Hypertension and combinations of cardiovascular risk factors. An epidemiologic case-control study in an adult population in Guadeloupe (FWI).

Our aim was to quantify the association between hypertension and four well-known cardiovascular risk factors (obesity, dyslipidemia, high blood glucose, smoking) and to determine the extent of their combinations in hypertensive subjects in an adult population in Guadeloupe (FWI). A case-control study was conducted in 1999. Odds ratios (ORs) and 95% confidence interval (95% CI) of hypertension according to cardiovascular risk factors were calculated by a logistic regression model. In all, 4210 subjects were included in the study: 2105 hypertensives and 2105 age and sex matched non-hypertensive controls. In the hypertensives, obesity (30%) was the most frequent risk factor followed by dyslipidemia (23.2%), current smoking (11.5%) and high blood glucose (8.2%). But, prevalence of current smokers was higher in normotensives (13.9 vs. 11.5%, p < 0.01). Among cases, 44.5% had no risk factor other than hypertension. The proportion of subjects with multiple risks factors (< or = 2) was higher in hypertensives than in controls (55.5 vs. 6.5%,p < 0.001) and higher in women than in men in cases (58.1 vs. 51.8%, p = 0.005). The adjusted ORs (95% CI) of hypertension were 2.41 (2.02-2.88) for obesity, 1.39 (1.16-1.66) for dyslipidemia and 1.67 (1.20-2.32) for high blood glucose. Our study documents the high prevalence of combinations of cardiovascular risk factors in hypertensive subjects in Guadeloupe and confirms the need of a global risk approach in prevention and treatment of hypertension.

Risk factors associated with ischaemic stroke in Guadeloupe

We carried out a case control study at the University Hospital of Pointe-Ó-Pitre, Guadeloupe, during eight months. Seventy patients with ischaemic stroke and seventy age- and sex-matched controls were involved. A standard questionnaire reported clinical characteristics and medical history. Seventy-six per cent of patients suffered from hypertension. Obesity and diabetes were more frequent in the case group than in the control group. Serum creatinine concentration (86 vs 74 mumol/l; p < 0.001), total cholesterol (5.9 vs. 5.2 mmol/l; p < 0.001), apolipoprotein B (1.2 vs 1.0 g/l; p < 0.001) and lipoprotein (a) (82 vs 48 mg/dl; p < 0.001) were significantly higher in patients than controls. Multiple logistic regression analysis revealed that in addition to serum creatinine, serum apolipoprotein B, hypertension, obesity, serum lipoprotein (a) and diabetes mellitus were associated independently and significantly with ischaemic stroke. These findings have implications for clinical practice and further research particularly with respect to serum creatinine concentration as a marker of renal damage from hypertension and as a risk factor itself for cerebrovascular disease.

Lipid profile in an adult population in Guadeloupe.

The purpose of this study was to provide data on lipid distribution and to investigate the association between hypercholesterolemia and other factors. A cross-sectional survey of insured subjects in an Health Center of Guadeloupe in 1999. Data from a consecutive series of 1 010 individuals aged 18 years and older, collected during a 3 month-period, were used. Standardized interviews and measurements of blood lipid abnormalities and other cardiovascular risk factors were carried out. Overall, 27% had elevated total cholesterol (TC) levels above 200 mg/dL, 11.7% had TC levels above 240 mg/dL, 18.1% had LDL-C levels above160 mg/dL, 12.5% had HDL-C below 35 mg/dL and 2.7% had triglyceride levels above 200 mg/dL. Isolated low HDL-C was found in 22% of the subjects and 10.8% had both TC above 240 mg/dL and LDL-C above 160 mg/dL. Only 22% of the subjects with high TC were aware of their diagnosis and 5% were treated. The risk of having hypercholesterolemia above 200 mg/dL was independently and significantly higher in case of hypertension, age above 45 in men or 55 in women, body mass index above 30 and familial history of dyslipidemia. These findings document the first report on dyslipidemia in Guadeloupe. It showed that the prevalence of hypercholesterolemia and hypertriglyceridemia was lower than in developed countries, but markedly higher than in Africa. Modifications of lifestyle and adapted therapeutics are necessary to decrease cardiovascular mortality.

Risk factors associated with ischaemic stroke in Guadeloupe.

We carried out a case control study at the University Hospital of Pointe-à-Pitre, Guadeloupe, during eight months. Seventy patients with ischaemic stroke and seventy age- and sex-matched controls were involved. A standard questionnaire reported clinical characteristics and medical history. Seventy-six per cent of patients suffered from hypertension. Obesity and diabetes were more frequent in the case group than in the control group. Serum creatinine concentration (86 vs 74 mumol/l; p < 0.001), total cholesterol (5.9 vs. 5.2 mmol/l; p < 0.001), apolipoprotein B (1.2 vs 1.0 g/l; p < 0.001) and lipoprotein (a) (82 vs 48 mg/dl; p < 0.001) were significantly higher in patients than controls. Multiple logistic regression analysis revealed that in addition to serum creatinine, serum apolipoprotein B, hypertension, obesity, serum lipoprotein (a) and diabetes mellitus were associated independently and significantly with ischaemic stroke. These findings have implications for clinical practice and further research particularly with respect to serum creatinine concentration as a marker of renal damage from hypertension and as a risk factor itself for cerebrovascular disease.

Cardiovascular risk factors associated with diabetes in an Indian community of Guadeloupe. A case control study.

Indians of Guadeloupe have an especially high prevalence type 2 diabetes mellitus and a particular susceptibility to coronary heart disease. This case-control study conducted from September 15 to 24, 1997, analysed cardiovascular risk factors associated with diabetes and particularly dyslipidaemia in the Indian community of Guadeloupe. The 172 subjects included 86 diabetic patients of Indian origin and 86 age- and sex-matched non-diabetic controls. All subjects underwent a physical examination by the same observer. Obesity and hypertension were assessed, and fasting lipid concentrations were measured. The body mass index and waist-to-hip ratio were higher among patients than controls: 27.8 vs 25.1 Kg/m2 (p < 0.001) and 0.94 vs 0.90 (p < 0.001). Mean arterial systolic and diastolic pressures were higher for patients than controls (p < 0.001). Median HDL-cholesterol was 1.23 mmol/L for patients vs 1.4 mmol/L for controls (p < 0.001), and median triglycerides were 2.0 vs 1.3 mmol/L (p < 0.001). Mean apolipoprotein B was 1.40 +/- 0.36 g/L for patients vs 1.23 +/- 0.35 g/L for controls (p < 0.001). Our results show slight hypertension, central obesity, a lower plasma HDL-cholesterol concentration, a higher triglyceride concentration, and a higher apolipoprotein B concentration for diabetics. These data would appear to have important implications for the prevention of cardiovascular disease in this population.