CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 29, ISSUE
2, MAR/APR 2018
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- Title: From the Editor’s Desk
Authors: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 29, Issue 2 March/April
Published: 2018
Pages: 67
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- Title: Stroke distribution patterns
and characteristics in Kenya’s leading public
health tertiary institutions: Kenyatta National
Hospital and Moi Teaching and Referral Hospital
Authors: Lydia Kaduka, Anne Korir, Chrispine Owuor Oduor, Judith Kwasa, Jane Mbui, Sylvanos Wabwire, Robai Gakunga, Nathan Okerosi, Yvonne Opanga, Isaac Kisiang’ani, Mercy Rotich Chepkurui, Erastus Muniu, Scot C Remick
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2018
Pages: 68-72
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DOI Number:10.5830/CVJA-2017-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-046
IBackground: Cardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinico-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya.
Methods: This was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran’s Mantel–Haenszel chisquared test of conditional independence was used with p-value set at 0.05.
Results: A total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%)] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age.
Conclusions: To our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.
- Title: Prevalence, awareness, treatment and control of hypertension,
diabetes and hypercholesterolaemia among adults in Dande municipality, Angola
Authors: João M Pedro, Miguel Brito, Henrique Barros
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2018
Pages: 173–81
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DOI Number:10.5830/CVJA-2017-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-047
Objectives: To estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia in an Angolan population aged 15 to 64 years and to determine relationships with sociodemographic, behavioural and anthropometric characteristics.
Methods: A total of 2 354 individuals were assessed for behavioural, sociodemographic and physical characteristics in a cross-sectional, community-based survey. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios for each variable related to the conditions were calculated using logistic regression models.
Results: Overall, the prevalence of hypertension was 18.0%, diabetes 9.2% and hypercholesterolaemia 4.0%. Among hypertensive individuals, the awareness rate was 48.5%; 15.8% were on treatment and 9.1% had their blood pressure controlled. Only 10.8% were aware they had diabetes, 4.5% were on treatment and 2.7% were controlled. The awareness level for hypercholesterolaemia was 4.2%, with 1.4% individuals on treatment and 1.4% controlled.
Conclusions: The prevalence levels of hypertension and diabetes, which were higher than previous findings for the region, together with the observed low rates of awareness, treatment and control of all conditions studied, constitute an additional challenge to the regional health structures, which must rapidly adapt to the epidemiological shift occurring in this population.
- Title: Assessment of left atrial
function in patients with type 2 diabetes
mellitus with a disease duration of six months
Authors: Oyku Gulmez, Hulya Parildar, Ozlem Cigerli, Nilgun Demirağ
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2018
Pages: 82–87
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DOI Number: 10.5830/CVJA-2017-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-048
Introduction: Changes in left atrial (LA) size and function are associated with adverse clinical events. Recently, duration of diabetes mellitus (DM2) has been found to be positively associated with increased LA volume and impaired LA function. This study was performed, using two-dimensional echocardiograpy, to evaluate the changes in LA volume and function in patients with DM2 with a disease duration of six months, and to assess the parameters that affect LA volume and function.
Methods: Fifty-six patients (28 male, age: 52.6 ± 6.5 years) with DM2 and 56 controls (24 male; age: 50.1 ± 7.0 years) were enrolled in the study. Each subject underwent conventional twodimensional echocardiography to assess LA volume (indexed maximal LA volume: Vmax, pre-atrial contraction volume: Volp, minimal LA volume: Vmin) and LA function [passive emptying volume – passive emptying fraction (PEV – PEF), active emptying volume – active emptying fraction (AEV – AEF), total emptying volume – total emptying fraction (TEV – TEF)].
Results: LA diameter, indexed Vmax, Volp, Vmin, AEV and TEV were found to be significantly higher in the DM2 group compared with the controls (p < 0.05). Indexed Vmax, Volp and Vmin were significantly correlated with HbA1c level, body mass index (BMI), high-sensitivity C-reactive protein and uric acid levels, mitral A wave, E/E′ ratio and A′ wave. According to multivariate analysis, age and BMI had a statistically significant effect on LA volume.
Conclusion: Impaired LA function may be present in patients with newly diagnosed DM2. BMI and increasing age caused LA enlargement and LA volumes that were independent of the effects of hypertension and DM2.
- Title: Upper limb ischaemia: a South
African single-centre experience
Authors: Tinus du Toit, Kathryn Manning, Nadraj G Naidoo
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2018
Pages: 88–92
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DOI Number: 10.5830/CVJA-2017-049
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-049
Objective: The aims of this study were to report on our experience with upper limb ischaemia (ULI), to define the pattern and distribution of disease, describe key demographic features and report on conventional clinical outcomes.
Methods: This was a single-centre, retrospective, descriptive study. All patients (n = 64) who underwent a surgical intervention for ULI over a 12-year study period were included. Findings were analysed and compared with the current literature.
Results: A male:female ratio of 0.60 was reported. Two major subgroups of patients were identified. The patients in the thrombo-embolic subgroup (n = 30) were notably younger than expected (mean age 55 years) compared to those in the atherosclerotic occlusive disease subgroup (n = 12, mean age 57 years). Presentation overall was generally late, with 8.6% of acute ULI and 48.3% of chronic ULI patients presenting with irreversible ischaemia and tissue loss, respectively. Thrombo-embolism was the dominant vascular pathology reported in this case series (47%). Ninety-five procedures were performed in 64 patients (89 open, six endovascular). Peri-operative (30-day) mortality rate was 7.8%. Systemic and procedure-related complications were observed in 13 and 23%, respectively. The overall major amputation rate was 10.9%. Adherence to follow up was poor (51% at six months).
Conclusion: Although few firm conclusions could be drawn, this review has expanded our overall perspective of ULI, specific to the population we serve. Collaboration between African vascular units should be encouraged in an attempt to further define the pattern of ULI by identifying distinct geographical confounders.
- Title: Comparison of carotid intima–media thickness and coronary
artery calcium score for estimating subclinical atherosclerosis in patients with
fatty liver disease
Authors: Hyun-Jin Kim, Hyung-Bok Park, Yongsung Suh, Yoon-Hyeong Cho, Eui-Seok Hwang, Deok-Kyu Cho, Tae-Young Choi
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2017
Pages: 93–98
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DOI Number: 10.5830/CVJA-2017-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-052
Introduction: Fatty liver disease (FLD) is correlated with cardiovascular disease. Carotid intima–media thickness (CIMT) and coronary artery calcium score (CACS) can noninvasively identify subclinical atherosclerosis and predict risk for cardiovascular events. This study evaluated CIMT and CACS measurements to detect subclinical atherosclerosis in patients with and without FLD.
Methods: Patients who underwent carotid and abdominal ultrasounds as well as cardiac computed tomography (CT) scans were evaluated retrospectively. The differences between the mean CIMT value and CACS measurements in patients with FLD and those with normal livers were estimated.
Results: Among 819 patients (average age of 53.3 ± 11.2 years), 330 had FLD. The CIMT was greater in patients with FLD compared to the controls (0.79 ± 0.17 vs 0.76 ± 0.17 mm, p = 0.012), and carotid plaques were more commonly seen in patients with FLD. The incidence of a composite of larger CIMT (≥ 75th percentile) plus plaque presence was higher in FLD patients (43.3 vs 36.0%, p = 0.041). Particularly among young patients (≤ 50), the CIMT was larger in patients with FLD than in the controls. FLD increased the risk of a composite of large CIMT plus plaque presence in young patients (odds ratio 1.92, 95% confidence interval 1.05–3.49, p = 0.034). However, patients with FLD had no greater incidence of CACS of over 100 than the controls.
Conclusion: CIMT was a better marker of underlying subclinical atherosclerotic risk among patients with FLD than CACS. FLD particularly, increases the risk of subclinical atherosclerosis in patients younger than 50 years of age. These patients should undergo screening CIMT to detect atherosclerosis and modify risk factors.
- Title: Participation in research improves overall patient
management: insights from the Global Rheumatic Heart Disease registry (REMEDY)
Authors: EA Prendergast, S Perkins, ME Engel, B Cupido, V Francis, A Joachim, M Al Kebsi, F Bode-Thomas, A Damasceno, A Abul Fadl, A El Sayed, B Gitura, N Kennedy, A Ibrahim, J Mucumbitsi, AM Adeoye, J Musuku, E Okello, T Olunuga, S Sheta, BM Mayosi, LJ Zühlke, for the REMEDY investigators
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2018
Pages: 98–105
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DOI Number: 10.5830/CVJA-2017-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-054
Background: Rheumatic heart disease (RHD) is a major public health problem in low- and middle-income countries (LMICs), with a paucity of high-quality trial data to improve patient outcomes. Investigators felt that involvement in a recent large, observational RHD study impacted positively on their practice, but this was poorly defined.
Aim: The purpose of this study was to document the experience of investigators and research team members from LMICs who participated in a prospective, multi-centre study, the global Rheumatic Heart Disease Registry (REMEDY), conducted in 25 centres in 14 countries from 2010 to 2012.
Methods: We conducted an online survey of site personnel to identify and quantify their experiences. Telephone interviews were conducted with a subset of respondents to gather additional qualitative data. We asked about their experiences, positive and negative, and about any changes in RHD management practices resulting from their participation in REMEDY as a registry site.
Results: The majority of respondents in both the survey and telephone interviews indicated that participation as a registry site improved their management of RHD patients. Administrative changes included increased attention to follow-up appointments and details in patient records. Clinical changes included increased use of penicillin prophylaxis, and more frequent INR monitoring and contraceptive counselling.
Conclusions: Our study demonstrates that participation in clinical research on RHD can have a positive impact on patient management. Furthermore, REMEDY has led to increased patient awareness and improved healthcare workers’ knowledge and efficiency in caring for RHD patients.
- Title: Prevalence of cardiometabolic
risk factors among professional male
long-distance bus drivers in Lagos, south-west
Nigeria: a cross-sectional study
Authors: Casmir E Amadi, Tim P Grove, Amam C Mbakwem, Obianuju B Ozoh, Oyewole A Kushimo, David A Wood, Michael Akinkunmi
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2018
Pages: 106–114
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DOI Number: 10.5830/CVJA-2018-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-006
Background: Professional drivers are known to be at high risk of cardiovascular disease (CVD). This study was carried out to highlight these risk factors and their predictors among male long-distance professional bus drivers in Lagos, southwest Nigeria, with a view to improving health awareness in this group.
Methods: Socio-demographic data, anthropometric indices, blood pressure, fasting plasma blood glucose levels and lipid and physical activity profiles of 293 drivers were measured.
Results: Mean age of the study population was 48 ± 9.7 years; 71.0 and 19.5% of the drivers used alcohol and were smokers, respectively; and 50.9% were physically inactive. The prevalence of overweight and obesity was 41.7 and 21.1%, respectively, while 39.7 and 13.9% were hypertensive and diabetic, respectively. Ninety (31.3%) subjects had impaired fasting glucose levels while 56.3% had dyslipidaemia. Predictors of hypertension were age and body mass index (BMI). BMI only was a predictor of abnormal glucose profile.
Conclusion: Professional male long-distance bus drivers in this study showed a high prevalence of a cluster of risk factors for CVD.
- Title: Status of cardiac arrhythmia services in Africa in 2018: a
PASCAR Sudden Cardiac Death Task Force report
Authors: MA Talle, A Bonny, W Scholtz, A Chin, G Nel, KM Karaye, JB Anzouan-Kacou, A Damasceno, YR Lubenga, MU Sani, BM Mayosi
From: Cardiovascular Journal of Africa, Vol 29, Issue 2, March/April
Published: 2018
Pages: 115–121
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DOI Number: 10.5830/CVJA-2018-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-027
Background: There is limited information on the availability of health services to treat cardiac arrhythmias in Africa.
Methods: The Pan-African Society of Cardiology (PASCAR) Sudden Cardiac Death Task Force conducted a survey of the burden of cardiac arrhythmias and related services over two months (15 October to 15 December) in 2017. An electronic questionnaire was completed by general cardiologists and electrophysiologists working in African countries. The questionnaire focused on availability of human resources, diagnostic tools and treatment modalities in each country.
Results: We received responses from physicians in 33 out of 55 (60%) African countries. Limited use of basic cardiovascular drugs such as anti-arrhythmics and anticoagulants prevails. Non-vitamin K-dependent oral anticoagulants (NOACs) are not widely used on the continent, even in North Africa. Six (18%) of the sub-Saharan African (SSA) countries do not have a registered cardiologist and about one-third do not have pacemaker services. The median pacemaker implantation rate was 2.66 per million population per country, which is 200-fold lower than in Europe. The density of pacemaker facilities and operators in Africa is quite low, with a median of 0.14 (0.03–6.36) centres and 0.10 (0.05–9.49) operators per million population. Less than half of the African countries have a functional catheter laboratory with only South Africa providing the full complement of services for cardiac arrhythmia in SSA. Overall, countries in North Africa have better coverage, leaving more than 110 million people in SSA without access to effective basic treatment for cardiac conduction disturbances.
Conclusion: The lack of diagnostic and treatment services for cardiac arrhythmias is a common scenario in the majority of SSA countries, resulting in sub-optimal care and a subsequent high burden of premature cardiac death. There is a need to improve the standard of care by providing essential services such as cardiac pacemaker implantation.
- Title: The aetiology of cardiovascular disease: a role for
mitochondrial DNA?
Authors: Marianne Venter, Francois H van der Westhuizen, Joanna L Elson
From: Cardiovascular Journal of Africa, Vol 29, Issue, 2, March/April
Published: 2018
Pages:122–132
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DOI Number: 10.5830/CVJA-2017-037
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-037
Abstract: Cardiovascular disease (CVD) is a world-wide cause of mortality in humans and its incidence is on the rise in Africa. In this review, we discuss the putative role of mitochondrial dysfunction in the aetiology of CVD and consequently identify mitochondrial DNA (mtDNA) variation as a viable genetic risk factor to be considered. We then describe the contribution and pitfalls of several current approaches used when investigating mtDNA in relation to complex disease. We also propose an alternative approach, the adjusted mutational load hypothesis, which would have greater statistical power with cohorts of moderate size, and is less likely to be affected by population stratification. We therefore address some of the shortcomings of the current haplogroup association approach. Finally, we discuss the unique challenges faced by studies done on African populations, and recommend the most viable methods to use when investigating mtDNA variation in CVD and other common complex disease.
- Title: Absolute cardiovascular risk of women using hormonal
contraception in Porto-Novo
Authors: Arnaud Sonou, Mathieu Ogoudjobi, Philippe Mahouna Adjagba, Corine Houehanou, Richard Aniglé, Léopold Codjo, Murielle Hounkponou, Rosaire Bognon, Salimatou Assani, Daniel Amoussou-Guénou, Dèdonougbo Martin Houénassi
From: Cardiovascular Journal of Africa, Vol 29, Issue, 2, March/April
Published: 2018
Pages:e1–e4
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DOI Number: 10.5830/CVJA-2018-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-016
Introduction: The purpose of this work was to determine the absolute cardiovascular risk (ACVR) of women using hormonal contraception in Porto-Novo.
Methods: We carried out a descriptive, cross-sectional study, including women at the time of renewal of a hormonal contraceptive method. Blood pressure, fasting venous blood glucose level, body mass index and electrocardiographic left ventricular hypertrophy were studied. The determination of ACVR was dual based on the World Health Organisation (WHO/ISH) and the European Society of Cardiology (ESC/ ESH) models.
Results: The mean age of the women was 35.3 ± 8.2 years. Blood pressure and blood glucose levels were high in 24 and 1.5% of cases, respectively. Left ventricular hypertrophy was present in 7.1% of cases. A high ACVR was found in 5.2% of these women, using the ESC/ESH model.
Conclusion: The occurrence of women with high ACVR in this group raises the problem of cardiovascular eligibility to the contraceptive method used.
- Title: Partial anomalous pulmonary venous connection with accessory
pulmonary veins
Authors: Vimalarani Arulselvam, Neale N Kalis, Suad R Al Amer
From: Cardiovascular Journal of Africa, Vol 29, Issue, 2, March/April
Published: 2018
Pages:e5–e7
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DOI Number: 10.5830/CVJA-2017-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-022
Abstract: We present a case of a six-year-old boy with complex partial anomalous pulmonary venous connections with accessory pulmonary veins, where multi-detector computed tomography proved crucial for accurate identification prior to planning for surgical correction.
- Title: Ischaemic heart disease and pregnancy: the tale of two
stories
Authors: Mamotabo R Matshela
From: Cardiovascular Journal of Africa, Vol 29, Issue, 2, March/April
Published: 2018
Pages:e8–e12
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DOI Number: 10.5830/CVJA-2017-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-050
Abstract: Ischaemic heart disease (IHD) is presumed to be rare in pregnancy. Based on that assumption, patients go undiagnosed or undertreated. IHD in pregnancy frequently occurs as a result of an unusual aetiology, therefore each patient needs to be managed individually since each may present differently. This may pose challenges to the consulting clinician. Pregnancy itself is a risk factor for cardiovascular disease, due to its associated hypercoagulable state. From current reports, the prevalence of IHD in females is increasing due to lifestyle changes, including cigarette smoking, diabetes and stress. In our modern societies, women delay childbearing until they are older, allowing time for risk factors to cluster. Although presumed to be rare in pregnant women, IHD is currently estimated to occur three to four times more often during pregnancy in middle- and high-income women, warranting an extensive review highlighting cases of IHD in pregnancy.
