BACKGROUND Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. OBJECTIVES In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. METHODS ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3–74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2–111.0 mg/dL). RESULTS In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [Cl]: 0.52–0.90) and 1.11 (95% Cl: 0.83–1.49), with treatment-lipoprotein(a) interaction on MACE ( P interaction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% Cl: 0.72–0.92) and 0.89 (95% Cl: 0.75–1.06), with P interaction = 0.43. CONCLUSIONS In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402 )

BACKGROUND Coronary artery disease (CAD) is the leading cause of mortality in men and women. Acute coronary syndrome (ACS), is a major reason for hospitalisation in our country. Dyslipidemia has been identified as one of the most important modifiable risk factors for CAD. The aim of the study was to determine the prevalence and pattern of dyslipidaemia and its relation to other modifiable risk factors. METHODS 100 cases were studied in a Krishna Institutes of Medical Sciences, Karad, over a period of 12 months from 1 st August 2015 to 31 st July 2016. This is a prospective observational study. All adults >18 years of age admitted for acute coronary syndrome were eligible for this study. The ACS group was studied as STEMI, NSTEMI, and Unstable Angina. RESULTS Majority of patients (33) was in the age group 51-60 years followed by 29 patients in the age group 61-70 years. Out of 100 ACS patients, 62 were STEMI, 20 were NSTEMI, and 18 were unstable angina. The prevalence of ACS was higher in males than females. Hypertension is the most common risk factor of ACS (41%) followed by diabetes mellitus (33%). We found that high levels of TC (more than 200 mg/dl) were found in 31% patients [mean ± SD (167.79 mg/dl ± 45.28)]. High levels of LDL (more than 130 mg/dl) were found in 23% patients [mean ± SD (97.47 mg/dl ± 38.24)]. Low levels of HDL (less than 40 mg/dl) were found in 52% patients [mean ± SD (40.69 mg/dl ± 11.84)]. High levels of TG (more than 150 mg/dl) were found in 37 % patients [mean ± SD (145.28 mg/dl ± 65.78)]. CONCLUSIONS Dyslipidemia is one of the major risk factors which is widely prevalent in patients with ACS and is more prevalent in males than in females. We recommend paying more attention to serum lipids and other modifiable risk factors for prevention of ACS

BACKGROUNDA 60 years old previously asymptomatic female was admitted with accelerated hypertension and she was incidentally found to have mirror images of normal anatomical organs in chest and abdomen called situs inversus totalis. Situs inversus totalis is a congenital anomaly characterized by transposition of abdominal viscera associated with dextrocardia. Complete situs inversus is a rare syndrome of autosomal recessive inheritance. The anatomic, pathologic, embryologic and aetiology of complete situs inversus and related abnormalities are presented in this case with special emphasis to genetic correlation.

Introduction: A wide range of traditional and nontraditional cardiovascular risk factors that may promote and foster the development of atherosclerosis have been reported in association with the metabolic syndrome, including atherogenic dyslipidemia, prothrombotic and proinflammatory milieu, and endothelial dysfunction. The present study was conducted to study the cardiovascular risk factors among the cases presented with metabolic syndrome in a tertiary healthcare institute. Material and methods: It was a cross sectional observational study conducted among 100 cases diagnosed with metabolic syndrome attending outpatient department of department of medicine, KIMS. Written consents were taken from the participants. Results: Mean Waist Circumference in cm was 99.62 ± 9.2, Hip Circumference was 106.3 ± 8.67 cm. The W/H ratio was 0.93 ± 0.79. These indices were higher as compared to the controls. 7.5 % cases had peripheral vascular disease, 8.2% cases had coronary artery disease, 4% had nephrotic syndrome, 6% had history of cerebrovascular disease. Conclusions: Evaluation of the parameters in metabolic syndrome can be a simple clinical tool to assess potential risk for development of cardiovascular diseases and hence assessment of prognosis and to establish and prioritize the resources appropriately.

BACKGROUND Accelerated hypertension is defined as a rapid and inappropriate intense elevation of blood pressure with or without a risk of rapid damage to target organs such as the heart. It is a common presentation to the emergency department and appears without history of hypertensive diseases in 23% of cases. The present study was conducted to study the brain imaging in cases admitted with accelerated hypertension to find the incidences of brain parenchymal insult in case of accelerated hypertension in a tertiary healthcare institute. METHODS The observational study was done among patients presenting with hypertensive emergencies admitted under the Department of Medicine, KIMS, Karad, from August 2018 to December 2018. On admission, detailed history was taken, and complete clinical examination was done. It was an observational study. RESULTS Majority of the cases had a haemorrhagic stroke (16.66%), followed by 4.16% cases of transient ischaemic attacks and 4.16% cases of ischaemic stroke. CONCLUSIONS Acute intracerebral haemorrhage was the most common form of end organ damage in present study. The hospital mortality among the patients with hypertensive emergencies were 18.75%.