Are Any Changes in Carotid Intima-Media Thickness Associated with Cardiometabolic Risk Among Adult Bantu Central African Hypertensive Patients from Monkole and Biamba Marie Mutombo Hospitals?

Background: Several classic/traditional risk factors are associated with intima-media thickness (IMT), a novel risk of cardio metabolic risk (CMR) in the literature but not in Kinshasa, a megacity prone to CMR. Thus, the objective of this study was to evaluate potential correlations between inflammation, kidney function, psychological stress, hemodynamics, and changes in IMT. Methods: This cross-sectional study was carried out between 2018 and 2021 within Monkole and Biamba Marie Mutombo Hospitals, respectively, and randomly selected from 10 health structures from East and West of Kinshasa, Capital of Democratic Republic Congo (DRC). A random sample of adult hypertensive Bantu Central Africans was examined after bivariate correlations and multiple linear regression. Results: Out of 280 patients with 140 men and 140 women aged 62 ± 11 years, the mean carotid intima-media thickness (CIMT) was 1.06 ± 0.5 mm and 73% (n = 204) patients had uncontrolled hypertension. After controlling for confounders, 52.9% variations (R2) of CIMT were independently and significantly (P = 0.037) predicted by CRP, 24-hour proteinuria, urinary albumin/creatinine ratio, duration of hypertension, heart rate, hip circumference, and psychological stress with Equation Y = 0.717 + 0.87 × CRP + 0.02 × 24 H - proteinuria + 0.005 × urinary albumin/creatinine ratio + 0.05 × duration of hypertension + 0.001 × heart rate + 0.006 × hip circumference + 0.017 × psychological stress. Conclusion: There is an urgent need to control inflammation, impaired renal function, cardiac rhythm, peripheral obesity, longer duration of hypertension management, and stress, which are emerging as specific novel determinants of the subclinical atherosclerosis for those Bantu Central African hypertensive patients.

Association of Helicobacter pylori infection with the metabolic syndrome among HIV-infected black Africans receiving highly active antiretroviral therapy.

INTRODUCTION: The metabolic syndrome (MetS) is common in human immune deficiency virus (HIV)-infected individuals receiving highly active antiretroviral therapy (HAART). Immune deficiencies caused by HIV give rise to numerous opportunistic gastrointestinal pathogens such as Helicobacter pylori, the commonest cause of chronic gastritis. The study sought to determine the relationship between H pylori infection and the MetS among HIV-infected clinic attendees. METHODS: This cross-sectional study was carried out in a specialised heart clinic in Kinshasa, DR Congo. Between January 2004 and December 2008, 116 HIV-infected patients (61 with MetS and 55 without MetS) who underwent upper gastrointestinal endoscopy for dyspeptic symptoms were included in the study following an informed consent. Univariate associations were determined by odds ratios (OR), while multivariate logistic regression analysis was used to identify factors associated with the MetS. RESULTS: H pylori infection (OR = 13.5, 95% CI: 10.3-17.6; p < 0.0001) and peripheral obesity (median hip circumference ≥ 97 cm) (OR = 4.7, 95% CI: 1.2-18.8; p = 0.029) were identified as MetS-related factors in HIV-infected patients. Higher rates of the MetS were associated with increased incidence of HIV-related immunocompromise using World Health Organisation (WHO) staging criteria. There was a univariate significant difference in the prevalence of the MetS between antiretroviral therapy (ART)-naïve patients and patients treated by means of a first-line HAART regimen of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). However, this difference was not significant in multivariate logistic analysis. CONCLUSION: H pylori infection was significantly associated with the MetS in HIV-infected patients.

Advanced age, altered level of consciousness and a new diagnosis of diabetes are independently associated with hypernatreamia in hyperglycaemic crisis.

BACKGROUND: There is limited literature on hypernatreamia in the setting of hyperglycaemic crisis. This is despite the fact that the presence of hypernatreamia may impact on the classification of hyperglycaemic crisis and its management particularly with regards to the nature of fluid therapy. We determined the prevalence of hypernatreamia and its associated factors at presentation for hyperglycaemic crisis. METHODS: This was a retrospective review of data for hyperglycaemic crisis admissions in Nelson Mandela Academic Hospital, Mthatha, South Africa. The prevalence of hypernatreamia (uncorrected Serum Sodium at presentation >145 mmol/L) was determined. Hyperosmolality was defined by calculated effective osmolality >320 mosmols/Kg. Multivariate logistic regression was undertaken using variables that were statistically significant in univariate analysis to ascertain those that were independently associated (Odds Ratio (OR) with 95% Confidence Interval (CI)) with hypernatreamia. RESULTS: The prevalence of hypernatreamia in our admissions for hyperglycaemic crisis was 11.7% (n = 32/273 including 171 females and 102 males). All admissions with hypernatreamia met the criteria for hyperosmolality. Age ≥ 60 years (OR = 3.9 95% CI 1.3-12.3; P = 0.018), Altered level of consciousness (OR = 8.8 95% CI 2.3-32.8; P < 0.001) and a new diagnosis of diabetes (OR = 3.7 95%CI 1.2-11.5; P = 0.025) were independently associated with hypernatreamia. CONCLUSION: The prevalence rate of hypernatreamia in hyperglycaemic admissions was high with all hypernatreamic admissions meeting the criteria for hyperosmolality. Advanced age, altered conscious level and a new diagnosis of diabetes were independently associated with hypernatreamia.

The deleterious effects of physical inactivity on elements of insulin resistance and metabolic syndrome in Central Africans at high cardiovascular risk.

AIM: We aimed to describe the physical activity and to investigate the association between classical hypertension, obesity, diabetes, and new inflammation, IDF-defined metabolic syndrome, insulin resistance CV risk factors. DESIGN: This was a cross-sectional study based on interviews and physical and biochemistry measurements among Central African patients. MEASUREMENTS: Waist circumference (WC), blood pressure, weight and height to calculate body mass index (BMI), fasting glucose, CRP, ERS, uric acid, cholesterol (C), LDL-C, HDL-C, triglycerides, elements of homeostatic model assessment (HOMA) including insulin, HOMA index, QUICKI, insulin sensitivity (%S), beta-cell function (%ß) and insulin resistance (IR). FINDINGS: Of the 60 patients included, 30 (50%) were physically inactive versus 30 (50%) active. In pooled analyses, in men and in women, there was significant and positive correlation between WC and seating/laying down position (WC=92.41+1.49 seating time in hours, R(2)=0.11; P<0.0001). The mean value of CRP and ERS were higher and those of all indices of HOMA were lower in inactive patients. The discriminant function for physical activity was Z (score=barycentre)=-7.36+1.013 HOMA index where -1.4 was the barycentre for active and +1.4 for inactive. HOMA index >2.42 was the optimal cut-off value to detect physically inactive patients: sensitivity=93.3%, specificity=100%, area under ROC=0.991±0.01 95%=0.975-1.0; P<0.0001. CONCLUSION: The association between low-grade inflammation markers, insulin resistance and physical inactivity favours the hypothesis that a low-grade inflammatory status and enhanced insulin, sensitivity may constitute a part of the CV benefits from physical activity.

Relationship between Younger Age, Autoimmunity, Cardiometabolic Risk, Oxidative Stress, HAART, and Ischemic Stroke in Africans with HIV/AIDS.

Background and Purpose. It now appears clear that both HIV/AIDS and antiretroviral therapy (HAART) use are associated with higher risk of cardiovascular disease such as stroke. In this study, we evaluated the prevalence, the risk factors, and the cardiometabolic comorbidities of stroke in HIV/AIDS Central African patients. Methods. This hospital-based cross-sectional study collected clinical, laboratory, and imaging data of black Central African heterosexual, intravenous drug nonuser, and HIV/AIDS patients. Results. There were 54 men and 62 women, with a female to male ratio of 1.2 : 1. All were defined by hypercoagulability and oxidative stress. Hemorrhagic stroke was reported in 1 patient, ischemic stroke in 17 patients, and all stroke subtypes in 18 patients (15%). Younger age <45 years (P = .003), autoimmunity (P < .0001), and metabolic syndrome defined by IDF criteria (P < .0001) were associated with ischemic stroke. Conclusions. Clustering of several cardiometabolic factors, autoimmunity, oxidative stress, and lifestyle changes may explain accelerated atherosclerosis and high risk of stroke in these young black Africans with HIV/AIDS. Prevention and intervention programs are needed.