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S Yusuf

Publications and source records attributed to S Yusuf.

278 records · Page 16Linked to original sources
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Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE).

Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese and Europeans. A total of 985 participants were recruited from three cities (Hamilton, Toronto and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured. Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5% and 2%, respectively; p=0.0004). Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm) and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and low-density lipoprotein cholesterol, higher triglycerides and lower high-density lipoprotein cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein(a), and plasminogen activator inhibitor-1. Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.

Adult↗
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Increased risk of acute myocardial infarction associated with beedi and cigarette smoking in Indians: final report on tobacco risks from a case-control study.

BACKGROUND: Tobacco smoking is an important risk factor for ischemic heart disease. In India, tobacco is smoked both as cigarettes and beedies. No studies have evaluated their importance as risk factors for ischemic heart disease among the Indian population. The present study explores the importance of smoking either cigarettes or beedies as risk factors for acute myocardial infarction. METHODS AND RESULTS: The study had a case-control design and was conducted in a tertiary teaching hospital in Bangalore. Three hundred subjects aged 30-60 years with a first acute myocardial infarction and 300 age- and sex-matched controls were recruited prospectively. Smoking, dietary and social history were recorded, body mass index and waist-hip ratio measured, and blood glucose, lipids, fasting plasma and insulin levels estimated. Cases and controls had a mean age of 47.2 years and 46.8 years, respectively. There were 279 (93%) males in each group. Diabetes mellitus (odds ratio 2.69, p<0.0009). hypertension (odds ratio 2.36, p=0.0009), fasting and post-load blood glucose (p<0.0001). and waist-hip ratio (p<0.0001) were found to be important risk factors for acute myocardial infarction. Smoking was an independent risk factor with a clear dose effect. Adjusted odds ratio for smoking > or = 10 cigarettes/day was 3.58 (p<0.0001) and was 4.36 (p<0.0001) for smoking > or = 10 beedies/day. CONCLUSIONS: Smoking > or = 10 cigarettes or beedies/day carries an independent four-fold increased risk of acute myocardial infarction. This reiterates the need for urgent tobacco control measures in India.

Adult↗
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Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America.

The prevalence of coronary heart disease (CHD) and its risk factors in first-generation Asian Indian immigrants to the United States of America (US) were compared with those of the native Caucasian population. A total of 1688 Asian Indian physicians and their family members (1131 men and 557 women, age > or = 20 years) completed a questionnaire and in 580 subjects serum lipoproteins were determined. The age-adjusted prevalence of myocardial infarction and/or angina was approximately three times more in Asian Indian men compared to the Framingham Offspring Study (7.2% versus 2.5%; P < 0.0001) but was similar in women (0.3% versus 1%; p = 0.64). Asian Indians had higher prevalence of noninsulin-dependent diabetes mellitus (NIDDM; 7.6% versus 1%; p < 0.0001) but markedly lower prevalence of cigarette smoking (1.3% versus 27%; p < 0.0001) and obesity (4.2% versus 22%; p < 0.0001). Hypertension was less prevalent in Asian Indian men 14.2% versus 19.1%, p < 0.008) but similar in women (11.3% versus 11.4%). The prevalence of elevated total a low-density lipoprotein (LDL) cholesterol levels was similar in men [17% versus 23.4% (p = 0.24) and 13.7% versus 22.3% (p = 0.22), respectively] but lower in women [15% versus 26.1% (p = 0.018) and 14.3% versus 19.6% (p = 0.047) respectively]. The mean levels of high-density lipoprotein (HDL) cholesterol were less in younger (30-39 years) Asian Indian men (mean: 0.98 versus 1.18 mmol/l; p < 0.001) and middle-aged (30-59 years) women (mean: 1.24 versus 1.45 mmol/l; p < 0.001). The prevalence of hypertriglyceridaemia was similar in men (18.5% versus 11.3%), but higher in Asian Indian women (8.3% versus 4.1%, p = 0.02). To conclude, immigrant Asian Indian men to the US have high prevalence of CHD, NIDDM, low HDL cholesterol levels and hypertriglyceridaemia. All these have "insulin resistance" as a common pathogenetic mechanism and seem to be the most important risk factors.

Adult↗
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A comparison of practice patterns for acute myocardial infarction between hospitals in Canada and India.

The increasing burden of cardiovascular disease in India, and the established efficacy of mortality-reducing therapies in acute myocardial infarction (AMI) served as the impetus to compare the management practices of AMI in an Indian hospital and a similar hospital in Canada. A retrospective chart review in each hospital was conducted to identify differences in risk factors, presentation, and acute in-hospital management in patients with AMI. Indian patients were younger (47 +/- 9 years versus 54 +/- 8 years), more likely to have a history of diabetes (21/87 versus 6/69) and less likely to have a previous history of angina (5/87 versus 22/69) compared to Canadian patients (all p < 0.001). The delay from symptom onset to hospital arrival was greater in Bangalore, India (median time 330 min versus 101 min, p < 0.001), yet the in-hospital delay in receiving thrombolytic therapy was greater in Hamilton, Canada (70.5 min in Hamilton versus 30 min in Bangalore, p < 0.0001). There was similarity and appropriate use of thrombolytic therapy, aspirin, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in both centres. The pattern of presentation and risk factors differ in Indian and Canadian patients. However, once patients present, the patterns of practice appear to be similar.

Aged↗
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The effect of RheothRx Injection on the hemorheological parameters in patients with acute myocardial infarction.

This study evaluated the hemorheological effects of a nonionic block copolymer surfactant, RheothRx Injection, on the hemorheological parameters in patients with acute myocardial infarction (AMI). For the in vitro study blood from 24 patients admitted with chest pains (mean age: 49 +/- 11 yrs) was sampled after admission and in AMI cases (15 patients, mean age: 53 +/- 13 yrs) a second sample was collected 48 hours later. Different concentrations of RheothRx were added (0.25, 0.5, 1, 2 and 5 mg/ml) and the blood was tested for RBC aggregation via our computerized Myrenne Aggregometer (at Hct = 40%). Besides other routine laboratory parameters, fibrinogen levels were measured. In a substudy for CORE Trial, the hemorheological effects of RheothRx infusion was studied. Seven patients (mean age: 63 +/- 13 yrs) admitted with AMI and randomized for CORE Trial were studied. The samples were collected after admission, at 12, 24, 48 hours, and at day 8 and 35. In vitro we found a significant (p < 0.05 or better) concentration-related decrease of RBC aggregation from 0.5 mg/ml drug concentration in the admission (both groups) and in the 48 hour (AMI) samples, in AMI patients with a mean decrease of 7 and 5% at 0.5 mg/ml, 13 and 8% at 1 mg/ml, 22 and 19% at 2 mg/ml and 39 and 33% at 5 mg/ml plasma concentration of the drug. In the CORE Trial patients hemorheological parameters (plasma and whole blood viscosity, RBC aggregation and fibrinogen level) decreased during and after the administration of RheothRx, but after 2-8 days their values returned to the baseline level. These findings indicate that this agent can significantly reduce RBC aggregation and other hemorheological parameters, and thus suggest its potential usefulness in clinical states associated with increased RBC aggregation.

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