Secondary preventive care for cardiovascular diseases in Bangladesh: a national survey

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A comparative study of atorvastatin and rosuvastatin on lipid lowering efficacy in hyperlipidemic patients

The aim of the present study was to compare the lipid lowering effect of atorvastatin and rosuvastatin in patients (n=52) with hyperlipidemia. Patients were assigned to atorvastatin 10 mg or rosuvastatin 5 mg daily for 8 weeks. The blood was collected at baseline and after intervention to measure the serum lipid profile. The level of serum total cholesterol in both atorvastatin and rosuvastatin groups was significantly reduced after intervention (p<0.00001 and p<0.00001 respectively) but no statistically significant difference (p=0.503) was observed between the two statin-treated groups. The reduction of serum triglyceride level was also significant (p=0.046 in atorvastatin group and p=0.0006 in rosuvastatin group). No significant difference was observed between the two groups (p=0.312). The serum LDL-C level was reduced significantly in both atorvastatin group (p<0.00001) and rosuvastatin group (p<0.00001). Again no statistically significant difference (p=0.749) was observed between the two groups. No significant change was observed in the serum HDL level. Intergroup difference was not significant (p=0.721). The present study indicates that both atorvastatin and rosuvastatin improve the lipid profile but no significant change was observed between the two groups

A comparative study of atorvastatin and rosuvastatin on lipid lowering efficacy in hyperlipidemic patients

The aim of the present study was to compare the lipid lowering effect of atorvastatin and rosuvastatin in patients (n=52) with hyperlipidemia. Patients were assigned to atorvastatin 10 mg or rosuvastatin 5 mg daily for 8 weeks. The blood was collected at baseline and after intervention to measure the serum lipid profile. The level of serum total cholesterol in both atorvastatin and rosuvastatin groups was significantly reduced after intervention (p<0.00001 and p<0.00001 respectively) but no statistically significant difference (p=0.503) was observed between the two statin-treated groups. The reduction of serum triglyceride level was also significant (p=0.046 in atorvastatin group and p=0.0006 in rosuvastatin group). No significant difference was observed between the two groups (p=0.312). The serum LDL-C level was reduced significantly in both atorvastatin group (p<0.00001) and rosuvastatin group (p<0.00001). Again no statistically significant difference (p=0.749) was observed between the two groups. No significant change was observed in the serum HDL level. Intergroup difference was not significant (p=0.721). The present study indicates that both atorvastatin and rosuvastatin improve the lipid profile but no significant change was observed between the two groups

Coronary artery disease in a rural population of Bangladesh: is dyslipidemia or adiposity a significant risk?

Background and Aims: The prevalence of cardiovascular diseases (CVD) are on the increase worldwide and more in the developing countries. Coronary artery disease (CAD) constitutes the major brunt of CVD. Despite the increasing morbidity and mortality, Bangladesh has a few published data on CAD in rural population. This study addressed the prevalence of CAD and its risk factors in rural population of Bangladesh. Study methods: Sixteen villages were purposively selected in a rural area. A population census was conducted in the selected area. The census yielded eligible participants, who reached at least eighteen years of age. Those who willingly consented to participate were enlisted. Each participant was interviewed regarding CAD risk (age, sex, social class, occupation, illness, family history). Anthropometry (height, weight, waist- and hip-girth) was recorded. Resting blood pressure (BP) was measured. Blood sample was collected for fasting blood glucose (FBG), total cholesterol (Chol), triglycerides (Tg), low density lipoproteins (LDL), very low density lipoproteins (VLDL) and high density (HDL). All participants having FBG>5.5mmol/l or systolic (SBP) ³135 or diastolic BP (DBP) ³85mmHg underwent electrocardiography (ECG). A team of cardiologists selected and accomplished exercise tolerance test (ETT) and echocardiography (Echo). Results: The prevalence of CAD was 4.5% (95% CI: 3.85 – 5.15). Compared with the female (3.5%, CI, 2.76 – 4.24) the male participants had significantly higher prevalence of CAD (6.0%, CI, 4.83 – 7.13). Comparison of characteristics between participants with and without CAD showed that age, SBP, DBP and FBG were significantly higher in CAD group. Bivariate analysis showed that age, sex, social class, glycemic status, metabolic syndrome (MetS) and smoking were significantly related to CAD. Stepwise logistic regression proved only male sex, rich social class, hypertension and diabetes had independent risk of CAD; whereas, age, obesity and dyslipidemia were proved not significant. Conclusions: The study concludes that the prevalence of CAD in a Bangladeshi rural population is comparable to other developed countries. The male sex, rich social class, hypertension and diabetes were proved to have excess risk of CAD. Neither obesity nor dyslipidemia were found significant for CAD. The younger people had similar risk as the aged ones, which necessitate primordial and primary prevention of CAD. Further study may be undertaken, which should include and consider physical activity and diet; and if possible, C-reactive protein, Vitamin D and homocysteine level. IMC J Med Sci 2017; 11(2): 61-6

P0835IDENTIFYING THE FREQUENCY OF CHRONIC KIDNEY DISEASE OF UNKNOWN ETIOLOGY (CKDU) IN A RURAL POPULATION OF BANGLADESH

Abstract Background and Aims The common etiologies of CKD are diabetes, hypertension and glomerulonephritis. Prevalence of CKD of unknown (CKDu) etiology is being increasingly considered as an emerging etiology, especially in the developing countries, with environmental predisposition to hot humid climate, dehydration and toxic metal contaminations. The aim was to identify the frequency of CKDu as an etiology in a rural population with environmental exposure. Method In this observational study subjects were selected from a geographically defined rural population in Bangladesh. Baseline information was recorded by the translated WHO STEP wise approach surveillance- Instrument v.3.1 (Core and Expanded). Blood Pressure was measured by digital blood pressure monitor. Serum creatinine was measured by enzymatic method using assays traceable to isotope dilution mass spectrometry (IDMS). A fasting blood sample and spot urine was collected. BP ≥140/90mmHg; FBS > 5.6 mmol/l and HbA1c ≥6.5%; and eGFR 30mg/g was taken as diagnostic cut-offs for hypertension, diabetes and nephropathy respectively. From diagnosed CKD patients CKDu group was further identified by stepwise approach of WHO criteria as suspected and probable stages. Results The mean age was 41.3 ± 12.7 years with male/female ratio 37/63 in preliminary 303 study subjects. They were 12.5% diabetic, 21% hypertensive and 75% had some form of dyslipidemia. Among all 51 subjects (16.8%) were diagnosed as CKD based on single measurement of eGFR and ACR. Of these 30 study subjects (58%) met the criteria of suspected CKDu. After repeat measures of eGFR and ACR at 3 months, prevalence of CKD came down to 10.2% persisting in 31 subjects (G1:5.3%, G2:2.3% and G3: 2.6%). Of these 7 study subjects (23%) met the criteria of probable CKDu. The main etiologies of CKD among these subjects were diabetic nephropathy (48%) followed by CKDu. The frequency of CKDu in total study population as a whole was 2.3%.The pattern of environmental exposures like types of farming, use of pesticide-fertilizer, NSAIDs intakes, water sources, amount of drinking water per day, duration of work under direct sun, pattern of fish-meat intakes, etc. were not different between subjects with CKDu versus the others. Conclusion The prevalence of chronic kidney disease in a rural area of Bangladesh is one in ten (10.2%). Among these nearly one-fourth (23%) of the subjects belonged to probable CKDu category. This alarmingly high frequency of CKDu needs further extensive evaluation to identify the predisposing factors responsible

Mutation in the beta-myosin heavy chain (β-MHC) gene of adult Bangladeshi patients with hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic cardiomyopathy characterized by sudden cardiac death. HCM is caused by the mutation in several genes that encode sarcomere proteins. Beta-Myosin Heavy Chain (β-MHC) gene is the one of the most mutated genes responsible for HCM. Studies on mutation spectrum of β-MHC gene are lacking in the Asian population including Bangladeshi patients. This study was intended to mutational analysis of β-MHC gene in Bangladeshi HCM patients. A cross-sectional study was conducted for mutation analysis of the β-MHC gene on 70 Bengali Bangladeshi HCM probands using nextgeneration sequencing at the Genetic Research Lab of Bangabandhu Sheikh Mujib Medical University. Structural and functional impact of the mutations were further analyzed by in-silico process. Thirty-nine nucleotide variants were found in both exonic (36%, n= 14) and intronic regions (64%, n=25) of β-MHC gene. We found 14 missense mutations, including the p.Glu965Lys, p.Arg941Pro, p.Lys940Met, p.Glu935Lys, and p.Met922Lys that are associated with inherited HCM. Most variants were heterozygous and one homozygous (p.Val919Leu) was found. The variant with most evidence of causing the disease was p.Glu935Lys. Among the missense variants, nine were not noted in ClinVar, dbSNP, GenomeAD databases. These unreported variants located between myosin head and tail domains might be novel mutations for Bangladeshi population. We found nine novel variants in the β-MHC gene. Findings of this research will help to developing a genetic database of HCM for early diagnosis and proper management of HCM patients in Bangladesh. Bangabandhu Sheikh Mujib Medical University Journal 2022;15(4):2-