The atherogenic index of plasma (AIP), defined as log [triglycerides (TG)/high-density lipoprotein cholesterol], an emerging lipid-based biomarker reflecting circulating TG and high-density lipoprotein cholesterol levels, has been associated with metabolic syndrome, coronary heart disease, and atherosclerosis. Its role in cardiovascular disease has been well established, yet there is growing interest in its application in cerebrovascular conditions, particularly stroke. Stroke is one of the leading causes of death and disability worldwide; hence, there is a need for integrative biomarkers to help improve risk prediction and accuracy of prognostication. Recent studies suggest that elevated AIP is independently associated with stroke incidence, especially among individuals with diabetes, prediabetes, and metabolic syndrome. Higher AIP levels have been associated with worse stroke severity at presentation, a higher risk of early neurological deterioration, and worse short-term outcomes. This is likely a consequence of AIP indicating vascular inflammation, endothelial dysfunction, and intracranial atherosclerosis. In observational studies, AIP has demonstrated comparable or stronger associations than other markers of insulin resistance, such as the TG-glucose index and the Chinese Visceral Adiposity Index, in specific metabolic populations. It is a low-cost and easily available biomarker, making it useful in primary prevention clinics, stroke units, and for managing metabolic syndrome. Given the increasing number of observational studies and population-based data, a comprehensive synthesis is needed to evaluate AIP’s diagnostic, prognostic, and pathophysiological significance in stroke. This narrative review consolidates current findings on AIP’s relevance in ischemic stroke and explores its potential integration into stroke risk stratification. Existing evidence is largely observational in nature, limiting causal interpretation.
Obesity is a global health crisis affecting developing nations, including India. The management of obesity continues to evolve with newer drugs, metabolic and bariatric surgery and endoscopic interventions, requiring family physicians and specialists to adapt their clinical practice accordingly. There is an urgent need for a standardized algorithm to diagnose, stage, and treat obesity. The Endocrine Society of India (ESI) and the Obesity Surgeons Society of India (OSSI) appointed a steering committee to develop an evidence-based algorithm for managing patients with obesity in India. This was put to vote by 80 specialists (38 from OSSI and 42 from ESI) in a physical meeting. A proposed stage-wise algorithm based on Edmonton Obesity Staging System, Asian definition of obesity, and resources in India, received 100
Post-COVID syndrome (PCS), or long COVID, refers to a cluster of enduring symptoms that extend beyond the acute phase of the initial SARS-CoV-2 infection. Acute infection predominantly impacts the respiratory tract, but there is growing evidence for the multisystem involvement, such as cardiovascular, metabolic, and neurological, to be responsible for the prolonged presentation in PCS. Underlying cardiometabolic vulnerability may contribute to a high degree of susceptibility in patients with comorbidities like hypertension (HTN) and diabetes mellitus (DM). This narrative review summarizes current literature regarding PCS in patients with HTN and/or DM, focusing on proposed pathophysiological mechanisms, clinical manifestations, and reported long-term outcomes. In these populations, PCS has been linked across studies to processes including endothelial dysfunction, chronic low-grade inflammation, autonomic imbalance, and potential dysregulation of the renin-angiotensin-aldosterone system (RAAS). Persistent cardiovascular, metabolic, and neurocognitive symptoms are reported, but the magnitude and patterns of risk vary across studies, while comparative findings across HTN and DM remain heterogeneous. Symptoms reported frequently include fatigue, cognitive impairment ("brain fog"), and psychological distress, supporting the multisystem complexity of PCS. Although, previous work has indicated that cardiometabolic comorbidities could interact and moderate PCS severity and persistence, there is an important shortfall of both causality and prognosis, as well as the management of PCS. Longitudinal studies are needed for future research regarding risk stratification, disease course, and targeted interventions in individuals with PCS with comorbid high blood pressure and diabetes.
Objectives: Cardiovascular magnetic resonance (CMR) is an advanced, non-invasive imaging modality with unparalleled accuracy for cardiac structure, function, and tissue characterization. Despite its global recognition, access and utilization remain uneven across regions, especially in developing countries. This study aimed to describe the clinical utility, diagnostic impact, and management implications of CMR at a tertiary care center in South India. Materials and Methods: This retrospective clinical audit analyzed 210 consecutive inpatients who underwent CMR between January 2021 and December 2023. Indications, final diagnoses, image quality, and impact on management were assessed. Results: Majority of the patients were aged 41–80 years, representing 160 (76%) individuals, with a male predominance of 128 (61%). The leading indications for CMR were viability assessment in 118 (56.2%), cardiomyopathy in 65 (31%), and myocarditis in 19 (9.0%) patients. The corresponding final diagnoses were ischemic cardiomyopathy (ICM)/coronary artery disease in 92 (43.80%) patients and non-ICM, including hypertrophic cardiomyopathy, in 65 (31%) patients. Image quality was diagnostic in 197 (94%) cine studies and 189 (90%) late gadolinium enhancement studies. CMR findings altered inpatient management through major medication changes in 94 (44.76%) patients and revascularization decisions in 88 (41.9%) patients. In addition, CMR results prompted device therapies in 34 (16.19%) patients and surgical or structural interventions in 18 (8.57%) patients. Anticoagulation therapy was initiated in 25 (11.90%) patients, and immunosuppression or anti-inflammatory therapy was started in 16 (7.62%) patients based on CMR findings. Conclusion: CMR is a robust and safe diagnostic tool with high image quality and significant clinical impact, improving decision-making in over half of the inpatients. This study represents one of the first systematic evaluations of real-world CMR practice from an Indian tertiary care setting, underscoring the need for broader accessibility and registry-based validation.
