The 52nd Annual Conference of the Cardiological Society of India was held in Chennai from 7th to 10th December, 2000. With its theme of "Intervention to Prevention in the 21st century", the CSI focussed on the emerging epidemic of cardiovascular disease in India. As mentioned by Dr. U. Kaul in his presidential message, the total number of patients with heart disease in India is estimated to be at least 50 million, while the projected figure by the end of year 2010 is 100 million. Hence greater number of epidemiological studies, early identification and management and preventive programmes are of vital importance. This article highlights some of the important issues discussed at CSI 2000.

Diabetes is now regarded simply as a disorder of glucose and lipid homeostasis Management of CHD in diabetes includes life style interventions as well as drug therapy. Life style changes include diet with particular emphasis on low fat and cholesterol intake, exercise and de-stressing techniques. Drug therapy includes the oral hypoglycaemic agents, of which sulphonylureas are the most widely prescribed. Another group of oral hypoglycemic agents are the insulin sensitisers, such as rosiglitazone and pioglitazone, which will revolutionise the management of diabetes. Metformin is an old drug but is the most versatile drug as it targets insulin resistance at both levels – liver and adipose true. Insulin is required in 30% of patients and is going to be needed in 60% of patients in the next 10 years.

The endothelium is the largest paracrine and endocrine organ. It synthesises numerous substances (vasodilators, inhibitors of smooth muscle cell growth, and thrombolytic factors/inhibitors of platelet aggregation) which promote normal blood flow. Endothelial dysfunction leads to atherosclerosis and is associated with many cardiovascular risk factors such as ageing, post-menopausal status, diabetes, hypertension, hypercholesterolemia, smoking and hyperhomocysteinemia. Drugs which influence endothelial dysfunction include statins, calcium antagonists (particularly nifedipine), ACE inhibitors and estrogens.

Beta blockers are now considered to be the most powerful tool available to add to standard regimens for the treatment of heart failure. They prevent or even reverse left ventricular remodelling, improve functional capacity and also improve survival. Unlike other selective beta blockers like metoprolol, drugs like carvedilol do not upregulate beta-1 receptors, also block beta-2 receptors (which increase during heart failure), prevent norepinephrine release mediated by presynaptic beta-2 receptors and also block alpha receptors which play an important role in the pathology of heart failure. Beta blockers have been found to be useful in all grades of heart failure.

ACE inhibitors are indicated in all patients with heart failure due to left ventricular systolic dysfunction. Digoxin is useful in moderate to severe chronic systolic failure not responding satisfactorily to adequate doses of diuretics and ACE inhibitors. It is especially useful in patients with atrial fibrillation. Diuretics should not be used as first line therapy or as monotherapy in chronic asymptomatic or mildly symptomatic systolic dysfunction.