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Taha AM, Roshdy MR, Abdelma'amboud Mostafa H, Abdelazeem B. Ischemic heart disease in Africa: An overnight epidemiological transition. Curr Probl Cardiol 2024; 49:102337. [PMID: 38103819 DOI: 10.1016/j.cpcardiol.2023.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
Ischemic heart disease (IHD) falls among the leading causes of death, representing a major burden, ranking first in all regions of the world and eighth in Africa as a leading killer. Recent evidence suggests that Africa is having an epidemiological transition with higher rates of non-communicable diseases (NCDs). IHD contributed to 361 thousand deaths in the African region in 2005, and this number is expected to be more than double by 2030. IHD currently ranks as the leading cause of death for men and the second leading cause of death for women in the African region in patients older than 60 years. There are multiple risk factors related to lifestyle associated with IHD. Thus, strict measures are the key in terms of health promotion and disease prevention. Hurdles impeding the prevention and control of IHD in Africa include poor health care services, low income, and rising costs of cardiac interventions..
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Affiliation(s)
- Amira Mohamed Taha
- Faculty of Medicine, Fayoum University, Fayoum, Egypt; Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
| | - Merna Raafat Roshdy
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of medicine Sohag University, Sohag, Egypt
| | - Hamed Abdelma'amboud Mostafa
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of medicine, Al Azhar University, Dameitta, Egypt
| | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
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Wireko MB, Hendricks J, Bedu-Addo K, Van Staden M, Ntim EA, Larbi JA, Owusu IK. Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study. J Prim Care Community Health 2024; 15:21501319241235594. [PMID: 38477301 PMCID: PMC10938620 DOI: 10.1177/21501319241235594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts. METHODS This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg). RESULTS Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P = .006, 95% CI (1.178-2.665)], [RR = 1.772, P = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P = .034, 95% CI (1.072-5.738)]. CONCLUSION Alcohol consumption is significantly related to increase BP regardless of HIV infection.
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Affiliation(s)
- Manasseh B. Wireko
- Department of Applied and Theoretical Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jacobus Hendricks
- Department of Physiology and Environmental Health, University of Limpopo, South Africa
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Marlise Van Staden
- Department of Physiology and Environmental Health, University of Limpopo, South Africa
| | - Emmanuel A. Ntim
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John A. Larbi
- Department of Applied and Theoretical Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac K. Owusu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Medicine, Komfo Anokye Teaching Hospital. Kumasi, Ghana
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Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana. Glob Heart 2022; 17:63. [PMID: 36199562 PMCID: PMC9438458 DOI: 10.5334/gh.1146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background There is an upsurge of cardiovascular diseases (CVDs) in sub-Saharan Africa (SSA). Irrespective of biological sex, gender-related factors could be the precursor of these conditions. Objective To examine the associations between biological sex, gender-related variables, and cardiovascular health (CVH) risk factors in SSA countries. Methods We used data from the STEPwise approach to surveillance of risk factors for non-communicable disease survey, conducted in adults from Ghana, Gambia, Mali, Guinea, and Botswana. The main outcome was CVH, measured through the health index with values ranging from 0 (worst) to 5 (best or ideal) CVH. Multivariable logistic regression was applied to determine the gender-related factors related to poorer CVH (index less than 4). Results Data included 15,356 adults (61.4% females, mean age 36.9 years). The prevalence of hypertension (21.6% vs. 13.8%) and overweight/obesity (48.3% vs. 27.5%) was higher among females as compared to males. Females were more likely to be unemployed (17.3% vs. 9.7%) or reported unpaid work (36.8% vs. 15.2%). Overall, females showed worse CVH than males (ORfemale = 0.95, 95% CI:0.91-0.99). Being married was associated with better CVH compared with being single, more so for males (ORmale = 1.09, 95% CI:0.96-1.24, pinteraction < 0.01). Males with unpaid work (ORmale = 1.28, 95% CI:1.12-1.47) had better CVH than their unpaid female counterparts (ORfemale = 1.08, 95% CI:1.01-1.17). Conclusion In SSA populations, being female was associated with poorer CVH given the disproportionate burden of hypertension and overweight/obesity. Gender-related factors such as marital status and unpaid work were associated with better CVH in males compared to females.
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Magutah K, Mbuthia G. Physical activity engagement in Eldoret, Kenya, during COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000339. [PMID: 36962184 PMCID: PMC10021677 DOI: 10.1371/journal.pgph.0000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023]
Abstract
The World Health Organization (WHO) recommends that individuals of all ages participate in regular physical activity (PA) for optimal health and to support with the control of multiple non-communicable diseases. In Kenya however, involvement in PA across the general population is low and there is an increase in sedentary lifestyles in both rural and urban areas. An inverse relationship exists between socioeconomic status and involvement in PA. The novel COVID-19 ushered in associated control measures to limit the spread of the virus. These measures included staying at home, social distancing, and closure of physical spaces such as gyms, public parks, sports grounds, outdoor playing areas and schools. The impact was immediate, impacting patterns and routines of PA in Kenya. The primary aim of this study was to verify if COVID-19 affected PA prevalence and patterns amongst adults in Eldoret, Kenya. The secondary aim was to ascertain if the modification in behaviour is consistent amongst individuals from different socioeconomic backgrounds. We used a cross-sectional study to examine self-reported PA data amongst 404 participants. All participants were ≥18 years and resided in Eldoret, Kenya. Data were collected using a self-administered, structured questionnaire adapted from the WHO Global Physical Activity Questionnaire (WHO GPAQ). The characteristics of participants' is summarized using descriptive statistics, and bivariate analyses for measures of associations of variables was done using Chi-squared and Fishers exact tests. Binary logistic regressions were performed to adjust for the various factors and report associations between variables. The p-value considered for significant differences was set at <0.05. Participants in this study had mean age of 30.2±9.8 years. Almost 90% of the participants were not aware of the current WHO guidelines on PA, 9% stopped PA engagement after COVID-19 was first reported in Kenya, and only 25% continued regular PA. Less than half maintained PA intensity after the advent of COVID-19, with almost half reporting a drop. Males had a drop in time taken per PA session while females maintained session lengths after COVID-19 (p = 0.03). Males preferred gym-setup or mixed-type PA while females opted for indoor (home) aerobics before and after COVID-19 (p = 0.01, p = 0.02 respectively). Compared to males, females were less likely to achieve both vigorous- and moderate-intensity PA recommendations (p<0.01 and p = 0.02 respectively). Zone of residence was associated with participation in aerobic PA (p = 0.04; 95% CI = 0.02499-0.96086) and, similarly, level of education was associated with knowledge of WHO recommendations for PA (p = 0.01; 95% CI = -1.7544 - -0.2070). A majority of the urban population of Eldoret, Kenya and especially those with lower level of education are unaware of WHO recommendations for PA, and 30% of them have not engaged in any form of PA for many years. The majority that report involvement in PA do not achieve the WHO recommended threshold levels of PA. The results also indicated that COVID-19 has negatively affected intensity of PA, and that there has been an increase in time spent sitting/reclining amongst individuals in the higher socio-economic classes and specifically amongst females.
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Affiliation(s)
| | - Grace Mbuthia
- Jomo Kenyatta University College of Health Sciences, Juja, Kenya
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Stassen W, Wylie C, Djärv T, Wallis LA. Out-of-hospital cardiac arrests in the city of Cape Town, South Africa: a retrospective, descriptive analysis of prehospital patient records. BMJ Open 2021; 11:e049141. [PMID: 34400458 PMCID: PMC8370552 DOI: 10.1136/bmjopen-2021-049141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES While prospective epidemiological data for out-of-hospital cardiac arrest (OHCA) exists in many high-income settings, there is a dearth of such data for the African continent. The aim of this study was to describe OHCA in the Cape Town metropole, South Africa. DESIGN Observational study with a retrospective descriptive design. SETTING Cape Town metropole, Western Cape province, South Africa. PARTICIPANTS All patients with OHCA for the period 1 January 2018-31 December 2018 were extracted from public and private emergency medical services (EMS) and described. OUTCOME MEASURES Description of patients with OHCA in terms of demographics, treatment and short-term outcome. RESULTS A total of 929 patients with OHCA received an EMS response in the Cape Town metropole, corresponding to an annual prevalence of 23.2 per 100 000 persons. Most patients were adult (n=885; 96.5%) and male (n=526; 56.6%) with a median (IQR) age of 63 (26) years. The majority of cardiac arrests occurred in private residences (n=740; 79.7%) and presented with asystole (n=322; 34.6%). EMS resuscitation was only attempted in 7.4% (n=69) of cases and return of spontaneous circulation (ROSC) occurred in 1.3% (n=13) of cases. Almost all patients (n=909; 97.8%) were declared dead on the scene. CONCLUSION To our knowledge, this was the largest study investigating OHCA ever undertaken in Africa. We found that while the incidence of OHCA in Cape Town was similar to the literature, resuscitation is attempted in very few patients and ROSC-rates are negligible. This may be as a consequence of protracted response times, poor patient prognosis or an underdeveloped and under-resourced Chain of Survival in low- to middle-income countries, like South Africa. The development of contextual guidelines given resources and disease burden is essential.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Craig Wylie
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Therese Djärv
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Magutah K, Thairu K, Patel N. Effect of short moderate intensity exercise bouts on cardiovascular function and maximal oxygen consumption in sedentary older adults. BMJ Open Sport Exerc Med 2020; 6:e000672. [PMID: 32180993 PMCID: PMC7050352 DOI: 10.1136/bmjsem-2019-000672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 01/11/2023] Open
Abstract
AIM To investigate effect of <10 min moderate intensity exercise on cardiovascular function and maximal oxygen consumption (V ˙ O2max) among sedentary adults. METHODS We studied 53 sedentary urbanites aged ≥50 years, randomised into: (1) male (MS) and (2) female (FS) undertaking three short-duration exercise (5-10 min) daily, and (3) male (ML) and (4) female (FL) exercising 30-60 min 3-5 days weekly. Resting systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate andV ˙ O2max were measured at baseline and 8 weekly for 24 weeks. RESULTS At baseline, 50% MS, 61.5% ML, 53.8% FS and 53.8% FL had SBP ≥120 mm Hg, and 14.3% MS, 53.8% ML, 23.1% FS and 38.5% FL had DBP ≥80 mm Hg. At 24 weeks, where SBP remained ≥120 mm Hg, values decreased from 147±19.2 to 132.3±9.6 mm Hg (50% of MS), from 144±12.3 to 128±7.0 mm Hg (23.1% of ML), from 143.1±9.6 to 128.0±7.0 mm Hg (53.8% of FS) and from 152.3±23.7 to 129±3.7 mm Hg (30.8% of FL). For DBP ≥80 mm Hg, MS and FS percentages maintained, but values decreased from 101±15.6 to 84.5±0.7 mm Hg (MS) and 99.0±3.6 to 87.7±4.9 mm Hg (FS). In ML and FL, percentage with DBP ≥80 mm Hg dropped to 15.4% (86.1±6.5 to 82.5±3.5 mm Hg) and (91.4±5.3 to 83.5±0.71 mm Hg).V ˙ O2max increased from 26.1±4.4 to 32.0±6.2 for MS, from 25.8±5.1 to 28.8±5.4 for ML (group differences p=0.02), from 20.2±1.8 to 22.7±2.0 for FS and from 21.2±1.9 to 24.2±2.7 for FL (groups differences p=0.38). CONCLUSION Accumulated moderate intensity exercise bouts of <10 min confer similar-to-better cardiovascular andV ˙ O2max improvements compared with current recommendations among sedentary adults.
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Affiliation(s)
- Karani Magutah
- Medical Physiology, Moi University School of Medicine, Eldoret, Kenya
| | - Kihumbu Thairu
- Medical Physiology, University of Nairobi, Nairobi, Kenya
| | - Nilesh Patel
- Medical Physiology, University of Nairobi, Nairobi, Kenya
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Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care. Prehosp Disaster Med 2018; 33:650-657. [PMID: 30430958 DOI: 10.1017/s1049023x1800105x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.ProblemData on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report. METHODS A total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report. RESULTS Of the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed. CONCLUSION There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country. TourayS, SanyangB, ZandrowG, TourayI. Incidence and outcomes after out-of-hospital medical emergencies in Gambia: a case for the integration of prehospital care and Emergency Medical Services in primary health care. Prehosp Disaster Med. 2018;33(6):650-657.
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Magutah K, Patel NB, Thairu K. Effect of moderate-intensity exercise bouts lasting <10 minutes on body composition in sedentary Kenyan adults aged ≥50 years. BMJ Open Sport Exerc Med 2018; 4:e000403. [PMID: 30305924 PMCID: PMC6173229 DOI: 10.1136/bmjsem-2018-000403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Sedentary lifestyles and related morbidities are rising among adults despite existing exercise recommendations. Appealing exercise regimes yielding similar/better body composition should be sought. OBJECTIVE We investigated the effect of moderate-intensity exercise bouts of <10 min on body composition in previously sedentary adults. METHODS This unblinded study enrolled 53 healthy sedentary volunteers aged ≥50 years, randomised into one of two gender-balanced exercise interventions: (1) male and (2) female short-duration bouts (MS, n=14; FS, n = 13), and (3) male and (4) female long-duration bouts (ML, n=13; FL, n=13). Short-duration bouts entailed 5-10 min of jogging thrice daily; long-duration bouts, 30-60 min 3-5 days weekly. Body composition was determined at recruitment and 8-weekly thereafter, for 24 weeks. RESULTS At baseline, 14.3% of MS, 38.5% of ML, 92.3% of FS and 69.2% of FL were obese, dropping to 7.1%, 15.4%, 61.5% and 30.8%, respectively. For waist:height ratio, 64.3 % of MS, 76.9% of ML, 100% of FS and 84.6.3% of FL had ratios >0.5, dropping to 42.9%, 30.8%, 92.9% and 26.2%, respectively. While baseline MS and ML waist:hip ratio (WHR) ≥0.9 were 64.3% and 69.2%, respectively, they correspondingly dropped to 23.1% and 21.4%. The FS and FL with WHR ≥0.85 dropped from 46.2% to 15.4% and from 30.8% to 7.7%, respectively. Body composition variables improved for both sexes (all p <0.05) and mean change between exercise regimes was comparable for both sexes. CONCLUSION In equal cumulative times, moderate-intensity exercise bouts lasting <10 min are comparable with current 30-60 min bouts in body composition modification for adults of ≥50 years.
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Affiliation(s)
- Karani Magutah
- Department of Medical Physiology, Moi University, Eldoret, Kenya
- Department of Medical Physiology, University of Nairobi, Nairobi, Kenya
| | - Nilesh B Patel
- Department of Medical Physiology, University of Nairobi, Nairobi, Kenya
| | - Kihumbu Thairu
- Department of Medical Physiology, University of Nairobi, Nairobi, Kenya
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An assessment of critical care capacity in the Gambia. J Crit Care 2018; 47:245-253. [PMID: 30059869 DOI: 10.1016/j.jcrc.2018.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/30/2018] [Accepted: 07/20/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Critical illnesses are a major cause of morbidity and mortality in The Gambia, yet national data on critical care capacity is lacking. MATERIALS AND METHODS We surveyed eight of the eleven government-owned health facilities providing secondary and tertiary care in The Gambia's public health sector. At each hospital, a designated respondent completed a questionnaire reporting information on the presence of an intensive care unit, the number of critical care beds where available, monitoring equipment, and the ability to provide basic critical care services at their respective hospitals. RESULTS The response rate was 88% (7/8 hospitals). Only one hospital had a dedicated intensive care unit with eight ICU beds, resulting in an estimated 0.4 ICU beds/100,000 population in the country. All hospitals reported treating more than 50 critically ill patients a month, with trauma, obstetric emergencies, hypertensive emergencies and stroke accounting for the leading causes of admission respectively. The country lacks any trained specialists and resources to diagnose and treat critically ill patients. CONCLUSIONS The Gambia has a very low ICU bed capacity and lacks the human resources and equipment necessary to diagnose and treat the large number of critically ill patients admitted to public hospitals in the country.
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Aggarwal M, Devries S, Freeman AM, Ostfeld R, Gaggin H, Taub P, Rzeszut AK, Allen K, Conti RC. The Deficit of Nutrition Education of Physicians. Am J Med 2018; 131:339-345. [PMID: 29269228 DOI: 10.1016/j.amjmed.2017.11.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/24/2022]
Abstract
Globally, death rates from cardiovascular disease are increasing, rising 41% between 1990 and 2013, and are often attributed, at least in part, to poor diet quality. With urbanization, economic development, and mass marketing, global dietary patterns have become more Westernized to include more sugar-sweetened beverages, highly processed foods, animal-based foods, and fewer fruits and vegetables, which has contributed to increasing cardiovascular disease globally. In this paper, we will examine the trends occurring globally in the realm of nutrition and cardiovascular disease prevention and also present new data that international nutrition knowledge amongst cardiovascular disease providers is limited. In turn, this lack of knowledge has resulted in less patient education and counseling, which is having profound effects on cardiovascular disease prevention efforts worldwide.
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Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, FL.
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | - Robert Ostfeld
- Division of Cardiology, Montefiore Medical Center, New York, NY
| | - Hanna Gaggin
- Division of Cardiology, Massachusetts General Hospital, Boston; Baim Institute for Clinical Research, Boston, Mass
| | - Pam Taub
- Cardiovascular Division, UC San Diego Health System, Calif
| | - Anne K Rzeszut
- Market Intelligence, American College of Cardiology, Washington, DC
| | - Kathleen Allen
- Department of Nutrition & Food Studies, New York University, New York, NY
| | - Richard C Conti
- Division of Cardiology, University of Florida, Gainesville, FL
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Nwose EU, Richards RS, Bwititi PT, Igumbor EO, Oshionwu EJ, Okolie K, Onyia IC, Pokhrel A, Gyawali P, Okuzor JN, Oguoma VM, Gardiner FW, Wang L. Prediabetes and cardiovascular complications study (PACCS): international collaboration 4 years' summary and future direction. BMC Res Notes 2017; 10:730. [PMID: 29228975 PMCID: PMC5725921 DOI: 10.1186/s13104-017-3017-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
Objective The prediabetes and cardiovascular complications studies proposes to develop a screening protocol for diabetes cardiovascular risk, and strategies for holistic management amongst others. Over 500 participants were recruited in the first 2 years of rural community research screening. Specific for this report, various published findings were reviewed. The objective is to summarize research outcomes and itemize limitations as they constitute basis of future directions. Results Affordability and availability are major confounding behavioural change wheel factors in the rural community. 4.9% prevalence of prediabetes, which may be lower or non-significantly different in urban areas. Hyperglycaemia co-morbidity with dyslipidaemia (5.0%), obesity (3.1%) and hypertension (1.8%) were observed. Limitation of the study includes participants being mostly over 60 years old, which has created impetus for the Global Alliance on Chronic Diseases agenda on vulnerability of older adults to diabetes being a new direction of the collaboration. Other directions in Australia and Nepal focus on patients with chronic kidney disease with or without cardiovascular complications. This report highlights the need to translational research. Electronic supplementary material The online version of this article (10.1186/s13104-017-3017-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E U Nwose
- School of Community Health, Faculty of Sciences, Charles Sturt University, Orange Campus, Leeds Parade, Orange, NSW, Australia. .,Public & Community Health Department, Novena University, Ogume, Kwale, Nigeria. .,Global Medical Research & Development Organization, Catholic Hospital Abbi, Albury, NSW, Australia.
| | - R S Richards
- School of Community Health, Faculty of Sciences, Charles Sturt University, Orange Campus, Leeds Parade, Orange, NSW, Australia
| | - P T Bwititi
- School of Biomedical Sciences, Faculty of Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - E O Igumbor
- Public & Community Health Department, Novena University, Ogume, Kwale, Nigeria
| | - E J Oshionwu
- Global Medical Research & Development Organization, Catholic Hospital Abbi, Albury, NSW, Australia.,California Department of State Hospital, Stockton, CA, 95215, USA
| | - K Okolie
- Global Medical Research & Development Organization, Catholic Hospital Abbi, Albury, NSW, Australia
| | - I C Onyia
- Global Medical Research & Development Organization, Catholic Hospital Abbi, Albury, NSW, Australia.,Onyx Hospital & Maternity, Lagos, Nigeria
| | - A Pokhrel
- Nepal Medical College & Teaching Hospital, Kathmandu, Nepal
| | - P Gyawali
- University of Montreal, Montreal, Canada
| | - J N Okuzor
- Global Medical Research & Development Organization, Catholic Hospital Abbi, Albury, NSW, Australia.,Laboratory Department, Texas Health Resources (HMH-HEB), Bethesda, TX, 76022, USA
| | - V M Oguoma
- School of Psychological & Clinical Sciences, Charles Darwin University, Wagga Wagga, NSW, Australia
| | - F W Gardiner
- School of Community Health, Faculty of Sciences, Charles Sturt University, Orange Campus, Leeds Parade, Orange, NSW, Australia.,Calvary Public Hospital, Bruce, ACT, Australia
| | - L Wang
- School of Biomedical Sciences, Faculty of Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
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Tsabedze N, McCutcheon K, Mkhwanazi L, Garda R, Vachiat A, Ramjee R, Moosa J, Maluleke T, Mukeshimana G, Karolia S, Mpanya D, Manga P. Periprocedural myocardial infarction during percutaneous coronary intervention in an academic tertiary centre in Johannesburg. Int J Cardiol 2016; 230:175-180. [PMID: 28062147 DOI: 10.1016/j.ijcard.2016.12.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 12/07/2016] [Accepted: 12/25/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is effective therapy for significant atherosclerotic coronary artery disease. Despite medical and technological advances in PCI, periprocedural myocardial infarction (PMI) remains a common complication. The frequency and factors associated with PMI have been well investigated in the developed world, yet there is a paucity of data from the developing world, especially Sub-Saharan Africa. METHODS We prospectively enrolled 153 adult patients undergoing PCI at the Charlotte Maxeke Johannesburg Academic Hospital from the 1st of February 2014 to 31st October 2014. Periprocedural Creatinine Kinase-MB and hs-Troponin I were routinely measured before PCI and at 16-24h post-procedure. The third universal definition of myocardial infarction was used to define a PMI event. RESULTS 152 participants met the inclusion criteria and were analysed for PMI. 70.4% participants were male. The mean age was 58.8 (SD 10.9) years old. Sixteen (10.5%) participants fulfilled the criteria for PMI. Side branch pinching with preserved TIMI III flow was noted in 62.5% of PMI cases. Duration of procedure (P=0.007), right coronary artery intervention (p=0.042) and total stent length (p=0.045) were independently associated with PMI. CONCLUSION PMI occurred in 10.5% of cases undergoing PCI. This is consistent with the prevalence of PMI internationally. Larger multicentre studies are required in our demographic region to further define relevant predictors and outcomes associated with PMI.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa.
| | - Keir McCutcheon
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Lancelot Mkhwanazi
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Riaz Garda
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Rohan Ramjee
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Jameel Moosa
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Themba Maluleke
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Gloria Mukeshimana
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Saffiyyah Karolia
- Division of Diagnostic Radiography, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Dineo Mpanya
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
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Wensink GE, Schoffelen AF, Tempelman HA, Rookmaaker MB, Hoepelman AIM, Barth RE. Albuminuria Is Associated with Traditional Cardiovascular Risk Factors and Viral Load in HIV-Infected Patients in Rural South Africa. PLoS One 2015; 10:e0136529. [PMID: 26309226 PMCID: PMC4550462 DOI: 10.1371/journal.pone.0136529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/04/2015] [Indexed: 01/13/2023] Open
Abstract
Context As life expectancy improves among Human Immunodeficiency Virus (HIV) patients, renal and cardiovascular diseases are increasingly prevalent in this population. Renal and cardiovascular disease are mutual risk factors and are characterized by albuminuria. Understanding the interactions between HIV, cardiovascular risk factors and renal disease is the first step in tackling this new therapeutic frontier in HIV. Methods In a rural primary health care centre, 903 HIV-infected adult patients were randomly selected and data on HIV-infection and cardiovascular risk factors were collected. Glomerular filtration rate (eGFR) was estimated. Albuminuria was defined as an Albumin-Creatinine-Ratio above 30 mg/g. Multivariate logistic regression analysis was used to analyse albuminuria and demographic, clinical and HIV-associated variables. Results The study population consisted of 903 HIV-infected patients, with a median age of 40 years (Inter-Quartile Range (IQR) 34–48 years), and included 625 (69%) women. The median duration since HIV diagnosis was 26 months (IQR 12–58 months) and 787 (87%) received antiretroviral therapy. Thirty-six (4%) of the subjects were shown to have diabetes and 205 (23%) hypertension. In the cohort, 21% had albuminuria and 2% an eGFR <60 mL/min/1.73m2. Albuminuria was associated with hypertension (adjusted odds ratio (aOR) 1.59; 95% confidence interval (CI) 1.05–2.41; p<0.05), total cholesterol (aOR 1.31; 95% CI 1.11–1.54; p<0.05), eGFR (aOR 0.98; 95% CI 0.97–0.99; p<0.001) and detectable viral load (aOR 2.74; 95% CI 1.56–4.79; p<0.001). Hypertension was undertreated: 78% were not receiving treatment, while another 11% were inadequately treated. No patients were receiving lipid-lowering medication. Conclusion Glomerular filtration rate was well conserved, while albuminuria was common amongst HIV-infected patients in rural South Africa. Both cardiovascular and HIV-specific variables were associated with albuminuria. Improved cardiovascular risk prevention as well as adequate virus suppression might be the key to escape the vicious circle of renal failure and cardiovascular disease and improve the long-term prognosis of HIV-infected patients.
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Affiliation(s)
- G. Emerens Wensink
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Annelot F. Schoffelen
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
| | | | - Maarten B. Rookmaaker
- Department of Nephrology & Hypertension at the University Medical Centre in Utrecht, Utrecht, The Netherlands
| | - Andy I. M. Hoepelman
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
| | - Roos E. Barth
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
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Nurnberg ST, Cheng K, Raiesdana A, Kundu R, Miller CL, Kim JB, Arora K, Carcamo-Oribe I, Xiong Y, Tellakula N, Nanda V, Murthy N, Boisvert WA, Hedin U, Perisic L, Aldi S, Maegdefessel L, Pjanic M, Owens GK, Tallquist MD, Quertermous T. Coronary Artery Disease Associated Transcription Factor TCF21 Regulates Smooth Muscle Precursor Cells That Contribute to the Fibrous Cap. PLoS Genet 2015; 11:e1005155. [PMID: 26020946 PMCID: PMC4447275 DOI: 10.1371/journal.pgen.1005155] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/18/2015] [Indexed: 01/10/2023] Open
Abstract
Recent genome wide association studies have identified a number of genes that contribute to the risk for coronary heart disease. One such gene, TCF21, encodes a basic-helix-loop-helix transcription factor believed to serve a critical role in the development of epicardial progenitor cells that give rise to coronary artery smooth muscle cells (SMC) and cardiac fibroblasts. Using reporter gene and immunolocalization studies with mouse and human tissues we have found that vascular TCF21 expression in the adult is restricted primarily to adventitial cells associated with coronary arteries and also medial SMC in the proximal aorta of mouse. Genome wide RNA-Seq studies in human coronary artery SMC (HCASMC) with siRNA knockdown found a number of putative TCF21 downstream pathways identified by enrichment of terms related to CAD, including “vascular disease,” “disorder of artery,” and “occlusion of artery,” as well as disease-related cellular functions including “cellular movement” and “cellular growth and proliferation.” In vitro studies in HCASMC demonstrated that TCF21 expression promotes proliferation and migration and inhibits SMC lineage marker expression. Detailed in situ expression studies with reporter gene and lineage tracing revealed that vascular wall cells expressing Tcf21 before disease initiation migrate into vascular lesions of ApoE-/- and Ldlr-/- mice. While Tcf21 lineage traced cells are distributed throughout the early lesions, in mature lesions they contribute to the formation of a subcapsular layer of cells, and others become associated with the fibrous cap. The lineage traced fibrous cap cells activate expression of SMC markers and growth factor receptor genes. Taken together, these data suggest that TCF21 may have a role regulating the differentiation state of SMC precursor cells that migrate into vascular lesions and contribute to the fibrous cap and more broadly, in view of the association of this gene with human CAD, provide evidence that these processes may be a mechanism for CAD risk attributable to the vascular wall. Coronary artery disease (CAD) is responsible for the majority of deaths in the Western world, and is due in part to environmental and metabolic factors. However, half of the risk for developing heart disease is genetically predetermined. Genome-wide association studies in human populations have identified over 100 sites in the genome that appear to be associated with CAD, however, the mechanisms by which variation in these regions are responsible for predisposition to CAD remain largely unknown. We have begun to study a gene that contributes to CAD risk, the TCF21 gene. Through genomic studies we show that this gene is involved in processes related to alterations in vascular gene expression, and in particular those related to the smooth muscle cell biology. With cell culture models, we show that TCF21 regulates the differentiation state of this cell type, which is believed critical for vascular disease. Using mouse genetic models of atherosclerotic vascular disease we provide evidence that this gene is expressed in precursor cells that migrate into the disease lesions and contribute to the formation of the fibrous cap that is believed to stabilize these lesions and prevent heart attacks.
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Affiliation(s)
- Sylvia T. Nurnberg
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Karen Cheng
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Azad Raiesdana
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Ramendra Kundu
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Clint L. Miller
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Juyong B. Kim
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Komal Arora
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Ivan Carcamo-Oribe
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Yiqin Xiong
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Nikhil Tellakula
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Vivek Nanda
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Nikitha Murthy
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - William A. Boisvert
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Ulf Hedin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Ljubica Perisic
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Silvia Aldi
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Milos Pjanic
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Gary K. Owens
- Department of Molecular Physiology and Biological Physics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Michelle D. Tallquist
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Thomas Quertermous
- Department of Medicine, Cardiovascular Research Institute, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Eholié SP, Lacombe K, Krain A, Diallo Z, Ouiminga M, Campa P, Bouchaud O, Bissagnene E, Girard PM. Metabolic disorders and cardiovascular risk in treatment-naive HIV-infected patients of sub-saharan origin starting antiretrovirals: impact of westernized lifestyle. AIDS Res Hum Retroviruses 2015; 31:384-92. [PMID: 25707418 DOI: 10.1089/aid.2014.0164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In a cohort of HIV-infected patients of sub-Saharan origin we describe the incidence of metabolic syndrome, insulin resistance, and lipodystrophy after 3 years of combined antiretroviral therapy, and model the 10-year risk of cardiovascular diseases, while taking into account environmental factors. This is a multinational, prospective cohort study conducted in HIV outpatient clinics from four tertiary care centers set in France and Côte d'Ivoire. The participants were HIV-infected, treatment-naive patients eligible to start antiretroviral treatment and were of sub-Saharan African origin. The main outcome measures were the incidence of metabolic syndrome, insulin resistance, and lipodystrophy, and the assessment of the 10-year risk of cardiovascular diseases using Framingham risk prediction, D.A.D. Cardiovascular Disease Risk, and WHO/ISH prediction charts. Of 245 patients followed for up to 3 years, the incidence of metabolic syndrome, insulin resistance, and lipodystrophy was 5.5, 8.5, and 6.8 per 100 person-years of follow-up (cumulative incidence: 14.4%, 19.2%, and 18.1%, respectively). Living in France as well as female gender and being overweight were risk factors for metabolic disorders as whole and only first generation protease inhibitors were marginally associated with metabolic syndrome. Cardiovascular risk as modeled through the three equations was high in all patients with the synergistic and deleterious effect of living in France compared to Côte d'Ivoire. This cohort study shows how the synergy between HIV, antiretroviral (ARV) exposure, and westernization of life style in a cohort of HIV-infected patients of sub-Saharan origin leads to a progressive increase in the risk of lipodystrophy, as well as metabolic syndrome and insulin resistance, all associated with increased cardiovascular risk.
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Affiliation(s)
- Serge Paul Eholié
- Department of Infectious Diseases and Tropical Medicine, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Karine Lacombe
- University of Pierre and Marie Curie, Paris VI, France
- Department of Infectious Diseases and Tropical Medicine, Hospital Saint-Antoine, AP-HP, Paris, France
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Alysa Krain
- Department of Infectious Diseases and Tropical Medicine, Hospital Saint-Antoine, AP-HP, Paris, France
| | - Zelica Diallo
- Department of Infectious Diseases and Tropical Medicine, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Mariama Ouiminga
- Department of Infectious Diseases and Tropical Medicine, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Pauline Campa
- Department of Infectious Diseases and Tropical Medicine, Hospital Saint-Antoine, AP-HP, Paris, France
| | - Olivier Bouchaud
- Department of Infectious Diseases and Tropical Medicine, Hospital Avicenne, AP-HP, Bobigny, France
| | - Emmanuel Bissagnene
- Department of Infectious Diseases and Tropical Medicine, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Pierre-Marie Girard
- University of Pierre and Marie Curie, Paris VI, France
- Department of Infectious Diseases and Tropical Medicine, Hospital Saint-Antoine, AP-HP, Paris, France
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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Naidoo P, Rambiritch V, Butkow N, Saman S. Optimal utilisation of sulphonylureas in resource-constrained settings. Cardiovasc J Afr 2015; 25:83-5. [PMID: 24844554 PMCID: PMC4026768 DOI: 10.5830/cvja-2014-007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/04/2014] [Indexed: 01/21/2023] Open
Abstract
Abstract Sulphonylureas (SUs) are oral anti-diabetic drugs (OADs) that were introduced more than 60 years ago. Clinicians are familiar with their use and they remain extensively used. However, the SU class is associated with adverse effects of weight gain and hypoglycaemia. In addition, their effects on cardiovascular events remain contentious. Newer classes of anti-diabetic agents have been developed and these agents are weight neutral (di-peptidyl peptidase IV inhibitors), while others reduce weight (glucagon-like peptide analogues and sodium glucose co-transporter inhibitors). Furthermore, the newer agents are less likely to cause hypoglycaemia and have a potentially better cardiovascular safety profile. However, the newer agents are more costly than SUs and their long-term safety is unknown. It is therefore likely that SUs will continue to be used, and more so in resource-limited settings. One may mitigate the adverse effects of weight gain and hypoglycaemia associated with the SU class by using members within this class that are less probable to cause these adverse effects. Furthermore, the specific SU must be used at the lowest effective therapeutic dose. In patients at high risk of SU-induced hypoglycaemic episodes (frail, clinically significant renal impairment), or patients in whom hypoglycaemic episodes may have devastating effects (bus drivers), newer anti-diabetic agents may be a justifiable alternative option.
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Affiliation(s)
| | | | - Neil Butkow
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Selvarajah Saman
- Port Shepstone Regional Hospital and University of Kwa-Zulu Natal, Durban, South Africa
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Kan J, Shi H, Liu X, Chen Z. Hypolipidemic effect of proteoglycans isolated from sweet potato (Ipomoea batatas LAM) in hyperlipidemia rats. Food Sci Biotechnol 2014. [DOI: 10.1007/s10068-014-0275-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mamabolo RL, Sparks M, Moss SJ, Monyeki MA. The association between dyslipidemia and anthropometric indicators in black and white adolescents residing in Tlokwe Municipality, North-West Province, South Africa: the PAHL study. Afr Health Sci 2014; 14:929-38. [PMID: 25834504 DOI: 10.4314/ahs.v14i4.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The dyslipidemia associated with excess weight is a risk for cardiovascular disease. Worldwide and in South Africa adolescent obesity has been reported. OBJECTIVES To determine the association between dyslipidemia and anthropometric indices in black and white adolescents. METHODS The study involved 129 black and 69 white adolescents aged 12 to 16 years. Data collected included height, weight, waist circumference (WC) and skinfolds, blood pressure and blood for glucose, insulin, total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (Trig) and C - reactive protein (CRP). RESULTS WC correlated negatively with HDL in both blacks (p=0.042) and whites (p=0.008) and in whites it correlated positively with LDL (p=0.006); TC/HDL (p=<0.001) and LDL/HDL ratio (p<0.0001). WC/Hgt correlated negatively with HDL (p=0.028) and positively with LDL/HDL (p=0.026 and p<0.0001) in both races. In whites positive correlations were between WC/Hgt and TC (p=0.049); LDL (p=0.003) and TC/HDL (p<0.0001). BAZ correlated positively with TC/HDL ratio (p=0.004) and LDL/HDL ratio (p=0.002). The most common abnormalities were HDL and LDL. CONCLUSION Whites exhibited more associations between dyslipidemia and anthropometric indicators as compared to Blacks, suggesting that there might be differences in the lipid metabolism or even susceptibility to risk factors in adolescents.
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[Epidemiological transition of mycosis diseases in sub-Saharan Africa: from surface to depth]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2014; 108:41-5. [PMID: 24997574 DOI: 10.1007/s13149-014-0376-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/06/2014] [Indexed: 01/29/2023]
Abstract
Fungi are schematically responsible for three distinct kinds of infections: superficial mycoses, subcutaneous and deep ones. The current socio-epidemiological transition observed in sub-Saharan Africa does not actually lead to similar consequences regarding these three categories of fungal entities. For instance, it has long been known that superficial mycoses are very prevalent in tropical areas, since they are partly due to the warm climate and the promiscuity. They are mostly caused by dermatophytic fungi or Malassezia sp. (Pityriasis versicolor). Subcutaneous mycoses are rarer, and usually due to dimorphic fungi which are accidentally inoculated into the body after a skin injury or a trauma. Sometimes very spectacular, the clinical outcome is then described as chronic. Thus, chromoblastomycosis, rhinoentomophtoromycosis or mycetoma are some examples of subcutaneous mycoses which remain well-known by practitioners of endemic countries. Deep mycoses (or invasive / systemic mycoses) are defined by fungal infections of deep anatomical sites that should be normally sterile. By contrast with the other entities mentioned above, the outcome may be rapidly fatal for the patient. One of the most outstanding examples was the great increasing of cryptococcal meningitis during the HIV outbreak in the 80'. A few other similar mycoses may be feared in a near future, since they usually occur in contexts of important immunosuppression which are about to be definitely experienced in Africa: overall increase of chronic diseases like diabetes, lengthening life expectancy and its associated diseases, widespread medical practices which were only seen in advanced intensive care units, onco-haematology departments or graft centers so far. Thus, the deep mycoses will inevitably increase in Africa, as they did in all developed countries over the last two decades. The consequences will not only be limited to the clinical management as described above: the diagnostic approach is also quite particular, since the identification of the involved fungal species should be established in emergency, if not the outcome will be fatal. Besides, the antifungal drugs are expensive, and their therapeutic monitoring is quite challenging all along the follow up. Overall, we have to thoroughly take into account the emergence of invasive mycoses right now in Intertropical Africa, in order to successfully achieve the socio-economic development of this continent.
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Jemmott JB, Jemmott LS, Ngwane Z, Zhang J, Heeren GA, Icard LD, O'Leary A, Mtose X, Teitelman A, Carty C. Theory-based behavioral intervention increases self-reported physical activity in South African men: a cluster-randomized controlled trial. Prev Med 2014; 64:114-20. [PMID: 24736094 PMCID: PMC4142492 DOI: 10.1016/j.ypmed.2014.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/04/2014] [Accepted: 04/06/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine whether a health-promotion intervention increases South African men's adherence to physical-activity guidelines. METHOD We utilized a cluster-randomized controlled trial design. Eligible clusters, residential neighborhoods near East London, South Africa, were matched in pairs. Within randomly selected pairs, neighborhoods were randomized to theory-based, culturally congruent health-promotion intervention encouraging physical activity or attention-matched HIV/STI risk-reduction control intervention. Men residing in the neighborhoods and reporting coitus in the previous 3 months were eligible. Primary outcome was self-reported individual-level adherence to physical-activity guidelines averaged over 6-month and 12-month post-intervention assessments. Data were collected in 2007-2010. Data collectors, but not facilitators or participants, were blind to group assignment. RESULTS Primary outcome intention-to-treat analysis included 22 of 22 clusters and 537 of 572 men in the health-promotion intervention and 22 of 22 clusters and 569 of 609 men in the attention-control intervention. Model-estimated probability of meeting physical-activity guidelines was 51.0% in the health-promotion intervention and 44.7% in attention-matched control (OR=1.34; 95% CI, 1.09-1.63), adjusting for baseline prevalence and clustering from 44 neighborhoods. CONCLUSION A theory-based culturally congruent intervention increased South African men's self-reported physical activity, a key contributor to deaths from non-communicable diseases in South Africa. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01490359.
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Affiliation(s)
- John B Jemmott
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA.
| | - Loretta S Jemmott
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Zolani Ngwane
- Haverford College, Department of Anthropology, Haverford, PA, USA
| | - Jingwen Zhang
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA
| | - G Anita Heeren
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Larry D Icard
- Temple University, College of Health Professions and Social Work, Philadelphia, PA, USA
| | - Ann O'Leary
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xoliswa Mtose
- University of Fort Hare, Faculty of Education, East London, South Africa
| | - Anne Teitelman
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Craig Carty
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
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Chronic diseases and multi-morbidity--a conceptual modification to the WHO ICCC model for countries in health transition. BMC Public Health 2014; 14:575. [PMID: 24912531 PMCID: PMC4071801 DOI: 10.1186/1471-2458-14-575] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/04/2014] [Indexed: 11/25/2022] Open
Abstract
Background The burden of non-communicable diseases is rising, particularly in low and middle-income countries undergoing rapid epidemiological transition. In sub-Saharan Africa, this is occurring against a background of infectious chronic disease epidemics, particularly HIV and tuberculosis. Consequently, multi-morbidity, the co-existence of more than one chronic condition in one person, is increasing; in particular multimorbidity due to comorbid non-communicable and infectious chronic diseases (CNCICD). Such complex multimorbidity is a major challenge to existing models of healthcare delivery and there is a need to ensure integrated care across disease pathways and across primary and secondary care. Discussion The Innovative Care for Chronic Conditions (ICCC) Framework developed by the World Health Organization provides a health systems roadmap to meet the increasing needs of chronic disease care. This framework incorporates community, patient, healthcare and policy environment perspectives, and forms the cornerstone of South Africa’s primary health care re-engineering and strategic plan for chronic disease management integration. However, it does not significantly incorporate complexity associated with multimorbidity and CNCICD. Using South Africa as a case study for a country in transition, we identify gaps in the ICCC framework at the micro-, meso-, and macro-levels. We apply the lens of CNCICD and propose modification of the ICCC and the South African Integrated Chronic Disease Management plan. Our framework incorporates the increased complexity of treating CNCICD patients, and highlights the importance of biomedicine (biological interaction). We highlight the patient perspective using a patient experience model that proposes that treatment adherence, healthcare utilization, and health outcomes are influenced by the relationship between the workload that is delegated to patients by healthcare providers, and patients’ capacity to meet the demands of this workload. We link these issues to provider perspectives that interact with healthcare delivery and utilization. Summary Our proposed modification to the ICCC Framework makes clear that healthcare systems must work to make sense of the complex collision between biological phenomena, clinical interpretation, beliefs and behaviours that follow from these. We emphasize the integration of these issues with the socio-economic environment to address issues of complexity, access and equity in the integrated management of chronic diseases previously considered in isolation.
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Shaffer D, Hughes MD, Sawe F, Bao Y, Moses A, Hogg E, Lockman S, Currier J. Cardiovascular disease risk factors in HIV-infected women after initiation of lopinavir/ritonavir- and nevirapine-based antiretroviral therapy in Sub-Saharan Africa: A5208 (OCTANE). J Acquir Immune Defic Syndr 2014; 66:155-63. [PMID: 24562349 PMCID: PMC4109714 DOI: 10.1097/qai.0000000000000131] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited comparative, prospective data exist regarding cardiovascular risk factors in HIV-infected women starting antiretroviral therapy in Africa. METHODS In 7 African countries, 741 women with CD4 <200 cells/mm were randomized to tenofovir/emtricitabine (TDF/FTC) plus either nevirapine (NVP, n = 370) or lopinavir/ritonavir (LPV/r, n = 371). Lipids and blood pressure (BP) were evaluated at entry, 48, 96, and 144 weeks. Multivariable linear and logistic regression models were used to evaluate mean risk factor changes and clinically relevant risk factor changes. RESULTS At entry, both NVP and LPV/r groups were similar regarding age [mean = 33.5 (SD = 7.1) years], CD4 [129 (67) cells/mm], and HIV-1 RNA [5.1 (0.6) log10 copies/mL]. Nearly, all women had normal lipids and BP except for high-density lipoprotein (HDL)-cholesterol. Over 144 weeks, the LPV/r compared with NVP group had significantly greater mean lipid increases (eg, non-HDL: +29 vs. +13 mg/dL) and smaller HDL increases (+12 vs. +21 mg/dL). In contrast, the NVP compared with LPV/r group had greater mean increases in BP (eg, diastolic BP: +5 vs. -0.5 mm Hg). Significantly, more women assigned LPV/r had week 144 "abnormal" lipid levels (eg, HDL 29.7% vs. 14.8% and triglycerides 28.6% vs. 8.2%), and significantly, more women assigned NVP had "abnormal" BP (eg, diastolic BP 22.7% vs. 6.5%). Most differences remained significant when adjusted for baseline risk factor, age, CD4, and HIV-1 RNA. CONCLUSIONS In HIV-infected women initiating antiretroviral therapy in Africa, LPV/r + TDF/FTC was associated with less favorable changes in lipids, and use of NVP + TDF/FTC was associated with less favorable changes in BP.
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Affiliation(s)
- Douglas Shaffer
- *Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya; †U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; ‡Harvard School of Public Health, Boston, MA; §Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD; ‖University of North Carolina Project, Kamuzu Central Hospital, Lilongwe, Malawi; ¶Social & Scientific Systems, Inc., Silver Spring, MD; #Brigham and Women's Hospital, Boston, MA; **Botswana Harvard School of Public Health AIDS Initiative Partnership, Gaborone, Botswana; and ††University of California Los Angeles, Los Angeles, CA (Dr. Douglas Shaffer is now with the U.S. Centers for Disease Control and Prevention (CDC), Kigali, Rwanda)
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Mocumbi AO. Lack of focus on cardiovascular disease in sub-Saharan Africa. Cardiovasc Diagn Ther 2013; 2:74-7. [PMID: 24282699 DOI: 10.3978/j.issn.2223-3652.2012.01.03] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/11/2012] [Indexed: 11/14/2022]
Abstract
Research into cardiovascular disease in Sub-Saharan Africa has been hampered by lack of funding and expertise. However, hospital- and community-based data reveal high economic and social costs of these diseases to the national health services and the communities, with the region facing a mixed burden of diseases related to poverty and infections, emergence of risk factors and diseases of affluence, as well as new cardiovascular problems caused by the HIV/AIDS epidemics. The availability of echocardiography has raised the profile of these conditions in sub-Saharan Africa, stimulating several projects led by local cardiologists under the umbrella of the Pan-African Society of Cardiology. This research may help to overcome the lack of focus on cardiovascular diseases in Sub-Saharan Africa, as well as increase the awareness of the public and policymakers on the burden of cardiovascular diseases.
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Affiliation(s)
- Ana Olga Mocumbi
- Instituto Nacional de Saúde & Universidade Eduardo Mondlane, Maputo-Mozambique
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Nwose EU, Richards RS, Digban K, Bwititi PT, Ennis G, Yee KC, Oguoma VM, Liberato S. Cardiovascular risk assessment in prediabetes and undiagnosed diabetes mellitus study: international collaboration research overview. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:625-30. [PMID: 24404539 PMCID: PMC3877434 DOI: 10.4103/1947-2714.122303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The study aims to develop a screening protocol for the risk of future cardiovascular disease and diabetes mellitus in people with prediabetes and undiagnosed diabetes; and to establish a framework for early identification and intervention of prediabetes including strategies for holistic management and monitoring of progression. The first phase is to identify prediabetes and undiagnosed diabetes in volunteers who are ≥18-years-old for 5 years. Point-of-care testing and questionnaire will be used to screen for prediabetes and cardiovascular disease. We anticipate screening more than 2000 individuals of both genders by the end of first phase. The second and third phases which shall run for 5-10 years will be longitudinal study involving participants identified in the first phase as having prediabetes without dyslipidaemia, or clinically established cardiovascular disease. The second phase shall focus on preventive management of risk of progress to diabetes with explicit diagnosis of cardiovascular disease. Oxidative stress measurements will be performed cum evaluation of the use of antioxidants, exercise, and nutrition. The third phase will include probing the development of diabetes and cardiovascular disease. Binomial logistic regression would be performed to generate and propose a model chart for the assessment of cardiovascular disease risk in prediabetes.
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Affiliation(s)
| | | | - Kester Digban
- Public Health Department, Novena University, Ogume, Delta State, Nigeria
| | | | | | | | | | - Selma Liberato
- Menzies School of Health Research, Charles Darwin University, Darwin NT, Australia
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25
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Omoleke SA. Chronic non-communicable disease as a new epidemic in Africa: focus on The Gambia. Pan Afr Med J 2013; 14:87. [PMID: 23646223 PMCID: PMC3641923 DOI: 10.11604/pamj.2013.14.87.1899] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 12/19/2012] [Indexed: 11/16/2022] Open
Abstract
Introduction Recent epidemiological data suggest increasing burden of NCDs in many African countries but these diseases have not been given adequate attention due to the overwhelming burden of infectious diseases. There are no recent reports or studies on NCDs or related issues in The Gambia, consequently, this report intends to stimulate further epidemiological studies and also policy initiatives to forestall an epidemic. Methods Routine data on morbidity (in and out-patients), hospitalisation and mortality due to NCDs from health facilities in The Gambia between 2008 and 2011 were used. Other relevant data from multiple sources were also used. Results There is an increasing trend in the morbidity, hospitalisation and mortality due to NCDs in the Gambia between 2008 and 2011; 19.8%, 9.9% and 23.4% increments respectively. There is evidence of gender differences in these variables; more males suffer higher mortality from NCDs than females (p < 0.001). Furthermore, there is dearth of highly skilled health workforce as well as poor health infrastructures in The Gambia. Conclusion NCDs are becoming a public health challenge and the capacity to respond to NCDs in most African countries, particularly, The Gambia is very weak. There is need for a population-based study to accurately quantify the burden and their risk factors as a first step towards policy formulation and effective implementation. Furthermore, there is dire need for increased investments on health workforce as well as medical products and technologies towards addressing the consequences of this emerging epidemic.
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