The country’s cardiology centers have been producing subspecialists in the field of Invasive and Interventional Cardiology. To date, 11 hospitals and/or medical centers are involved in training these subspecialists in a 1 to 2-year program. And to this date, there have been no uniform standards and guidelines as to what comprises the basic and/or acceptable training outcomes for the interventionalist in training. This paper describes the development of the core curriculum for an interventional cardiovascular training program to prepare its trainees to be competent in performing invasive diagnostic and interventional cardiovascular procedures as part of comprehensive patient care. The task force for the core curriculum of the interventional training program gathered several officers and leaders of the PSCCI, the training heads of the various interventional programs in the country, as well as experts in the field of cardiology education. Through a series of meetings, consultations, and workshops, the task force laid out the template on which all the training programs would be based. Such a framework considered the international standards regarding minimum caseloads for interventional training and the peculiar situation of each training institution. International standards like the Core Cardiovascular Training Statement (COCATS 4) Task Force 10: Training in Cardiac Catheterizations and the 2020 EAPCI Core Curriculum for Percutaneous Cardiovascular Interventions served as the reference framework for key recommendations. A consensus was achieved that upheld the highest standards of competence without disenfranchising certain institutions due to intricacies and uniqueness of hospital set-up and training situation.

Training ; Education ; Curriculum

Objective. Several studies showed that genetic factors affect responsiveness to statins among different populations. This study investigated the associations of candidate genetic variants with poor response to statins among Filipinos.

Methods. In this unmatched case-control study, dyslipidemic participants were grouped into statin responders and poor responders based on the degree of reduction in LDL-c from baseline. DNA from blood samples were genotyped and analyzed. The association of candidate variants with statin response was determined using chi-square and logistic regression analysis.

Results. We included 162 adults on statins (30 poor responders as cases, 132 good responders as controls). The following variants are nominally associated with poor response to statin among Filipinos at a per-comparison error rate of 0.05: rs173539 near CETP (OR=3.05, p=0.015), rs1800591 in MTTP (OR=3.07, p=0.021), and rs1558861 near the BUD13-ZPR1-APOA5 region (OR=5.08, p=0.004).

Conclusion. Genetic variants near CETP, MTTP and the BUD13-ZPR1-APOA5 region are associated with poor response to statins among Filipinos. Further study is recommended to test the external validity of the study in the general Filipino population.

Lipids ; Hydroxymethylglutaryl-CoA Reductase Inhibitors

Background. Low levels of high-density lipoprotein cholesterol (HDL-c) is a well-recognized risk factor in the development of cardiovascular diseases. Associated gene variants for low HDL-c have already been demonstrated in various populations. Such associations have yet to be established among Filipinos who reportedly have a much higher prevalence of low HDL-c levels compared to other races.

Objective. To determine the association of selected genetic variants and clinical factors with low HDL-c phenotype in Filipinos.

Methods. An age- and sex-matched case-control study was conducted among adult Filipino participants with serum HDL-c concentration less than 35 mg/dL (n=61) and those with HDL-c levels of more than 40 mg/dL (n=116). Genotyping was done using DNA obtained from blood samples. Candidate variants were correlated with the low HDL-c phenotype using chi-squared test and conditional logistic regression analysis.

Results. Twelve single nucleotide polymorphisms (SNPs) were associated with low HDL-c phenotype among Filipinos with univariate regression analysis. The variant rs1260326 of glucokinase regulator (GCKR) (CT genotype: adjusted OR=5.17; p-value=0.007; TT genotype: adjusted OR=6.28; p-value=0.027) remained associated with low HDL-c phenotype, together with hypertension and elevated body mass index, after multiple regression analysis.

Conclusion. The variant rs1260326 near GCKR is associated with low HDL-c phenotype among Filipinos. Its role in the expression of low HDL-c phenotype should be further investigated prior to the development of possible clinical applications.

Cardiovascular Diseases ; Dyslipidemias ; Genetics ; Polymorphism, Single Nucleotide

Introduction: Takayasu’s arteritis (TA), a large vessel vasculitis has various initial presenting manifestations; making it difficult to diagnose. Hence, the number of those with the disease in the population is underestimated. The study intends to update local data and to describe different presentations of the disease to enhance awareness for TA. Methods: This is a retrospective study done in a tertiary government hospital. Twenty-two out of twenty three charts of patients diagnosed with TA based on the 1990 ACR criteria were reviewed. Demographic profile, initial clinical manifestations, imaging, treatment and outcomes were collected. Descriptive statistics was applied. Institutional Review Board approval was obtained prior to study initiation. Results: Majority (90.1%) were female; mean age at onset of symptoms and at diagnosis were 30.4 (+12.3)years and 33.2 (+12.0)years respectively. The common reasons for consult were hypertension (26.3%), claudication (21.1%) and abdominal pain (11%). Laboratories showed elevated erythrocyte sedimentation rate (87.5%), leukocytosis (43.8%), anemia (31%) and thrombocytosis (4.5%). Common imaging findings were cardiomegaly (27.3%), aortic regurgitation (27.3%) and carotid stenosis (18.2%). CT angiogram in 90% of cases demonstrated arterial wall narrowing. Other findings were aneurysm (31.8%), contour irregularities (13.6%) and femoral artery occlusion (4.5%). Treatment for active disease were glucocorticoids alone (44%) and combined glucocorticoids and other immunosuppressants (56%). Of the 22 records reviewed, six patients (27%) had stroke. Four (18.2 %) had different surgical procedures; ray amputation of toe for digital ischemia, embolectomy for digital gangrene, balloon angioplasty of the renal artery and renal angioplasty for stenosis. Two (9.1%) who had pregnancies after TA diagnosis had premature deliveries without neonatal complications. No mortality was recorded over the mean follow-up of 49.33 patient-years. Conclusion Clinicians should be aware of the different initial presenting signs and symptoms of TA since development of collateral circulation may mask other symptoms. Thus, thorough history and physical assessment are essential tools in the diagnosis of TA.

BACKGROUND: Congenital heart diseases (CHD) pose a major global concern due to its increasing survival trend in the adult stage; but data in our country is lacking. Despite improvement in management, formal assessment for anxiety and depression in patients with adult CHD is not routinely done. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument highly reliable for detecting states of anxiety and depression for use in medical practice. Identifying the prevalence of anxiety and depression through a simple screening tool that may lead to a proper psychiatric referral may help health-care providers consider the contribution of these components of the disease and identify additional points of holistic care for our patients.

OBJECTIVES: We aim to determine the prevalence of anxiety and depression in adult CHD Filipino patients using the HADS-P questionnaire (validated Tagalog version of the HADS). We also aim to determine association between depression & anxiety and disease characteristics.

METHODS: This is a cross-sectional study using nonprobability sampling of adult Filipinos with CHD in the Philippine General Hospital (UP-PGH). The HADS-P is a 14-item, self-administered rating scale with independent subscales for anxiety and depression (seven items each) was administered to both the study and control groups after securing consent.

A cut-off score of > 8.0 points on either of the depression and anxiety subscale of the HADS was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression.

RESULTS: A total of 92 patients with CHD with a mean age of 33 years old were recruited. The prevalence of anxiety and depression was higher among those with CHD compared to local literature (61% and 34% respectively). Majority had an atrial septal defect, ventricular septal defect, and patent ductus arteriosus. On the basis of a HADS-P score of >8.0 per category, 56 patients had anxiety and 31 patients had depression. Simple logistic regression identified employment status, a higher NYFC, low distance six-minute walk test, uncorrected defects, and heart failure as predictors of anxiety; whereas lower educational achievement, higher functional class, right-to-left shunt or Eisenmenger physiology, low distance six-minute walk test, and heart failure were predictors of depression. Multiple logistic regression identified only employment status (ie. being unemployed) as a significant predictor of anxiety [OR 4.54, 95% CI 1.38 - 14.28, p 0.012]; while having a rightto-left shunt or Eisenmenger physiology was a significant predictor of depression [OR 6.44, 95% CI 1.82-22.76, p 0.004].

CONCLUSION: This cohort of adult Filipinos with CHD has higher HADS-P scores, suggestive of a higher prevalence of anxiety and depression compared to available data. Factors associated with anxiety and/or depression were related to their underlying CHD and sociodemographic profile. Screening for emotional disorders is of paramount importance to provide holistic care for this vulnerable population. Health care professionals should be alert for the possible need for psychological intervention for adult survivors of CHD, even among those that are seemingly emotionally well-adjusted.

Human ; Male ; Female ; Middle Aged ; Adult ; Depression ; Heart Septal Defects, Ventricular ; Ductus Arteriosus, Patent ; Vulnerable Populations ; Anxiety ; Heart Septal Defects, Atrial ; Heart Failure