Lipids and related parameters in Saudi type II diabetes mellitus patients

Hypertension and its management in countries in Africa and the Middle East, with special reference to the place of β-blockade

BACKGROUND

The prevalence and clinical consequences of hypertension in countries in Africa and the Middle East have not been studied as well as in other regions.

SCOPE

We have reviewed the literature on the epidemiology and management of hypertension and related cardiovascular complications in countries within Africa and the Middle East. A PubMed search for countries in the region and 'hypertension' was supplemented by articles identified from reviews, and by literature suggested by the authors.

FINDINGS

The prevalence of hypertension is >20% in some countries in the Middle East and Africa, despite an average population age that is some 10-15 years lower than those of developed countries. Hypertension in these countries is associated with an increased risk of cardiovascular risk factors and cardiovascular disease, as elsewhere. Awareness rates of hypertension are low. Hypertension and its complications are undertreated, and mortality rates from cardiovascular disease are higher than in developed countries.

CONCLUSION

Available resources should be brought to bear on the management of hypertension in these countries. In particular, a recent downgrading of the importance of β-blockers in hypertension management guidelines needs to be reassessed. These agents are as effective as other antihypertensive classes both on blood pressures and on cardiovascular event rates. General concerns over an increased rate of new-onset diabetes with β-blockers have been overstated, although these agents should be avoided in metabolic syndrome.

Clinical significance of HbA1c as a marker of circulating lipids in male and female type 2 diabetic patients

Diabetic patients with accompanied (but often unnoticed) dyslipidemia are soft targets of cardiovascular deaths. An early intervention to normalize circulating lipids has been shown to reduce cardiovascular complications and mortality. Glycated hemoglobin (HbA(1c)) is a routinely used marker for long-term glycemic control. This investigation is an attempt to evaluate the diagnostic value of HbA(1c) in predicting diabetic dyslipidemia. Venous blood samples were collected from 2,220 type 2 diabetic patients (ages, 35-91 years; male/female ratio, 1.07). The sera were analyzed for HbA(1c), fasting blood glucose (FBG), total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL). The levels of HbA(1c) did not differ significantly between males (8.33 +/- 0.06%) and females (8.47 +/- 0.07%), whereas female patients had significantly higher FBG (10.01 +/- 0.13 mmol/l) than males (9.31 +/- 0.11 mmol/l). HbA(1c) showed direct and significant correlations with cholesterol, triglycerides and LDL and inverse correlation with HDL. Female diabetic patients had significantly higher levels of serum cholesterol (5.42 +/- 0.03 vs. 5.18 +/- 0.03 mmol/l) and HDL (1.32 +/- 0.01 vs. 1.12 +/- 0.01 mmol/l) as compared to males. There was no significant difference in triglycerides and LDL between the two genders. Older patients (>70 years) had significantly lower FBG, cholesterol, triglycerides and LDL. There was a linear and significant increase in triglycerides in the patients of both genders with impaired glycemic control. Both male and female patients with worse glycemic control (HbA(1c) > 9%) had significantly high cholesterol and LDL levels. Serum HDL showed a significant and inverse relationship with uncontrolled hyperglycemia in females but not in males. These findings clearly suggest that HbA(1c) can provide valuable supplementary information about the extent of circulating lipids besides its primary role in monitoring long-term glycemic control. Further studies are warranted to reinforce the potential of HbA(1c) as a biomarker for screening of high-risk diabetic patients.