CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 10, November 2012
AFRICA
533
Cardiovascular Topics
Prevalence and determinants of electrocardiographic
abnormalities in sub-Saharan African individuals with
type 2 diabetes
ANASTASE DZUDIE, SIMEON-PIERRE CHOUKEM, ABDOUL K ADAM, ANDRE P KENGNE,
PATRICIA GOUKING, MESMIN DEHAYEM, FÉLICITÉ KAMDEM, MARIE S DOUALLA, HENRY A JOKO,
MARIELLE EE LOBE, YVES M MBOUENDE, HENRY LUMA, JEAN-CLAUDE MBANYA, SAMUEL KINGUE
Abstract
Aim:
This study assessed the prevalence and determinants
of electrocardiographic abnormalities in a group of type
2
diabetes patients recruited from two referral centres in
Cameroon.
Methods:
A total of 420 patients (49%men) receiving chronic
diabetes care at the Douala General and Yaoundé Central
hospitals were included. Electrocardiographic abnormalities
were investigated, identified and related to potential determi-
nants, with logistic regressions.
Results:
The mean age and median duration of diagnosis
were 56.7 years and four years, respectively. The main elec-
trocardiographic aberrations (prevalence %) were: T-wave
abnormalities (20.9%), Cornell product left ventricular
hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart
disease (13.6%), conduction defects (11.9%), QTc prolon-
gation (10.2%) and ectopic beats (4.8%). Blood pressure
variables were consistently associated with all electrocardio-
graphic abnormalities. Diabetes-specific factors were associ-
ated with some abnormalities only.
Conclusions:
Electrocardiographic aberrations in this popu-
lation were dominated by repolarisation, conduction defects
and left ventricular hypertrophy, and were more related to
blood pressure than diabetes-specific factors.
Keywords:
diabetes mellitus, sub-Saharan Africa, Cameroon,
ECG, cardiovascular disease
Submitted 28/5/11, accepted 4/7/12
Published online 19/9/12
Cardiovasc J Afr
2012;
23
: 533–537
DOI: 10.5830/CVJA-2012-054
A major threat to the health of diabetes subjects is cardiovascular
disease (CVD), which currently accounts for about three-
quarters of all deaths in diabetes patients in major populations
and settings.
1
Attempts to maintain cardiovascular health in
diabetics include: (1) routine prescription of medications with
proven beneficial effects on cardiovascular health, such as statins
and aspirin; (2) investigation and treatment of individuals with
abnormal levels of modifiable risk factors; (3) monitoring of
individuals for infra-clinical changes, which are indicators of
future high risk for cardiovascular events, or those with less-
advanced stages of diabetes, whose course could be modified
through early intervention.
2
The electrocardiogram (ECG) is widely used for monitoring.
3
ECG changes appear early in the course of diabetes, and usually
include alterations such as sinus tachycardia, QTc prolongation,
QT dispersion, changes
in heart rate variability, ST–T changes,
and left ventricular
hypertrophy. These changes and others,
detected with the use of a resting ECG, often together with
an exercise ECG, are used to detect silent ischaemia, assess
prognosis and predict future risk. Because the ECG is a
non-invasive and relatively easy test to perform, it is used in the
series of investigations conducted as part of the annual clinical
evaluation of people with diabetes around the world.
3
Department of Internal Medicine, Douala General Hospital,
Cameroon
ANASTASE DZUDIE, MD, FWHF
SIMEON-PIERRE CHOUKEM, MD
FÉLICITÉ KAMDEM, MD
SOLANGE DOUALLA, MD
HENRY A JOKO, MD
MARIELLE EE LOBE, MD
YVES M MBOUENDE, MD
HENRY LUMA, MD
Department of Internal Medicine, Buea Faculty of Health
Sciences, Cameroon
ANASTASE DZUDIE, MD, FWHF,
SIMEON-PIERRE CHOUKEM, MD
Universite Université des Montagnes, Bangangte,
Cameroon
ABDOUL K ADAM, MD
Department of Medicine, University of Cape Town and
Medical Research Council, Cape Town, South Africa
ANDRE P KENGNE, MD, PhD
Diabetes and Endocrine Service, Yaoundé Central Hospital
and Faculty of Medicine, Cameroon
PATRICIA GOUKING, MD
MESMIN DEHAYEM, MD
JEAN-CLAUDE MBANYA, MD, PhD
Department of Internal Medicine, Yaoundé Faculty of
Medicine, Cameroon
SOLANGE DOUALLA, MD
HENRY LUMA, MD
JEAN-CLAUDE MBANYA, MD, PhD
SAMUEL KINGUE, MD
