Srinivas Mallya

BACKGROUND: Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). OBJECTIVES: This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. METHODS: The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks. RESULTS: MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). CONCLUSIONS: Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408).

No abstract available.

Objectives: Previous studies have shown that hypertension is a risk factor of mortality and morbid events following acute myocardial infarction. In addition, patients with hypertension may have other risk factors for acute myocardial infarction such as diabetes mellitus, tobacco use, physical inactivity. This study aimed to explore the distribution of cardiovascular (CV) risk factors among patients of acute myocardial infarction with and without hypertension. Methods: Participants were acute myocardial infarction patients (n = 3522) admitted to 22 tertiary care hospitals with hypertension (n = 1014) and without hypertension (n = 2508), aged 18–80 years, recruited for the Yoga-CaRe, a multicenter randomized controlled trial. Data on socio-demographics, clinical and behavioral characteristics of those with and without hypertension were compared and analyzed using multivariable logistic regression model. Results: The prevalence of hypertension among male and female AMI patients were 25.9% and 47.0% respectively. The mean age (years) for hypertensive patients was 57.1 ± 9.7 and for non-hypertensive patients was 51.8 ± 11.0. Patients with hypertension had higher odds of having diabetes, overweight, central obesity and being physically inactive (Table 1). No differences were found in ever tobacco use between hypertensive and non-hypertensive groups. Conclusion: Hypertensive acute myocardial infarction patients had higher odds of behavioral and physiological cardiovascular risk factors. Cardiac rehabilitation may be tailored to address these differentials.