ABSTRACT
Congestive Heart failure (CHF) is a very common medical disorder and a major health problem in Libya. CHF is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate and describe the main risk factors and complications of CHF among people with a particular interest in Libyan community. Methodology: This project is classified as a community based descriptive cross-sectional study using the CHADS2 questionnaire as well as the local Libyan classification called the Community Stroke Risk Classification (CSRC). Area; North Africa (North of Libya, the capital Tripoli). Time; five years from 2010-2014 Population: Convenient sampling was done from a large cohort of individuals living in the Libyan community. 7497 individuals were screened for risk factors of stroke. CHF was one such factor which was studied in detail among the sample population and was diagnosed by taking detailed histories (including treatment), medical examinations and previous hospital confirmations. Results: The prevalence of CHF among our participants (7497 individuals) was 15.2% (1139 patients) among the sample population as a total with males and females being 51.2% and 48.8% respectively (P=0.87). Among different age groups, females had higher rates than the males except for age interval from 60 to 79 where males had higher rates. The male to female ratio among the total population screened for CHF was 7.8%: 7.4% (583:556 respectively with males being higher). CHF prevalence increased with the progress of age, with higher rates among age groups of over 40 (P <0.0001). 68.3% of CHF patients had hypertension (778 patients), 54.3% had DM (618 patients), 38.7% had transient ischemic attach (TIA) (441 patients), 27.2% had atrial fibrillation (AF) (310 patients), 25.9% had prior stroke (PS) (295 patients), All of these risk factors accompanying CHF increased with age (P<0.0001). 99.92% of CHF patients had risk points of stroke in CHADS2 scores (0.08% had no risk points), from whom 27.1% had intermediate scores (1-2 Risk Points) and 72.9% had high scores (≥3 risk points) (P<0.0001). Results of the CSRC scores showed that 99.91% had risk factors of stroke (0.09% had no risk factors), from whom 29.5% had intermediate scores (1-2 Risk Factors) and 70.5% had high scores (≥3 risk factors) (P<0.0001). Conclusion: CHF is a major risk factor of stroke among the Libyan population in North Africa of whom had very high CHADS2 risk scores. These scores are defined as a combination of six different risk points; 0 points being low risk, 1-2 being intermediate, and a score of 3 or more risk points is defined as being high risk. CHF appeared to dominate the high scores (≥3 risk points). Almost all CHF patients had risk factors of stroke on the CSRC scoring system of whom expressed intermediate and high scores with a significant proportion of high scores (≥3 risk factors of stroke). Hypertension, DM, AF and being aged of over 40 years were very important risk factors contributing to CHF. Both genders of male and female had similar chances of developing CHF in the Libyan community. CHADS2 & CSRC classification scores are very useful and simple tools to be used to classify and describe the risk factors of stroke in populations living within a community.
ABSTRACT
Hypertension is a very common medical disorder and a major health problem in North Africa. Hypertension is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate the importance of hypertension (HT) as a stroke predisposing risk factor among people living in Libyan community using both CHADS2 and Community Stroke Risk Classification (CSRC). Methodology: Area; North Africa (North of Libya, the capital Tripoli). Time; Five years from 2010-2014. The study was a community based descriptive cross-section, which screened 7497 individuals living in local communities, looking for risk factors of stroke. Hypertension was one of the factors which was studied in details by community physicians, among this population whom have HT were diagnosed by their past histories, medical reports, hospital discharge letters, whether they were taking any treatment or on a diet for hypertension and also medical examinations were conducted to confirm diagnosis by measuring blood pressures. Results: The prevalence of HT among study participants (7497 individuals) was 38% (2850 patients), among males and females was 50.2% and 49.8% respectively (P =0.041). Among different age groups, males had higher rates than females except for age intervals of 50-59 and ≥80 where females had higher rates. The male to female ratio among the total population screened was almost similar (19%: 18.9%). HT prevalence rose with the increase of age, with higher rates among age groups of over 40 (P <0.0001). 53% of hypertensive patients had: Diabetes Mellitus (DM) (1538 patients), 27.3% had Congestive Heart Failure (CHF) (778 patients), 15.6% had Atrial Fibrillation (AF) (446 patients), 26.7% had Transient Ischemic attack (TIA) (761 patients), and 14.8% had prior stroke (PS) (423 patients), All these risk factors accompanying hypertension rose with increase of age (P<0.0001). 99.9% of hypertensive patients had risk points of stroke on the CHADS2 scoring system (0.1% had no risk points), from that 53% had intermediate scores (1-2 Risk Points) and 47% had high scores (≥3 risk points). Results of CSRC score showed that 99.9% of hypertensive patients had risk factors of stroke (0.1% had no risk factors), from whom 56% had intermediate scores (1-2 Risk Factors) and 54% had high scores (≥3 risk factors). Conclusion: Hypertension is a major risk factor of stroke among the North African Libyan population and many, of whom have HT, had very high risk scores in CHADS2 which mainly concentrates on 1-6 risk points (P<0.0001). Almost all hypertensive patients had risk factors of stroke on CSRC scores which was generally contributed to intermediate and high scores. CHADS2 & CSRC classification scores are very useful tools to be used to classify and describe the risk factors of stroke in a population of a community regardless of having hypertension or not.
ABSTRACT
Diabetes mellitus (DM) is a very common medical disorder and a major health problem in North Africa including Libya. DM is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate the importance of DM as a stroke risk factor among people living in Libyan community. Methodology: The study was community based descriptive cross-sectional study used CHADS2 Questionnaire, as well a local Libyan classification of stroke risk factors called Community Stroke Risk Classification (CSRC). Area: North Africa (North of Libya, the capital Tripoli). Time: Five years from 2010-2014. Population: Sampling was done from a large cohort of individuals living in the community, 7497 individuals were screened looking for risk factors of stroke. Results: The prevalence of DM among our participants (7497 individuals) was 39% (2908 patients), among males and females was 54.1% and 45.9% respectively (P =0.0001). Among different age groups, males have higher rates compared to females except in very young (10-19) and very old (>80) where females dominated. The male to female ratio among total population screened was 21%: 17.8% (1573:1335 respectively). DM prevalence increased with age, with higher rates among age over 40 (P <0.0001). 53% of DM patients had hypertension (1538 patients), 21.3% had Congestive Heart Failure (CHF) (618 patients), 13% had Atrial Fibrillation (AF) (382 patients), 22% had Transient Ischemic Attach (TIA) (643 patients), 12.3% had Prior Stroke (PS) (359 patients), All those risk factors accompanying DM increased with age increase (P<0.0001). 100% of DM patients had risk of stroke on CHADS2 and CSRC scores, which mainly concentrated in intermediate and high scores. Conclusion: DM is a major risk factor of stroke among Libyan population and had very high risk scores in CHADS2 and CSRC.