Major cardiovascular risk factors and serious mental disorders, a double-edged sword: literature review

Background. The burden of mental disorders continues to grow with significant impacts on health. Their prevalence is higher in patients presenting cardiovascular risk factors.This review takes stock of the frequency, the mechanisms, and the implications of major cardiovascular risk factors in patients with serious mental disorders. Methods. A literature search was done in PubMed from 1980 to 2021 using various combinations of Mesh termslike tobacco, diabetes mellitus, hypertension, dyslipidemia, major depressive disorder, bipolar disorder, schizophrenia. Results. People with serious mental disordershave a greater prevalence of major cardiovascular risk factors compared to the general population. Conversely, people with cardiovascular diseases more frequently suffer from serious mental disorders. More specifically, we note that 45 to 88% of patients suffering from schizophrenia are tobacco users, Depression is reported to be 3 times higher in hypertensives than in non-hypertensives while around 19% of type 2 diabetic patients suffer from major depressive disorderwhich is 3 times greater than in the general population, and the prevalence of dyslipidemia among persons with severe and persistent mental illness is higher than the prevalence in the general population and ranges from 25% to 70%. The concomitant presence of these different pathologies can be explained either by their intertwined pathophysiological mechanisms, or by the side effects of the various medications taken in the context of these chronic diseases. Conclusion. The predisposing factors for the coexistence of mental illnesses and cardiovascular diseases are often entangled. It would be interesting to carry out more studies to elucidate precisely the different pathophysiological mechanisms of these diseases.

Contexte. La prévalence des maladies mentales est plus élevée chez les patients présentant des facteurs de risque cardiovasculaire. Cette revue fait le point sur la fréquence, les mécanismes et les implications des facteurs de risque cardiovasculaire majeurs chez les patients atteints de pathologies psychiatriques graves. Méthodologie. Une recherche documentaire a été effectuée dans PubMed de 1980 à 2021 en utilisant diverses combinaisons de termes MeSH comme tabac, diabète, hypertension, dyslipidémie, trouble dépressif majeur, trouble bipolaire, schizophrénie. Résultats. Les personnes atteintes de maladie mentales graves ont une plus grande prévalence de facteurs de risque cardiovasculaire majeurs comparé à la population générale. A l'inverse, les personnes atteintes de maladies cardiovasculaires souffrent plus fréquemment de troubles mentaux graves. Plus précisément, on note que 45 à 88% des patients souffrant de schizophrénie consomment du tabac. La dépression serait 3 fois plus élevée chez les hypertendus que chez les non hypertendus. Par ailleurs, environ 19% des patients diabétiques de type 2 souffrent d'un trouble dépressif majeur ce qui est 3 fois plus élevée que dans la population générale. La prévalence des dyslipidémies chez les personnes atteintes d'une maladie mentale grave est supérieure à la prévalence dans la population générale et varie de 25 % à 70 %. La présence concomitante de ces différentes pathologies s'explique soit par leurs mécanismes physiopathologiques imbriqués, soit par les effets secondaires des différents médicaments pris dans le cadre de ces maladies chroniques. Conclusion. Les facteurs prédisposant à la coexistence des maladies mentales et des maladies cardiovasculaires sont souvent intriqués. Il serait intéressant de mener plus d'études pour élucider précisément les différents mécanismes physiopathologiques de ces maladies.

Profil glucido-lipidique et risque cardiovasculaire chez les diabétiques de type 2 / Carbohydrate and lipid profile associated with cardiovascular risk in type 2 diabetics

Introduction-Le diabète est un véritable problème de santé publique du fait de ses nombreuses complications potentielles, notamment cardiovasculaires. Notre objectif était de décrire le profil clinico-biologique chez une population de diabé tique type 2 et d'étudier la relation entre l'équilibre glycémique et les anomalies lipidiques avec les complications micro et macroangiopathiques. Matériels et méthodes -Nous avons mené une étude rétrospective portant sur 341 pa tients diabétiques type 2.Les données ont été analysées par le logiciel IBM® SPSS statis tics 20.0. Seules, les associations significatives (p ≤ 5%) étaient retenues. Résultats - quatre-vingt deux pourcent et demi des patients ont un taux d'HbA1c ≥7 %. Plus de 60 % ont une dyslipidémie. Cinquante deux pourcent des patients ont un taux du LDLc ≤ 1 g/l, et 64,4 % ont un taux du Non-HDLc >1g/l. Environ 66 % des patients ont une hypertension artérielle. quarante pourcent des patients ont présenté une macroangio pathie et 66,8 % une microangiopathie (p=0,0001). L'analyse par régression logistique, a montré que l'HbA1c est le paramètre biologique le plus associé aux complications macroangiopathiques (p=0,008), alors que pour les complications micro-angiopathiques, l'HTA était le seul facteur associé (p = 0,03). Pour la cardiopathie ischémique, la dyslipi démie et l'HTA étaient les facteurs les plus associés. Conclusion -Notre étude a montré une fréquence élevée des complications micro et macroangiopathiques et des anomalies lipidiques, ainsi qu'un très mauvais équilibre glycémique. L'HbA1c, la dyslipidémie et l'HTA sont les facteurs les plus associés au risque cardiovasculaire.

Background-Diabetes is a real health public problem because of its many potential complications, particularly the cardiovascular ones.The aim of this work was to describe the clinical and biological profile in type 2 diabetic population, then to study the relationship between glycemic control and lipid abnormalities with micro and macro vascular complications. Methods - It was about a retrospective study of 341 type 2 diabetes patients' with an average age of 60.1 ± 11.71 years.The IBM® SPSS statistics 20.0 software was used for analyzing data. Only significant associations (p ≤ 5%) were retained. Results -An HbA1c level ≥7% was observed in 82,5% of patients, More than 60% have dyslipidemia. 52,8% of them have an LDLc level ≤ 1 g/l, and 64,4% have a Non-HDLc level >1g/l. Sixty-six percent of patients have high blood pressure. The macrovascular disorders were observed on 30,9% of patients and microvascular ones on 66,8% of them (p = 0.0001).The logistic regression analysis showed that HbA1c was the most significant biological parameter (p=0,008). while for micro-vascular complications, high blood pressure was the only associated factor (p = 0.03). For ischemic heart disease, dyslipidemia and high blood pressure were the most associated factors. Conclusion - this study showed a high frequency of micro and macrovascular complications, lipid abnormalities and a very poor glycemic control. The elevation of HbA1c level, the high blood pressure and dyslipidemia are the most associated factors with a high cardiovascular risk.

Children and adolescents with diabetes at Tygerberg Hospital ­ at risk of cardiovascular complications?

Objectives. To determine the prevalence of dyslipidaemia and HT in paediatric diabetic patients seen at Tygerberg Hospital (TBH) and establish whether either is associated with body mass index (BMI), glycosylated haemoglobin (HbA1c) or duration of diabetes. Further, to determine whether the prevalence differs between two specified periods.Methods. A retrospective study of 154 diabetic patients, aged 1 - 19 years, seen at TBH between 2007 and 2017, was undertaken. The following data were recorded: age; sex; duration of disease (time since diagnosis); height; weight; blood pressure; HbA1c; high-density lipoprotein cholesterol (HDL-C); triglycerides (TG); and low-density lipoprotein cholesterol (LDL-C). Results. More than half of the patients (57.8%; n=89/154; 95% confidence interval (CI) 51.7 - 65.0) had dyslipidaemia, 16.3% (n=24/147) had low HDL-C levels, 53.8% (n=78/145) had high LDL-C levels and 14.9% (n=22/148) had raised TG levels. Nearly half of the patients (48.7%; n=75/154; 95% CI 41.6 - 55.1) were hypertensive and 93.5% (n=144/154) were poorly controlled (HbA1c >7.5%). Dyslipidaemia was not associated with HT or BMI percentile and its prevalence did not change between the two specified periods. Prevalence of dyslipidaemia and HT was not associated with duration of diabetes. About one-third (30.8% (n=4/13); 95% CI 11.9 - 59.3) of the pre-adolescents and 60.3% (n=85/141; 95% CI 51.9 - 68.1) of the adolescents had dyslipidaemia (p=0.04). Dyslipidaemia was diagnosed in 62.6% (n=82/131) of adolescents with poorly controlled diabetes (p=0.04) and in 71.7% (95% CI 59.0 - 81.7) of patients ≥16 years of age (p=0.005). Conclusions. Poor glycaemic control, dyslipidaemia and HT are common in diabetic children, putting them at risk of cardiovascular complications in adulthood.S Afr J Child Health 2022;16(4):205-208. https://doi.org/10.7196/SAJCH.2022.v16i4.1862Children and adolescents with diabetes at Tygerberg Hospital ­ at risk of cardiovascular complications?L N Dookhony,1 MMed (Paeds); C J Lombard,2 MSc, PhD; E W Zöllner,3 MMed, PhD1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; and SSRN Hospital, Pamplemousses, Republic of Mauritius2Biostatistics Unit, South African Medical Research Council, Division of Biostatistics; and Department of Global Health, University of Stellenbosch, Cape Town, South Africa3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

Cholesterolemia and triglyceridemia changes in adult with malaria in a hypo-endemic malaria region, Butembo-DR Congo

changes occur commonly among patients affected with malaria. This study aimed to assess lipid changes in blood among patients with malaria in Butembo, a hypoendemic region. Methods: This cross-sectional study, conducted in the Departments of Internal and Parasitology of Matanda Hospital, located in Butembo, from July 1st, 2020, to November 2, 2020; involved 100 patients diagnosed with malaria. Biochemical analyses carried out by three lab technicians were performed among patients who had positive malaria using positive thick film. Plasmodial species, the parasite density, the triglycerides, the total cholesterol, the HDL-cholesterol, the LDL-cholesterol were assessed. Results: Cholesteroleamia and HDLemia demonstrated a low level in 93% and in 61% of participants respectively; whereas 73% of cases showed an increased level of triglycerides in the blood. Lipidemia profile was independently associated with parasite density among patients with malaria. Conclusion: Although the lipid changes in the blood are not specific in the diagnosis of malaria, this study highlighted their status among patients with malaria. Further researches should be conducted to determine their impact on malaria outcomes. Therefore, dyslipidemia could be used in malaria screening.

Comparison of plasma lipid profiles and atherogenic indices among hypertensives with or without type 2 diabetes

Background: Several atherogenic indices derived from the lipid profiles are postulated to better detect dyslipidemias and predict the risk of having cardiovascular events even in the presence of insignificant changes in individual lipid parameters. Objective: To compare the lipid ratios and atherogenic index of plasma (AIP) to conventional atherogenic indices among hypertensive type 2 diabetics to hypertensive nondiabetes (HND) controls. Materials and Methods: A case­control study in which 210 participants with type 2 diabetes mellitus with hypertension (hypertensive­diabetic [HD]) compared with 150 (n = 155) hypertensive without diabetes (HND) with similar ages were enrolled. Blood samples for fasting lipid profile were collected and analyzed, and the following indices and ratios were calculated: (TC/high­density lipoprotein­cholesterol [HDL­C]), (low­density lipoprotein­cholesterol [LDL­C]/HDL­C), (HDL­C/ LDL­C), and AIP. The indices were compared in both the participants and control group. Results: There was no significant difference in the clinical characteristics of HD compared to the HND except the systolic blood pressure, weight, and HDL­C which were lower in the HND group. The frequency of dyslipidemia was found to be significantly higher in the HD group except elevated LDL­C in males (25.8% vs. 17.4%, χ2 = 0.055, respectively). Furthermore, all the lipid ratios, except (Castelli risk index II [CRI­ II] were found to be significantly different among HD as compared to HND group (P = 0.002, P = 0.045, respectively). Conclusions: This study concludes that Nigerians with both type 2 diabetes and hypertension have worse dyslipidemia and abnormal lipid ratios compared to those with only hypertension.

Statistical study of the relationship between hyperuricemia, dyslipidemia and type 2 diabetes in rural population of Tizi-Ouzou, Algeria

Aim : The main objective of our work was to assess the relationship between type 2 diabetes, hyperuricemia and dyslipidemia in the population of Tizi-Ouzou. By evaluating the relationship between hyperuricemia and some blood lipid parameters, we thus establish, in type 2 diabetes, the correlation between uremia and these lipid parameters. Subjects and methods: The survey was carried out by means of an individual questionnaire. We excluded from our study pregnant women, patients with cancer, patients with end-stage renal disease and subjects who did not respond to the questionnaire. Results: Serum uric acid level increased with age (p = 0.025). Hyperuricemia was associated with heart disease (p = 0.0007). All patients with gout presented an elevated serum uric acid (p = 0.000001). Dyslipidemia was more common in patients with elevated serum uric acid levels (p = 0.0008). Triglyceridemia was significantly associated with hyperuricemia (p = 0.025). The relationship between type 2 diabetes and glomerular filtration rate was not significant, while the latter was decreased in patients with elevated serum uric acid levels (p = 0.0001). In, stratified analysis, age was effect modifier, the age-dependent results make us understand that resistance to insulin constitutes a significant factor of hyperuricemia. Conclusion: The association between hyperuricemia and dyslipidemia in type 2 diabetes emphasizes that insulin resistance acts on both lipid parameters and uricemia. A diet correcting dyslipidemia may also correct the uricemia

Oxidative stress and lipid profile among hypertensive patients at a tertiary centre in Kano, Northwest, Nigeria

Background: Hypertension as a global public health challenge is a major risk factor for cardiovascular (CVD) and coronary heart diseases (CHD) because of its chronic sequelae. It is accompanied by dyslipidemia and oxidative stress leading to increase in lipid peroxidation. This study aimed to measure the fasting serum lipid profile and malondialdehyde (MDA) and determine the atherogenic index as well as the cardiovascular risk ratio among hypertensive patients in Kano, Nigeria. Patients and Methods: Two hundred subjects (100 hypertensive patients vs. 100 normotensive controls) were recruited for the study. The fasting serum lipid profile and MDA were assayed using routine laboratory methods. Lipid ratios that predict and identify an individual's increased risk for cardiovascular diseases were then determined from the results of the profile. Results: The serum total cholesterol (7.0±0.5 vs 4.1±0.4 mmol/L), triglycerides (2.9±0.2 vs 2.0±0.3 mmol/Lg/dl), LDL cholesterol (3.8±0.4 vs 2.6±0.4 mmol/L), VLDL cholesterol (3.0±0.2 vs 2.1±0.2 mmol/L) and MDA (TBARS) (9×10-5±1.4×10-5 vs 3×106±0.9×10-6 mol/l) were significantly (p<0.05) increase in hypertensive patients compared to normotensive controls. HDL cholesterol was significantly higher (p<0.05) in normotensive controls compared to hypertensive patients (31.4±8 vs 23.9±6 mg/dl). A statistically significant (p<0.05) positive correlation was observed between LDL cholesterol and MDA only. Both the atherogenic index (AI) ratio and the CardioRisk ratio were significantly higher in Hypertensives than Normal controls (10.4 vs 4.1; 11.7 vs 5.1 respectively). Conclusion: This study demonstrated an increased occurrence of atherogenic lipid profile and oxidative stress among hypertensive patients. It further showed a strong correlation between dyslipidaemia and oxidative stress. Therapeutic lifestyle changes and use of statins should be considered an integral part of the treatment for hypertensive patients in Nigeria

Prevalence of dyslipidaemia among healthcare workers in University of Benin Teaching Hospital, Benin City, Nigeria

Healthcare workers are predisposed to cardiovascular diseases just as the patients they manage. Dyslipidaemia has been identified as an important cardiovascular risk factor among the healthcare workers. Elevated LDL-cholesterol and triglyceride along with reduced HDL-cholesterol have been implicated in the pathogenesis of atherosclerotic cardiovascular diseases. Deposition of proatherogenic lipids along the wall of the blood vessels forms the basis of atherosclerotic cardiovascular diseases. This study determined the prevalence of dyslipidaemia among the healthcare workers in University of Benin Teaching Hospital (UBTH), Benin City, South-South, Nigeria. Three hundred and twenty-five hospital workers ranging from doctors, nurses and other healthcare workers were recruited for this study. Demographic and socioeconomic data were collected using a structured questionnaire. One hundred and sixty (49%) were males while 165(51%) were females with 2 average age of 40.9 ± 8.8 years and average body mass index of 26.7 ± 5.9kg/m. Anthropometric and blood pressure measurements were determined using standard techniques while the serum lipids (triglyceride, total cholesterol, HDL-cholesterol and LDL-cholesterol) were analyzed using the standard enzymatic methods. Abnormal lipid levels were found in the study population. Total cholesterol (5.06 ± 1.33 mmol/L), LDL-cholesterol (3.66 ± 1.38mmol/L) and non HDL-cholesterol (4.08 ± 1.37 mmol/L) were elevated. Serum HDL-cholesterol (0.98 ± 0.14 mmol/L) was found to be low. Prevalence of dyslipidaemia was reported as follow: elevated total cholesterol (43.4%), elevated LDL-cholesterol (56.0%), and reduced HDL-cholesterol (82.2%). Significant risk factors identified include: physical inactivity (32%) and alcohol ingestion (53.5%). Prevalence of dyslipidaemia is high among the healthcare workers in UBTH; most especially reduced HDL-cholesterol and elevated LDL-cholesterol. Therapeutic lifestyle modification is therefore advocated among the healthcare workers to reduce the risk of cardiovascular diseases

Prevalence and pattern of dyslipidaemia in type 2 diabetes mellitus patients at a tertiary care hospital

Background: Diabetes mellitus (DM) is a common secondary cause of dyslipidaemia, particularly if glycaemic control is poor, which in turn is an important risk factor for atherosclerosis and coronary artery disease.Objectives: (1) To study the prevalence and pattern of dyslipidaemia in patients with type 2 DM. (2) To determine the relationship (if any) between HbA1C and the lipid profile in type 2 diabetic patients.Methods: This was a cross-sectional study done in 200 type 2 diabetic patients attending the Diabetic Clinic at the Helen Joseph Hospital. Patients suffering from other known causes of secondary dyslipidaemia were excluded. Each patient's HbA1C and lipid profile results were recorded from their clinic files. The lipid profile included total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and calculated low-density lipoprotein cholesterol (LDL-C). Patients with one or more of the above parameters outside the targets recommended by the 2012 South African Dyslipidaemia Guidelines were considered to have uncontrolled dyslipidaemia.Results: Of the 200 type 2 DM patients studied, 86 (43%) were male and 114 (57%) female. Despite all patients being treated with lipid-lowering therapy (simvastatin at a mean daily dose of 20 mg), 187 patients (93.5%) did not achieve all their lipid targets. The most prevalent lipid parameter not at target was an LDL-C of ≥ 1.8 mmol/l in nearly 80% of patients. The most common pattern of dyslipidaemia was a combined dyslipidaemia(any two abnormal lipid parameters) affecting a total of 82 out of the 187 patients (43.8%) not reaching recommended targets. No significant relationship was found between HbA1C and any of the lipid parameters. Conclusion: The vast majority of the type 2 diabetic patients studied had dyslipidaemia not meeting recommended targets, despite the use of lipid-lowering therapy in all patients. There is a need for more intensive lipid-lowering therapy, particularly statin therapy in patients with dyslipidaemia. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital and need to be implemented for effectively controlling dyslipidaemia and reducing the burden of CVD

Obesity in Botswana: time for new cut-off points for abdominal girth?

Introduction: Country-specific cut-off points for defining central obesity in black Africans are long overdue. Methods: Anthropometric data from 215 (51.4%) male and 203 (48.6%) female patients seen in Gaborone between 2005 and 2015 were analysed to establish appropriate cut-off points for waist circumference (WC) corresponding to a body mass index (BMI) of 30 kg/m2. Relative risks for cardiometabolic disorders were calculated for different BMI and WC categories using MedCalc®. The subjects' mean age was 50.0 ± 10.8 years and 80.6% were Botswana.Results: Only 7.2% of patients had a BMI < 25 kg/m2, 27.3% were overweight and 65.5% were obese; mean BMI was 34.9 ± 6.5 kg/m2 in the women versus 31.0 ± 4.9 kg/m2 in the men(p < 0.0001). New cut-off points of 98 cm in men and 85 cm in women emerged. Different weight and WC categories appeared not to confer increased relative risk of hypertension, dysglycaemia or dyslipidaemia.Conclusion: The proposed WC cut-off values, if validated, should set the pace for larger studies across sub-Saharan Africa

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

Profil lipidique des patients traités par statines en service de cardiologie, CNHU, Bénin. Les objectifs cibles de LDL-C sont-ils atteints ?

Introduction : Les maladies cardiovasculaires sont une cause majeure d'incapacité et de décès prématurés à l'échelle mondiale et les dyslipidémies représentent un facteur de risque majeur d'athérosclérose. Le but est d'évaluer l'atteinte des objectifs de LDL-C chez les patients traités par statines dans le service de cardiologie du CNHU-HKM de Cotonou.Méthode : Il s'agit d'une étude rétrospective, portant sur la période du 1er juin 2013 au 31 décembre 2014, nous avons inclus de façon exhaustive les patients de plus 18 ans, hospitalisés et traités par statines. Les données cliniques, biologiques, thérapeutiques et évolutives ont été révisées et une stratification de risque basée les tables SCORE (Systematic Coronary Risk Evaluation) a été faite à postériori.Les taux de LDL-C des patients ont été comparés aux cibles de LDL-C retenues par les recommandations de l'European Society of Cardiology (ESC) 2011. La valeur de p<0,05 est retenu comme seuil de significative.Résultats : Sur 551 patients hospitalisés, 130 patients étaient traités par statines. L'âge moyen est de 60,01 ±12,78 ans, le sex ratio H/F est de 1,65. Chez 53,8% des patients on retrouvait une dyslipidémie avec 40% d'hypercholestérolémie. Les autres facteurs de risque athéromateux étaient dominés par l'HTA (72,3%). Le niveau de RCV était élevé chez 93,8% des patients à l'instauration des statines. La prescription des statines était principalement faite en prévention secondaire. L'objectif de LDL-C cible n'était pas atteint chez 61% des patients. La valeur seuil du LDL-C initiale ≥ 1,6 g/l était prédictive de non atteinte de l'objectif LDL-C. Conclusion : Les objectifs cibles de LDL-C sont atteints chez moins de 4 patients sur 10 dans notre série. Notre étude suggère la nécessité de mettre en place des stratégies appropriées pour l'atteinte des objectifs de LDL-C au cours du traitement par statines

High Prevalence of Primary Dyslipidaemia in Black South African Patients at a Tertiary Hospital in Northern Gauteng; South Africa

BACKGROUND:The prevalence of cardiovascular disease is projected to be 38.7% for the USA in 2020; including coronary heart disease at 8.6% and stroke at 3.6%. In South Africa (SA); premature deaths due to heart and blood vessel diseases in people of working age (35 - 64 years) have been predicted to increase by 41% between 2007 and 2030; with enormous negative economic impact. Atherosclerosis underlies much of the pathogenesis; which involves risk factors including dyslipidaemia. Secondary dyslipidaemia associated with diabetes mellitus; hypothyroidism; chronic renal disease; cholestasis; nephrotic syndrome; alcohol excess; drugs such as thiazide diuretics and antiretroviral agents may respond to treatment of underlying causes; but residual dyslipidaemia may in such cases be due to primary disorders of metabolism. Primary dyslipidaemias are uncommon and to a large extent underdiagnosed; especially in the black population of SA; reflecting a lack of clinical and laboratory awareness or expertise. Specific diagnoses enable effective intervention in the patients as well as the families.OBJECTIVE:To assess the burden and prevalence of dyslipidaemia in the SA black population at Dr George Mukhari Hospital in the north region of Gauteng.METHOD:A retrospective data analysis of 12-month lipid profiles comprising triglyceride (TG); total cholesterol (TC); high-density lipoprotein cholesterol and directly measured low-density lipoprotein (LDL) cholesterol (LDLC).RESULTS:There were 24 656 requests for 6 348 patients. The lipid cut-off levels were somewhat arbitrary but were based on the commonly used decision-making levels in the treatment guidelines. Severe hypercholesterolaemia (etgt;7 mmol/L) was seen in 299 (4.7%) patients and extreme hypercholesterolaemia (etgt;12 mmol/L) was seen in 30 (0.5%) patients. LDLC (etgt;5 mmol/L) occurred in 80 (1.3%) patients and etgt;10 mmol/L in 19 (0.3%) patients. A predominant triglyceride problem was seen in 578 (9.1%) patients with TG (etgt;2 mmol/L) and TC (etlt;5 mmol/L); whereas moderate hypertriglyceridaemia (etgt;5 mmol/L) was present in 113 (1.8%) patients; and more severe hypertriglyceridaemia (etgt;10 mmol/L) in 10 (0.2%). TC (etgt;5 mmol/L) with LDL (etgt;3 mmol/L) but TG in the normal range was seen in 369 (5.8%) patients; indicating a cholesterol-predominant problem. In contrast; LDLC (etgt;3 mmol/L) and TG (etgt;1.7 mmol/L) was seen in 249 (3.87%) representing mixed hyperlipidaemia. Paediatric patients with severe dyslipidaemia mostly suffered from nephrotic syndrome.CONCLUSION:A significant burden and a high prevalence of dyslipidaemias were present in adults in whom a monogenic disorder should be considered. The extent and severity of dyslipidaemia justify a special clinic and laboratory to ensure accurate diagnosis with effective intervention for patients and their families

Dyslipidémie athérogène chez le diabétique de type 2 à Cotonou

Introduction : Les anomalies lipidiques sont fréquentes chez les diabétiques, en particulier les diabétiques de type 2.Objectif : Cette étude avait pour objectif de déterminer la prévalence et les facteurs associés à la dyslipidémie athérogène (DA) chez les diabétiques de type 2 à la Banque d'insuline de Cotonou Méthodes : Il s'agit d'une étude rétrospective descriptive et analytique qui s'est déroulée sur 5 mois (de Mai à Octobre 2014). Résultats : L'effectif total des patients diabétiques de type 2 retenus était de 156 (56% femmes). L'âge moyen était de 54,14 ± 10,5 ans avec des extrêmes de 31 ans et 80 ans. La prévalence d'obésité (37%), d'excès pondéral (36%), d'hypertension artérielle (69%) étaient importantes. Celle du tabagisme était faible (2%). La prévalence de la dyslipidémie athérogène était de 5,1%. Mais séparément, les prévalences de l'hypocholestérolémie HDL et de l'hypertriglycéridémie étaient respectivement de 39% et 12%. C'est la prévalence de l'hypercholestérolémie LDL qui est la plus élevée (71%). Parmi les facteurs associés recherchés dans notre étude, seule l'obésité a été retrouvée comme favorisant la survenue de la DA (p=0,02).Conclusion : Les anomalies lipidiques étaient fréquentes chez les diabétiques de type 2, mais la prévalence de la DA dans notre étude paraissait moins élevée

Prevalence of traditional cardiovascular risk factors among staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria

Aim: The aim was to describe the frequency of occurrence of traditional cardiovascular (CV) risk factors among selected university workers in Ladoke Akintola University of Technology (LAUTECH) Nigeria.Materials and Methods: A cross­sectional study of 206 staff of LAUTECH, Ogbomoso, Nigeria had an assessment for nine traditional CV risk factors. Demographic and clinical parameters were taken. Blood sample was taken to determine the random blood sugar and lipid profile. 12­lead resting electrocardiography (ECG) was done for all participants. Statistical analysis was performed with the aid of Statistical Package for Social Sciences (SPSS)version 17.0 (Chicago Ill., USA)Results: The study population included 96 males (46.6%) and 110 females. The mean age was 45.3 ± 7.9 years (range 27-73 years). The prevalence of CV risk factors were as follows: Hypertension 84 (40.8%), visceral obesity 92 (44.7%), generalized obesity 79 (38.3%), low high density lipoprotein 113 (54.9%), impaired blood glucose 16 (7.8%), diabetes mellitus 3(1.5%),hypercholesterolemia 102 (49.5%), left ventricular hypertrophy­ECG 24 (11.7%), elevated low density lipoprotein­cholesterol 99 (48.1%). About ­ (72.3%) had two or more CV risk factors clustered together. Females had a higher prevalence of CV risk factors and its clusters than their male counterparts. Of those diagnosed with hypertension in this study, more than half had never been told they werehypertensive 48 (57.1%). Conclusion: This study suggests a very high prevalence of CV risk factors among University Staff in LAUTECH,Ogbomoso, Nigeria. Clustering of CV risk factors is more prevalent among women. Appropriate preventive strategy in terms of education and modification of risk factors are important to reduce the burden of CV diseases among this population

Association of elevated Factor VII activity with hyperglycaemia, dyslipidaemia and obesity in a rural black community in Limpopo Province, South Africa

Metabolic disorders are some of the major sources of complications in the body. About 1.7 million people worldwide have obesity-related problems that include hyperglycaemia; dyslipidaemia and haemostatic defects. The purpose of the study was to determine the association of elevated Factor VII (FVII) activity with hyperglycaemia; dyslipidaemia and obesity in a rural black population living in Ga-Mothapo village. This cross-sectional study consisted of 286 females and 96 males aged 18-65 years. Fasting blood samples were analysed for glucose; triglycerides; total cholesterol; high density lipoprotein cholesterol (HDL-C) and FVII. Low density lipoprotein cholesterol (LDL-C) was calculated from total cholesterol; triglycerides and HDL-C using the Friedewald formula. Weight and height were measured using a weighing scale and the Seca telescopic height-measuring rod; respectively. Body mass index was calculated from weight and height. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. The following results were obtained: correlation between elevated FVII activity and hyperglycaemia (p=0.000); hypercholesterolaemia (p=0.000); LDL-C (p=0.000); obesity (p=0.000); hypertriglyceridaemia (p=0.572) and low HDL-C (p=0.201). In conclusion; elevated FVII activity was found to be significantly associated with hyperglycaemia; hypercholesterolaemia; high LDL-C and obesity. The association with hypertriglyceridaemia and a low HDL-C level was not significant

Can Metabolic Factors be Used Prognostically for Short-Term Mortality in HIV-Infected Patients?

Background: Metabolic abnormalities are common throughout the course of human immunodeficiency virus (HIV) infection and may occur either due to HIV infection or as a result of side effects of antiretroviral therapy. It has been established that dyslipidemia and dysglycemia associated with HIV disease reduce the long-term survival of the patients; but their role for predicting prognosis of short-term mortality in HIV patients is unknown. Aim: To study dyslipidemia and dysglycemia as a prognostic indicator for short-term mortality (3 months) in HIV patients. Subjects and Methods: An observational; prospective study was conducted at a tertiary care center over a period of 6 months. Consecutive HIV-positive patients hospitalized (both; HIV status known prior to hospitalization and the diagnosis made for the first time at admission) in medical wards from March to May 2010 were studied. All patients had their random blood sugars; fasting blood sugars (if possible); fasting lipid profile; and cluster of differentiation 4 (CD4) counts tested at the time of enrollment. The patients were followed for a period of 3 months; at the end of which they were categorized as survivors and non-survivors; and the demographic; clinical; and investigational parameters were compared between the above groups. Data was analyzed by applying Mann-Whitney U test; two sample t-test; Fisher-Exact test; and stepwise logistic regression analysis of significance; using the computer-based program; Stata; version 11.1. Results: A total of 82 patients were enrolled for the study of which 64 (78.05) were males and 18 (21.95) were females; with a mean (SD) age of 34.00 (7.0) years. The mean CD4 count was 206.23 (129.5) cells/mm 3 . The overall mortality within 3 months was 20.7 (17/82). Mycobacterium tuberculosis as opportunistic infection was found in 42 patients; out of which 13 expired (P

Can Metabolic Factors be Used Prognostically for Short-term Mortality in HIV-infected Patients?

Metabolic abnormalities are common throughout the course of human immunodeficiency virus (HIV) infection and may occur either due to HIV infection or as a result of side effects of antiretroviral therapy. It has been established that dyslipidemia and dysglycemia associated with HIV disease reduce the long-term survival of the patients; but their role for predicting prognosis of short-term mortality in HIV patients is unknown. Aim: To study dyslipidemia and dysglycemia as a prognostic indicator for short-term mortality (3 months) in HIV patients. Subjects and Methods: An observational; prospective study was conducted at a tertiary care center over a period of 6 months. Consecutive HIV-positive patients hospitalized (both; HIV status known prior to hospitalization and the diagnosis made for the first time at admission) in medical wards from March to May 2010 were studied. All patients had their random blood sugars; fasting blood sugars (if possible); fasting lipid profile; and cluster of differentiation 4 (CD4) counts tested at the time of enrollment. The patients were followed for a period of 3 months; at the end of which they were categorized as survivors and non-survivors; and the demographic; clinical; and investigational parameters were compared between the above groups. Data was analyzed by applying Mann-Whitney U test; two sample t-test; Fisher-Exact test; and stepwise logistic regression analysis of significance; using the computer-based program; Stata; version 11.1. Results: A total of 82 patients were enrolled for the study of which 64 (78.05) were males and 18 (21.95) were females; with a mean (SD) age of 34.00 (7.0) years. The mean CD4 count was 206.23 (129.5) cells/mm 3 . The overall mortality within 3 months was 20.7(17/82). Mycobacterium tuberculosis as opportunistic infection was found in 42 patients; out of which 13 expired (P

Oxidative stress and dyslipidaemia among ghanaian HAART-Naive HIV Patients and those on HAART

"Background: Pharmacogenomics/pharmacogenetics has the potential to mitigate adverse drug reactions and optimize pharmacotherapy in individuals. Over the past several years; there has been increasing attention towards the characterization of pharmacogenomic biomarkers in African populations; both locally and internationally. However; the perceptions of the African health care community towards pharmacogenomic testing have not been studied. Objectives: To assess knowledge and perceptions of pharmacogenomics among health care professionals in Benin City; Nigeria. Methods: In this preliminary and pilot investigation; we used a semi-structured qualitative survey methodology to understand the perceptions of pharmacists and pharmacologists towards pharmacogenomics in an academic care centre in Benin City; Nigeria. Three themes were explored: Knowledge and experience with pharmacogenetics; Expectations about how a pharmacogenetic testing service could be used; and Capacity building for pharmacogenetic service delivery.Results: Though none of the participants had received training or undertaken research in pharmaco-genomics; all participants were familiar with the field and listed beneficial outcomes associated with pharmacogenetic testing. Participants identified factors such as lack of funding; infrastructure; and manpower for limitations of pharmacogenomic testing in Nigeria. Participants listed numerous ethical issues and concerns in recruiting participants for research and introducing pharmacogenetics in the clinic; including the need to ""win the confidence of the people."" Conclusion: Pharmacists and pharmacologists in an academic centre in Nigeria are aware of the benefits of pharmacogenomics; but cite many hurdles to overcome before this field can become a routine part of patient care in their communities."

Hypertension

Approximately one in four adults has hypertension; a prevalence that increases with age and may reach to two out of three adults older than 70 years of age. In the Framingham Heart Study 65-75 of hypertension in the elderly is of the isolated systolic hypertension variety. Hypertension causes a two- to threefold increased risk of atherosclerotic cardiovascular events. Hypertension clusters with dyslipidaemia; insulin resistance; glucose intolerance and obesity in more than 80 of cases.1 The great majority of hypertensives thus have additional cardiovascular risk factors. The global cardiovascular risk; of which hypertension is but one component; is best appreciated by the use of risk charts such as the Framingham Risk Score