Cord Blood Lipid Profile of Term and Preterm Newborns in a Tertiary Hospital in South East Nigeria: Relationship with Gestational Age and Birth Weight

Background: Early-onset atherosclerosis is a marker of future cardiovascular diseases. However, indicators of early dyslipidemia for primary prevention are generally lacking in sub-Saharan Africa. This study aimed at describing the cord blood lipid profile among apparently healthy newborns in a tertiary hospital in Southeast Nigeria, and its relationship with gestational age and birth weight.Methods: Cross-sectional study of 167 consecutively recruited apparently well newborns in a tertiary hospital whose cord blood lipid profile parameters (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL ­C), low-density lipoprotein cholesterol (LDL ­C) and very low-density lipoprotein cholesterol (VLDL ­C)) were assessed using an autoanalyzer (BiOLis 24i). Lipid variables were presented with descriptive statistics whereas their relationship with gestational age and birth weight was highlighted using Spearman's rank correlation analysis. Dunnett's T3 Post Hoc analysis was used for pairwise comparisons.Results: The 167 newborns recruited included 15 (9%) moderate preterm, 46 (27.5%) late preterm and 106 (63.5%) term babies of which 79 (47.3%) were males and 88 (52.7%) were females. The number of recruited SGA, AGA and LGA were respectively 13 (7.8%), 142 (85%), 12 (7.2%). Mode of delivery was majorly vaginal delivery (69.5%) while the rest (30.5%) was by caesarean section. The median values (in mg/dL) of TC, TG, HDL ­C, LDL ­C and VLDL ­C were 60.0, 30.5, 29.0, 25.8 and 6.1 respectively, all within the normal international ranges. Triglycerides and VLDL-C had a moderate positive correlation with gestational age (rs = 0.4;p < 0.001) and were significantly higher in small-for-gestational-age newborns. Total cholesterol, HDL ­C, and LDL-C had a weak negative correlation with gestational age and birth weight (spearman rs˂-0.3). Birth weight, gestational age, and paternal age were the common predictors of lipid profile variability.Conclusion: The finding of a significant relationship between lipid variables with gestational age and birth weight underscores the need to clinically interpret these given the relationship. The relationship with paternal age is another interesting finding which needs to be replicated and the mechanism(s) elucidated.

Correlation between dyslipidiemia and the severity of coronary artery disease using SYNTAX scoring system

Background: the relationship between hyperlipidiemia and an increased risk of coronary heart disease has been well documented and has served as a motivating factor for research into lipoproteins structure, function and metabolism. Many epidemiological studies have revealed that chronically elevated lipid and cholesterol levels are associated with an increased incidence of atherosclerosis. Dyslipidemia together with hypertension and diabetes is major modifiable risk factors for atherosclerotic disease and the subsequent development of cardiovascular events. Dyslipidemia is known to be an independent predictor for cardiovascular events, other risk factors including family history, hypertension, tobacco use, age, sex and diabetes also have been found to be associated with an increased risk of coronary artery disease (CAD). This cross-sectional study was aimed to investigate the association of Dyslipidemia as an atherosclerosis predictor and its relationship to the severity of CAD using SYNTAX score. Patients and Methods: the current study included 535 patients who presented during 2015 with chest pain to Dar Al Fouad Hospital, experiencing symptoms of CAD or evidence of CAD by noninvasive testing were enrolled, a fasting blood sample was extracted and assessed for lipids profile. Patients underwent coronary angiography either using femoral or radial approach, and the resulting angiographic study was used to calculate the SYNTAX score of each patient. Patients were divided in to two group i.e. CAD and Non-CAD group. The CAD group was further divided into three sub-groups according to the SYNTAX score into low risk, intermediate risk and high risk group. Results: in this study, triglycerides, total cholesterol and LDL-C levels were positively associated with sever CAD and higher number of diseased vessels. Higher HCL-C levels were also found in subjects with normal coronaries. Conclusion: there was no significant proportionate, linear relation between the SYNTAX score and the levels of triglycerides, total cholesterol or LDL-C

Comparison of Quality of Life in Patients with Peripheral Arterial Disease Caused by Atherosclerosis Obliterans or Buerger's Disease : Cardiovascular Topic

Objective: Buerger's disease and atherosclerosis obliterans (ASO) are two peripheral arterial diseases (PAD) that are frequently encountered. The aim of this study was to compare quality of life (QOL) in patients with Buerger's disease and ASO. Methods: We prospectively followed 86 patients who were admitted to our hospital due to ASO or Buerger's disease. Their ischaemia was evaluated according to the clinical category chronic limb ischaemia at the time of hospital admission and at six and 12 months. The QOL was measured at the time of hospital admission and at six and 12 months with the Short Form Health Status Survey (SF-36) and Vascular Quality of Life Questionnaire (VASCUQOL). Results: A total of 86 patients with ASO or Buerger's disease (47 and 39; respectively) were included in the study. Pain parameters from both SF-36 and VASCUQOL scores were lower in patients with Buerger's disease at the time of hospital admission and at six months. The impairment in QOL was found to be proportional to the extent of chronic limb ischaemia. Conversely; when patients with critical limb ischaemia were evaluated; no difference was observed between those with ASO or Buerger's disease in terms of QOL. Amputations were found to have a negative effect on quality of life. Conclusion: Buerger's disease had a more pronounced negative effect on QOL than ASO; particularly in terms of pain score. When critical limb ischaemia was considered; ASO and Buerger's disease impaired quality of life at the same rate

Coronary Endothelial Dysfunction; Obesity and the Metabolic Syndrome

Objective : To define the impact of the metabolic syndrome (MetS) and obesity on coronary vascular function; with the hypothesis that subjects with MetS will have endothelial dysfunction. Background : Obesity or the metabolic syndrome is associated with a higher risk of diabetes and coronary artery disease (CAD). Endothelial dysfunction is a common causal pathway in the initiation and progression of CAD. Methods : A total of 418 patients (165 obese; 239 MetS) with and without angiographic evidence of CAD underwent coronary vascular function testing by measuring coronary blood flow (CBF) velocity in response to intracoronary infusion of acetylcholine (ACH) and sodium nitroprusside (SNP) and coronary flow reserve with adenosine. Results : Endothelium-dependent microvascular vasodilation correlated with body mass index (BMI) (r = -0.12; p = 0.02); with ACH responses significantly lower in overweight; obese and MetS subjects (p = 0.003). The number of MetS components correlated with the response to ACH in both the coronary microcirculation and the epicardial coronary arteries; and with impaired coronary microcirculatory responses to adenosine. No significant correlation was observed with SNP. In multivariable analysis; beyond age; only the total number of MetS components; and not BMI; emerged as an independent predictor of impaired microvascular response to ACH (CBF: ? = -0.18; p 0.001). Low-grade inflammation (C-reactive protein) was higher in patients with MetS; but was not associated with coronary vascular function. Conclusions : We demonstrate that the clustering of MetS components is an important and independent determinant of coronary endothelial dysfunction in subjects with and without CAD

Lack of Association of Glycated Haemoglobin with Blood Pressure and Subclinical Atherosclerosis in Black South Africans: a Five-Year Prospective Study

Objectives: Hypertension and diabetes are common in rapidly urbanising sub-Saharan African communities. However; lack of longitudinal data in these regions prevents adequate analysis of the link between measures of glycaemia and cardiovascular disease. Therefore; we examined the relationships of fasting glucose and glycated haemoglobin (HbA1c) with brachial and central blood pressure (BP); and measures of vascular structure and function after five years in black South Africans.Setting and subjects: Nine hundred and twenty-eight participants were included as part of the Prospective Urban Rural Epidemiological (PURE) study in the North West Province.Outcome measures: Fasting glucose; HbA1c and brachial BP at two time points were determined. Central BP; augmentation index (AI) and carotid intima-media thickness (CIMT) were taken at follow-up. Results: Fasting glucose [4.78 (3.50; 6.30) vs. 5 mmol/l (3.96; 6.42)]; HbA1c [5.6 (4.9; 6.3) vs. 5.9 (5.2; 6.9) and (37 vs. 41 mmol/mol)]; and BP (134/88.1 vs. 138/89.5 mmHg) increased significantly over five years (p-value 0.05). However; an association was absent between BP; AI or CIMT and either baseline or the five-year change in glucose or HbA1c. Multivariate analyses confirmed that neither glucose or HbA1c predicted changes in BP; CIMT or AI; but factors that did associate significantly were age; male gender; rural location; abdominal obesity; alcohol intake; total cholesterol to high-density lipoprotein ratio; C-reactive protein and antihypertensive medication (R2; ranging from 0.24-0.36).Conclusion: Although both BP and measures of glycaemia increased significantly over five years in black South Africans; glucose was not independently associated with BP or measures of large artery structure or function. We suggest that fasting glucose and HbA1c below the threshold of diagnosing diabetes should not be used in isolation to predict cardiovascular risk in African individuals

Rupture spontanee de l'aorte thoracique par une plaque d'atherome ulceree. A propos d'un cas decouvert au cours d'une autopsie

Introduction. La rupture spontanee de l'aorte thoracique sans formation d'anevrisme est rare. Le but de cette etude est de montrer la responsabilite de ce mecanisme dans la survenue des morts subites. Cas clinique. Nous rapportons l'observation d'un sujet age de 52 ans; qui est decede subitement au cours du sommeil a son domicile; necessitant la realisation d'une autopsie medico-legale accompagnee d'un examen histologique des organes et d'une analyse toxicologique des fluides biologiques. Resultat. Le diagnostic retenu etait celui d'un hemothorax massif gauche provoque par la rupture spontanee de l'aorte thoracique descendante favorisee par une plaque d'atherome. Conclusion. Dans la recherche des etiologies des hemothorax gauches; le praticien ne doit pas omettre de penser a une rupture spontanee de l'aorte thoracique favorisee par une plaque d'atherome ulceree

Obstructive Sleep Apnoea and Obesity

The global obesity epidemic continues to gain momentum; and South Africa is one of those countries with an extremely high prevalence of obesity. The reported association between obstructive sleep apnoea (OSA) and obesity has resulted in a parallel increase in the incidence of OSA. Obesity and OSA interact by inducing systemic inflammation; metabolic aberrations and endocrine abnormalities; all of which predispose patients to atherosclerosis and cardiovascular disease. OSA is associated with a pro-inflammatory state; and increased serum C-reactive protein concentrations. Cardiovascular complications of OSA include myocardial infarction; stroke; congestive heart failure; hypertension and cardiac arrhythmias. The complications of OSA and obesity result in reduced quality of life; significant morbidity; and increased mortality; for untreated patients. OSA causes symptoms such as snoring; apnoea; excessive daytime sleepiness; and morning headaches; but 80-90 of patients are never diagnosed; or treated for their condition. Recognition of these symptoms; and referral of patients for a polysomnogram (home- or laboratory-based); expedites the diagnosis and therapy of OSA. While continuous positive airway pressure (CPAP) remains the mainstay of therapy; dietary measures are important; and should be implemented. Loss of weight can lead to significant reductions in the apnoea-hypopnoea index (AHI) of patients with OSA; and obese patients with OSA should aim for a 10 reduction in body weight

Endothelial Dysfunction: a Predictor of Atherosclerosis

Endothelial dysfunction is a systemic disorder and a critical element in the pathogenesis of atherosclerotic diseases and its complications. Growing evidences suggest that the individual burden of currently known cardiovascular risk factors is not the only determinant of endothelial function; rather endothelial integrity depends on the balance of all cardiovascular risk factors and vasculoprotective elements in a given individual; including the genetic predisposition. Recent studies have demonstrated that patients with endothelial dysfunction have an increased risk of clinical cardiovascular events. The coronary events including myocardial infarction; death or neovascularization occur only in patients with severely impaired endothelial functions. Interventions like risk factor modification and treatment with various drugs may improve prognosis. Hence given its reversibility and granted the availability of a diagnostic tool to identify patients at risk and to control the efficacy of therapy in clinical practice; endothelial dysfunction may be an attractive target; in an effort to optimize individualized strategies to reduce cardiovascular morbidity and mortality. Thus a deep insight in to the pathophysiology of endothelium and its functions can be of value in identifying and preventing the risk factors of various cardio vascular diseases. The early risk prediction would ensure a better quality of life in the adulthood if the preventive steps are taken in the childhood itself since there is no age bar for the onset of the endothelial dysfunction

Hypercholesterolaemia in Children and Young Adults - Current Management

Atherosclerosis begins in childhood. Not uncommonly; the first presentation of atherosclerosis is sudden cardiac death. It therefore makes sense that risk-factor modification to prevent the development or delay the onset of atherosclerosis needs to begin early in life. Dietary intervention is the key component for the primary prevention of hyperlipidae- mia. However; if diet and lifestyle fail to correct hyperlipidaemia; drug therapy may have to be considered. All children and adolescents with high-risk lipid disorders such as familial hypercholesterolaemia (FH); those with diabetes mellitus or other cardiovascular disease risk factors or with a family history of premature coronary artery disease should be considered for lipid-lowering therapy if diet and lifestyle intervention are ineffective. There are now numerous studies that have documented the safety and efficacy of statin therapy in both children and young adults. Based on these studies; it is now recommended that statin therapy be initiated in all male FH children from the age of ten years and at the onset of menses in females with FH. The initiation of statin therapy could be considered even earlier in FH children at high risk

Role of Quercetin in Cardiovascular Diseases

Cardiovascular disease constitutes a major public health concern in industrialized nations. Over recent decades; a large body of evidence has accumulated indicating that oxidative stress induced free radicals play a critical role in cellular processes implicated in atherosclerosis and many other heart diseases. However a diet high in antioxidants is associated with a reduced risk of cardiovascular disease. The compound quercetin is a dietary antioxidant with a polyphenolic structure that is present in many foods; such as onion; apples; wine and tea. An increased intake of quercetin has been correlated with a decrease in the risk of cardiovascular diseases. Quercetin has been reported to exhibit a wide range of biological and pharmacological effects in animals and man besides its antioxidative and free radical scavenging actions. This paper reviews various steps of oxidative stress mediated atherogenesis and their signaling pathways and also emphasizes the role of quercetin in controlling oxidative stress and reducing the incidence of cardiovascular diseases

Comparaison des facteurs de risque atherogene entre des joueuses de handball et des non sportives

Sedentarity during adolescence is important therogenous risk factors in adults; but physical activity contributes to reducing the risk. Objectives: this study aimed at comparing Beninese handball players to non players; i.e. 1) factors associated with atherogenous risk; 2) frequency of athergenous risk factors; 3) determinants of indirect VO2 max. Methods: this cross sectional study; a case-control; was carried out on 100 girls about sixteen to twenty five. The case group (GS) was constituted of 50 handball players girls; who are involved very often in Beninese first division championship. Fifty girls non players constituted the control group (GC). Adiposity indexes; blood pressure; resting heart rate; plasma HDL-C and indirect VO2max were detriment in a single blind fashion and in the same conditions for both groups. Results: the values of plasma HDL-C and indirect VO2max were higher (P0.05) in the GS group than in GC (0.47+- 0.13 gl versus 0.36+- 0.13 g/l and 45.06 +- 6.32 ml.kg.min.-1 versus 33.96 +- 3.52 ml.kg-1.min-1). In GC; the frequency of the atherougenous risk factors was higher than in GC; for P0.05 (TT/TH : 72