronary artery disease. Fasting serum lipid and lipoprotein levels were measured in 620 consecutive male survivors of myocardial infarction and compared with those of 524 healthy male volunteer controls, and the presence of hypercholesterolaemia and hypertriglyceridaemia in the patient group was related to other non-lipid coronary risk factors. All survivors and controls were below age 61 years. Total cholesterol, triglyceride and low-density-lipoprotein cholesterol concentrations varied significantly with age both in patient and control groups, whereas high-density-lipoprotein (HDL) cholesterol did not vary with age in either group. Using the 90th-percentile age-adjusted values of controls for total cholesterol (7.1 mmol/l) and triglyceride (3.0 mmol/l) as cut-off points, 287 (46%) survivors were hyperlipidaemic. Hypercholesterolaemia with or without associated hypertriglyceridaemia was the commonest abnormality: 125 (20%) patients showed hypercholesterolaemia without associated hypertriglyceridaemia; 73 (12%) had both hypercholesterolaemia and hypertriglyceridaemia and 89 (14%) hypertriglyceridaemia without associated hypercholesterolaemia. The frequency of hyperlipidaemia did not vary with age. HDL cholesterol levels below 0.66 mmol/l (10th percentile) were observed in 131 (22%) survivors. Obesity was significantly more frequent among hypertriglyceridaemic survivors, whilst diabetes and hypertension were seen more frequently in survivors with combined hypercholesterolaemia and hypertriglyceridaemia. No significant difference was noted in the frequency of smoking and family history of coronary artery disease in hyperlipidaemia and normolipidaemic patients.

Adult↗
PubMed1991

Pulmonary hypertension in aortic regurgitation: early surgical outcome.

A review of the haemodynamic data of 139 patients with isolated, severe, chronic aortic regurgitation revealed severe pulmonary hypertension (pulmonary artery systolic pressure of greater than or equal to 60 mmHg) in 34 (24 per cent). The left ventricular end-diastolic pressure was high in all patients, suggesting that pulmonary hypertension was a consequence of severe long-standing regurgitation with ventricular dysfunction. Aortic valve replacement was performed in 69 patients, 33 of whom had normal or mildly elevated pulmonary artery systolic pressure (less than 39 mmHg; group I) and 36 of whom had moderate or markedly elevated pulmonary artery systolic pressures (less than 40 mmHg; group II). There was no difference in mortality or prevalence of post-operative complications between these two groups of patients. Furthermore, New York Heart Association (NYHA) functional class and cardiothoracic ratio were similar in both groups at the six-month assessment. The pulmonary vascular resistance fell from 4.7 +/- 3.5 to 1.5 +/- 0.8 units x m2 in 13 of 17 patients who had repeat catheterization after surgery. Pulmonary artery systolic pressure reverted to normal in 10 of these 13 patients. It is concluded that pulmonary hypertension consequent upon raised left ventricular end-diastolic pressure is common in severe aortic regurgitation, is largely reversible, and does not influence the early outcome after aortic valve replacement.

Adult↗
PubMed1990

Abnormalities in sex hormones are a risk factor for premature manifestation of coronary artery disease in South African Indian men.

The relation between sex hormone levels and myocardial infarction was studied in a case-control study among 117 Indian men with myocardial infarction aged 30-60 years and in 107 healthy Indian male controls. The patients and controls were further divided into subsets defined by age in decades. In the total patient population, testosterone concentration was significantly lower than in the controls (P less than 0.01), whilst oestradiol (P less than 0.0005) and the oestradiol to testosterone ratio (P less than 0.0005) were significantly higher. Multivariate stepwise logistic regression analyses demonstrated that free testosterone index, the free oestradiol index, and the oestradiol to testosterone ratio were significantly associated with myocardial infarction, and that this association was independent of age, body mass index, smoking and serum lipids. Further analyses according to age subsets revealed that compared to respective control groups, patients in the 4th decade had both significant hypotestosteronaemia and hyperoestrogenaemia, whereas in patients of the 5th decade significant differences in total and in the calculated free oestradiol index were noted, and in the 6th decade a significant difference was detected only in the free oestradiol index. Hence, we conclude that aberrations in endogenous sex hormones are significantly associated with myocardial infarction, and that this association appears to be strongest in young men and diminishes with age, suggesting that these disturbances in sex hormones may be associated with premature manifestation of coronary artery disease.

Coronary Artery Disease↗
PubMed1990

Balloon dilatation of the mitral valve by a single bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter.

The efficacy of balloon dilatation of the mitral valve by a bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter (single catheter technique) was assessed in 53 patients (mean age 28) with mitral stenosis, most of whom were women. The procedure was unsuccessful in three patients. After balloon dilatation the left atrial pressure decreased from 22 mm Hg to 13 mm Hg and the mitral valve gradient from 12 mm Hg to 4 mm Hg. The mitral valve area increased from 0.7 cm2 to 2.1 cm2. Exercise time on the standard Bruce protocol increased from 3.9 minutes to 7.2 minutes. In 22 (44%) patients mitral regurgitation developed or the grade of regurgitation increased. Left to right shunts with pulmonary to systemic flow ratios greater than 1:5 were detected in four patients. Transient cerebrovascular episodes developed in two patients. One patient died after emergency valve replacement for severe mitral regurgitation. Balloon dilatation of the mitral valve by the single catheter technique with the bifoil or trefoil catheters is an effective treatment for patients with mitral stenosis. Mild mitral regurgitation is a frequent complication of the procedure.

Adolescent↗
PubMed1989

Prognostic importance of admission plasma glucose in diabetic and non-diabetic patients with acute myocardial infarction.

We assessed the relationship of plasma glucose concentrations measured on admission to mortality during the acute phase of myocardial infarction in 143 diabetic patients and 277 patients without a previous history of diabetes. Mortality in hospital in patients not known to have diabetes increased significantly from 4 per cent in patients with admission plasma glucose below 8 mmol/l to 35 per cent in patients with admission plasma glucose above 11 mmol/l. In diabetic patients the mortality increased with increasing admission plasma glucose but the difference was not significant. In patients with diabetes mean admission plasma glucose levels of the survivors and those who died were similar, whilst in the non-diabetic group the mean plasma glucose levels of the patients who did not survive were significantly higher than those of the survivors. Stepwise logistic regression analyses identified admission plasma glucose level as an important predictor of mortality in the non-diabetic group but not in the diabetic patients. Plasma glucose level on admission is an important prognostic indicator in non-diabetic patients, in that hyperglycaemia is associated with a higher mortality. In diabetic patients a clear relationship between admission plasma glucose and mortality was not demonstrated.

Adult↗
PubMed1988

Incidence and bedside diagnosis of haemodynamically significant right ventricular infarction.

The incidence, diagnosis and clinical course of haemodynamically significant right ventricular infarction (RVI) were assessed prospectively in 90 patients with their first acute inferior myocardial infarction. The haemodynamic criteria for RVI were defined as a mean right atrial pressure of 10 mmHg or more and a mean right atrial pressure equal to or greater than the mean pulmonary capillary wedge pressure. Twenty-six patients (29%) had haemodynamic evidence of RVI (group A) whereas 64 (71%) did not meet the criteria (group B). ST-segment elevation in lead V4R was observed in 25 patients (96%) with haemodynamic evidence of RVI and in 15 (23%) without (P less than 0.001). The jugular venous pressure (JVP) was found to be elevated in 24 of the 26 group A and in 7 of the 64 group B patients (P less than 0.001). Kussmaul's sign was present in 21 group A and 3 group B patients (P less than 0.001). Of the clinical signs, elevation of the JVP with clear lung fields on the chest radiograph had the best predictive value (92%) for haemodynamically significant RVI. The ECG was highly sensitive (96%) but less specific (77%) and had a low predictive value (63%) for haemodynamically significant RVI. Hypotension and complete atrioventricular block occurred more frequently in group A patients (P less than 0.001 and P less than 0.01 respectively). The hospital mortality rate was similar in both groups.

Blood Pressure↗
PubMed1988

Plasma lipids can be reliably assessed within 24 hours after acute myocardial infarction.

Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients. The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 +/- 0.10 vs 6.18 +/- 0.09 mmol/l) and women (6.75 +/- 0.30 vs 6.44 +/- 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P less than 0.0005). Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there with a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance. These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients' basal lipid state.

Adult↗
PubMed1988

Abnormal glucose tolerance is the dominant risk factor in South African Indian women with myocardial infarction.

Risk factors for coronary artery disease were determined at least 3 months following myocardial infarction in 90 Indian women between the ages of 26 and 60 years. The risk factors were analysed according to age (greater than 45 vs. less than or equal to 45 years) and also their prevalence was compared to that of 76 healthy age- and sex-matched Indian controls. In the total patient cohort, 98% had at least one major coronary risk factor. Older patients (greater than 45 years) were characterized by a higher risk profile: mean number of risk factors 2.7 compared to 1.9 in women less than or equal to 45 years (p less than 0.005). Diabetes mellitus was the commonest risk factor and was present in 78% of patients. While diabetes mellitus was detected with similar frequency in both age groups of patients (79 and 77%), hypertension, lipid aberrations and family history of myocardial infarction were encountered more frequently in the older women. Compared to the control population, the patients had a higher frequency of lipid abnormalities (p less than 0.0005), obesity (p less than 0.01) and a positive family history of myocardial infarction in first-degree relatives (p less than 0.01). The prevalence of smoking was low both among patients (10%) and control subjects (5%). This analysis thus indicated that of the identifiable risk factors, diabetes mellitus was most prominent in all age groups with hypertension and lipid aberrations being significant synergistic factors in the older women.

Adult↗
PubMed1987

Risk factors in young Indian males with myocardial infarction.

Risk factors were assessed in 108 young Indian males with myocardial infarction. The mean age was 36 years (range 21-40 years). Cigarette smoking was the most common risk factor (79% of patients). Serum cholesterol levels were above 6.5 mmol/l in 50% and serum triglyceride levels were above 2.0 mmol/l in 53% of patients. High-density lipoprotein cholesterol levels below 0.83 mmol/l were found in 52% of patients. Ninety-six per cent of patients had one or more of the following risk factors: a history of cigarette smoking, hypercholesterolaemia, hypertension, and abnormal glucose tolerance. Thus, in young Indian males with myocardial infarction, one or more risk factors are usually present.

Adult↗
PubMed1987

Histocompatibility antigens in Indian patients with myocardial infarction.

The frequency of HLA-A, B, C and DR tissue antigens in 103 Indian men aged 40 years or under who had experienced a myocardial infarction was compared with the frequency in 760 healthy Indian controls. No significant differences in antigen frequencies were found. The findings in this study provide no support for either a genetic or an immunological basis for myocardial infarction in young Indian men.

Adult↗
PubMed1987

Stress hyperglycaemia is a predictor of abnormal glucose tolerance in Indian patients with acute myocardial infarction.

66 non-diabetic Indian patients with acute myocardial infarction were assessed prospectively for the presence of hyperglycaemia and the value of this admission hyperglycaemia and glycosylated haemoglobin (HbA1) levels in reflecting the glucose tolerance status of the patients was studied. Hyperglycaemia, defined as admission plasma glucose greater than or equal to 8 mmol/l was detected in 49% of the patients, whilst raised HbA1 values were seen in 11%. The admission plasma glucose (APG) correlated significantly with both the HbA1 levels and with the 2 hour glucose value in the oral glucose tolerance test (p less than 0.001). An oral glucose tolerance test performed 3 months after the acute episode revealed that 35 patients (53%) had abnormal glucose tolerance according to WHO criteria. Of the patients with initial hyperglycaemia, 75% had abnormal glucose tolerance tests, whilst 32% of patients with normal APG had abnormal glucose tolerance. Abnormal glucose tolerance was also detected in all patients with raised HbA1 values (greater than 8.9%) and in 48% of patients with normal levels. The sensitivity and specificity of APG greater than or equal to 8 mmol/l for abnormal glucose tolerance was 68.6% and 74.2% respectively and that of raised HbA1 values were 20% and 100%. Hence an APG greater than or equal to 8 mmol/l in patients with myocardial infarction is more likely to indicate the presence of unrecognized abnormal glucose tolerance rather than stress. HbA1 measurements do not appear to offer any further advantage in the assessment of hyperglycaemia following myocardial infarction.

Adult↗
PubMed1984

Insulin response to oral glucose in young, non-obese Indian males with myocardial infarction.

Plasma glucose and insulin concentrations were estimated during an oral glucose tolerance test (OGTT) in a group of 25 young (less than 40 years), non-obese Indian males 6-12 months after an episode of acute myocardial infarction and in 25 age- and sex-matched controls. All the subjects in both groups had a normal response to the OGTT according to the 1980 World Health Organization criteria. Glucose values during the OGTT and the mean plasma insulin response were significantly higher in the patients who had had a myocardial infarction. However, there was no significant difference in the insulinogenic indices. These findings indicate that Indian patients with myocardial infarction have aberrations in carbohydrate metabolism which manifest as higher glucose values during an OGTT and that the stimulated hyperinsulinism is secondary to these raised glucose levels.

Adult↗