Page 26 - 4th All African Conference on Heart Disease, Diabetes and Stroke

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013 24 AFRICA
BLOOD PRESSURE GRADIENTS AND CARDIOVASCULAR
RISK FACTORS IN URBAN AND RURAL POPULATIONS
IN ABIA STATE, SOUTH EASTERN NIGERIA, USING THE
WHO STEPWISE APPROACH
Ogah OS*, Okpechi IG, Chukwuonye II, Tiffin N, Madukwe O,
Onyeonoro UU, Umeizudike T
Department of Medicine, University College Hospital, Ibadan,
Nigeria
Introduction: Developing countries of sub-Saharan Africa (SSA)
face a double burden of non-communicable diseases (NCDs) and
communicable diseases. As high blood pressure (BP) is a common
global cardiovascular (CV) disorder associated with high morbidity
and mortality, the relationship between gradients of BP and other CV
risk factors was assessed in Abia state, Nigeria.
Subjects and methods: Using the WHO STEPwise approach
to surveillance of chronic disease risk factors, we conducted a
population-based cross-sectional survey in Abia state, Nigeria. Data
collected at various steps included: demographic and behavioural
risk factors (Step 1); BP and anthropometric measurements (Step 2)
and blood cholesterol and fasting blood glucose (Step 3).
Results: Of the 2 983 subjects with complete data for analysis,
52.1% were females and 53.2% were rural dwellers. Overall, the
distribution of selected CV disease risk factors was diabetes (3.6%),
hypertension (31.4%), cigarette smoking (13.3%), use of smokeless
tobacco (4.8%), physical inactivity (64.2%) and being overweight or
obese (33.7%). Presence of hypertension, excessive intake of alco-
hol, smoking (cigarette and smokeless tobacco) and physical inac-
tivity occurred more frequently in males than in females (p <0.05);
while low income, lack of any formal education and use of smokeless
tobacco were seen more frequently in rural dwellers than in those
living in urban areas (p <0.05). The frequency of selected CV risk
factors increased as BP was graded from optimal, normal to hyper-
tension, and high BP correlated with age, gender, smokeless tobacco,
overweight or obesity, annual income and level of education.
Interpretation: Given the high prevalence of hypertension in this
part of Nigeria, there is an urgent need to focus on the reduction of
preventable CV risk factors we have observed to be associated with
hypertension, in order to effectively reduce the burden of NCDs in
Africa.
CARDIOVASCULAR RISK FACTORS AND NON-COMMU-
NICABLE DISEASES IN ABIA STATE, NIGERIA: REPORT
OF A COMMUNITY-BASED HOUSE-TO-HOUSE SURVEY
Ogah OS*, Madukwe OO, Onyeonoro UU, Chukwuonye II, Ukegbu
AU, Akhimien MO , Okpechi I
Department of Medicine, University College Hospital, Ibadan,
Nigeria
Introduction: The aim of this survey was to determine the burden
of NCDs, as well as associated risk factors, in the state using the
WHO stepwise approach. It is believed that information obtained
will provide the basis for policies, plans and programmes, as well
as evolve strategies in designing, implementing and evaluation of
appropriate interventions that are geared towards controlling them.
Subjects and methods: A stratified cluster sampling technique was
used to select the study participants. The target population were
adult men and women aged 18 years and above who are resident in
the state. WHO-STEPs questionnaire was used for data collection.
Respondents had their biophysical parameters measured: weight,
height, waist circumference, hip circumference, pulse rate and blood
pressure. Biochemical parameters measured were blood glucose and
lipids.
Results: A total of 2 999 respondents participated in the study.
Women constituted 52.1% and the mean age of the entire popula-
tion was 41.7 ± 18.5 years with the majority in the 20–29-years
age group. Three hundred and eighty-seven respondents had ever
smoked cigarettes, 373 men and 14 women; 55.8% had ever used
alcohol, 84.2% of these did so in the last year. Drinking alcohol was
commoner in men (67.9%), urban dwellers, and those within the
age group of 20–52 years. Many of the respondents (65.5%) were
engaged in sedentary work. Over 80% of our population are aware
of cancer. Hypertension was present in 31.8% and diabetes mellitus
in 3.6%. Obesity was present in 13.8% while low HDL-cholesterol
was detected in 54.1%. Care-seeking behaviour and traffic safety
were rated as poor.
Interpretation: The study showed current prevalence of modifiable
risk factors for cardiovascular diseases in Abia state. A suggestion
is made for the establishment and strengthening of NCDs surveil-
lance systems in the state and standardisation of data collection on
risk factors, disease incidence and mortality by cause. Surveillance
of NCDs and associated risk factors using the WHO stepwise
surveillance for NCDs should be ongoing in the state and should be
conducted every 2 years.
SOLUBLE ST2 DETECTS LEFT VENTRICULAR GEOMET-
RIC PATTERNS IN A COHORT OF AFRICAN HYPERTEN-
SIVE SUBJECTS
Ojji DB*, Opie LH, Lecour S, Lacerda L, Adeyemi BM, Sliwa K
Cardiology Unit, Department of Medicine, University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria
Introduction: Left ventricular hypertrophy (LVH) may be classified
according to geometric pattern into four types: concentric hyper-
trophy, eccentric hypertrophy, concentric remodelling and normal
geometry. Furthermore, the prevalence of death or cardiovascular
complications associated with hypertension depends on the particular
geometric pattern. Soluble ST2 is a novel circulating cardiac biomar-
ker of mechanical strain and a prognostic marker for ischaemic heart
disease and heart failure which is also elevated in hypertension.
Even though soluble ST2 levels are increased in hypertension, the
relationship with hypertensive LV geometric patterns has not been
studied. We therefore studied the relationship between soluble ST2
and different left ventricular (LV) geometric patterns in a cohort of
African hypertensive subjects.
Subjects and methods: Echocardiography was performed on each
of the 133 subjects. LVH was considered present when the LV mass
index exceeded 49.2 g/m 2.7 in men and 46.2 g/m 2.7 in women.
Concentric hypertrophy was the commonest geometric pattern in our
study cohort.
Results: Subjects with concentric hypertrophy had higher soluble
ST2 levels compared to those with normal geometry (20.4 ± 8.4 v.
14.3 ± 5.4, p-value <0.002), ST2 levels were tightly linked to specific
echocardiographic parameters.
Interpretation: LVH not only increased the serum levels of ST2 in
African hypertensive subjects, but the concentration of soluble ST2
was linked to the geometric abnormalities. Therefore, soluble ST2
may be a future biomarker pointing to an increased LV mass relative
to the severity of hypertension.
THE SPECTRUM OF HEART DISEASE IN TWO CITIES IN
SUB-SAHARAN AFRICA UNDERGOING SOCIO-ECONOM-
IC TRANSITION
Ojji D*, Stewart S, Ajayi S, Manmak M, Jacob A, Sliwa K
Cardiology Unit, Department of Medicine, University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria
Introduction: With rapid westernisation in sub-Saharan Africa,
cardiovascular disease is gradually becoming the major cause of
morbidity and mortality in this part of the world. Unfortunately, there
is still a dearth of data on the pattern of heart disease in sub-Saharan
Africa. We therefore studied the pattern of heart disease in Abuja,
Nigeria and compared our findings with similar data derived from
the Heart of Soweto study.
Subjects and methods: We prospectively studied 1 515 subjects
with confirmed cardiac disease referred to the cardiology clinic of
the University of Abuja Teaching Hospital during a 4-year period.