Relationship between waist circumference and cholesterol in Central Africans with congestive heart failure.

BACKGROUND: There are controversies as to what the traditional risk factors for coronary heart disease should be in sub-Saharan Africa. OBJECTIVE: To assess the relationship between cholesterol and cardiovascular disease risk factors including Helicobacter pylori infection in black Africans with congestive heart failure. METHOD: A cross-sectional and observational study of 48 men and 52 women. RESULTS: Congestive heart failure was associated with abdomal obesity, hypertension, chronic renal failure, moderate levels of low HDL-C, excessive alcohol intake and hyperuricaemia, but low levels of cholesterol and triglycerides. TC was related by Univariate analysis with red cells, glucose, weight, waist circumference with HDL-C, CRP, fibrinogen and IgG antibodies against H pylori. Multivariate analysis revealed that waist circumference (B=0.688) and HDL-C (B=0.826) were the significant determinants of TC. There was a respective U-shaped relationship between CVD (P>0.05), chronic renal failure (P<0.05) H. pylori-induced chronic gastritis (P<0.05) and the HDL-categories. Ischemic stroke and myocardial infarction were significantly (p<0.05) associated with low HDL-C, respectively. Clinical insulin resistance (P<0.01) was predominantly more commonin the intermediate HDL-C category than in low and high HDL-categories. There was an inverse relation between lower TC: HDL-C ratio, high HDL-C and abdominal obesity/ insulin resistance in men. H. pylori gastritis was positively related to higher TC: HDL-C ratio in both men and women. CONCLUSION: Preventive measures, more studies on the interplay between HDL-C level and its function and a specific ethnic dfinition of metabolic syndrome in the African are needed.

Is hyperuricemia a risk factor of stroke and coronary heart disease among Africans?

BACKGROUND: Uric acid stabilizes platelet aggregation and enhances thrombotic tendency. OBJECTIVE: To examine the relationship between raised serum uric acid and subsequent cardiovascular events (mortality, myocardial infarction, stroke). METHODS: This is a longitudinal study in a small random number (418) of patients in Kinshasa, Congo. In this hospital-based study, uricemia was determined with respect to gender, obesity and hypertension as well correlated with traditional cardiovascular risk factors. A univariate regression model was used to investigate the association of serum uric acid with the incidence of mortality, stroke and myocardial infarction. RESULTS: Serum uric acid was higher (P<0.05) in obese women and men as well in hypertensives, than in their controls. The significant (P<0.05 and 0.001) highest frequency of hyperuricemia was observed in both diabetic and hypertensive patients. Blood pressure (BP) was higher (P<0.001) in patients with hyperuricemia than in those with normal serum uric acid. Serum uric acid was significantly correlated with body weight, BP, glucose, fibrinogen, urea, creatinin and total cholesterol. In men, hyperuricemia was significantly (P<0.01) associated with a twofold increased risk of both myocardial infarction and stroke incidence. However, hyperuricemia was significantly related to a double risk of all mortality and stroke onset. CONCLUSION: Our results indicate that hyperuricemia among african patients is a strong predictor of myocardial infarction in men, stroke in both sexes and all causes of mortality in women.

Low birth weight and risk of hypertension in African school children.

BACKGROUND: In accordance with Baker's programming hypothesis, many studies have demonstrated a relationship between low birth weight (LBW) and high risk of hypertension in adulthood. The present study examines a possible association between LBW and the risk of a child having hypertension later in life. METHODS: The study was a cross-sectional, semi-urban survey. Information on the perinatal characteristics of 2648 randomly sampled school children was collected retrospectively in Kinshasa town, Democratic Republic of Congo. RESULTS: High risk of hypertension in these African school children was related to LBW (<2.500 g); the odds ratio was 2 (95% confidence interval 0.9-8.2, P<0.01) and 2.3 (95% confidence interval 0.6-11.5, P<0.01) for systolic and diastolic hypertension respectively. Birth weight was inversely related with both blood pressure and heart rate; the strongest association was shown in females and adolescents. CONCLUSIONS: Antenatal stress leading to LBW may be associated with programming induced by foetal undernutrition, which in turn leads to the emergence of cardiovascular disease and increased risk of hypertension.

Assessment of ventricular diastolic function in AIDS patients from Congo: a Doppler echocardiographic study.

OBJECTIVE: To investigate the prevalence of left ventricular dysfunction in African patients infected with the human immunodeficiency virus (HIV). The hypothesis was that HIV infected patients with left ventricular dysfunction are asymptomatic. METHODS: M mode, cross sectional, and Doppler echocardiography were performed in 49 consecutive patients (30 HIV positive (HIV+) carriers and 19 AIDS patients). None of the patients or 58 controls had a medical history of cardiovascular abnormalities. RESULTS: Cardiac abnormalities were not suspected on physical, electrocardiographic, and radiological examination. Forty-two of the HIV infected patients had left ventricular diastolic dysfunction; this was more pronounced in AIDS patients than in HIV+ carriers. Systolic function was normal in both stages of HIV infection. Left ventricular isovolumic relaxation time (mean SD)) increased from 87.2 (12.4) ms in the carrier state to 103.9 (19.3) ms in AIDS (p < 0.05, Bonferoni correction), peak early filling velocity declined from 0.54 (0.1) to 0.44 (0.1) m/s (p < 0.05), and late velocity increased from 0.64 (0.1) to 0.69 (0.2) m/s. A restrictive filling pattern was explained by concentric hypertrophy in 23 HIV infected patients, and by systemic amyloidosis with left ventricular dilatation in 12 of 49 HIV infected patients. CONCLUSIONS: Echocardiography is a useful technique for detecting left ventricular diastolic dysfunction in HIV infected patients with clinically unsuspected cardiac lesions. Systolic function was normal despite the presence of such cardiac abnormalities.