Page 30 - 4th All African Conference on Heart Disease, Diabetes and Stroke

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013 28 AFRICA
affections médicales aiguës et 39 les facteurs de risque de MTEV
comme indications de la prévention des MTEV. Les affections
médicales aiguës les plus citées étaient l’AVC (11), l’insuffisance
cardiaque aigue (9), l’IDM (6) et les maladies infectieuses (5).
Les facteurs de risques de MTEV cités étaient l’immobilisation
prolongée (31), l’obésité (28), les antécédents de MTEV (8) et l’âge
supérieur à 40 ans (8). Les moyens physiques pour la prévention de
la MTEV cités étaient: lever précoce (35 médecins), mobilisations
active et passive (37), compression veineuse (27), compression pneu-
matique intermittente (6), pansement alcoolisé (3) et surélévation des
membres (19). Les moyens médicamenteux cités étaient: HBPM (38
médecins), HNF (12), AVK (27), antiagrégants plaquettaires (25) et
veinotoniques (5). 26 praticiens considéraient que la prévention de la
MTEV doit commencer dès J1. La durée de la prévention se ferait
durant toute l’hospitalisation (20). Seulement 4 médecins pratiquai-
ent toujours la prévention, 21 pratiquaient souvent et 14 pratiquaient
rarement.
Interpretation: La survenue de la MTEV en médecine est relative-
ment connue des médecins à Lomé. Mais sa prévention est mal connue
et insuffisamment pratiquée par ceux-ci. D’où la nécessité d’organiser
les formations médicales continues et d’établir des plates formes.
DO ENVIRONMENTAL FACTORS, INCLUDING SLEEPING
PATTERNS, AFFECT THE PREVALENCE OF OBESITY IN
AN URBAN AFRICAN POPULATION?
Pretorius S*, Sliwa K, Stewart S, Carrington M, Crowther NJ
Soweto Cardiovascular Research Unit, University of the
Witwatersrand, Johannesburg, South Africa
Introduction: Urbanisation and the nutrition transition in South
Africa are accompanied by an increase in CVD risk factors, particu-
larly obesity, in African populations. Furthermore, environmental
factors other than food intake and urbanisation are also known to
affect the prevalence of obesity. The aim of this study was to examine
the relationship of these environmental factors (education, employ-
ment, exercise, smoking, sleeping patterns) with obesity in an urban
population of African subjects.
Subjects and methods: We systematically collected data on 1 311
consecutive patients attending two pre-selected primary health care
clinics in Soweto, South Africa. Education, employment status, level
of exercise, smoking habits and variables related to sleep duration
were obtained using questionnaires. Weight and height were meas-
ured using standard procedures and body mass index (BMI) was
calculated.
Results: The prevalence of obesity was 45.4% in females and 11.3%
in males. A multiple regression model was designed using variables
that correlated with BMI in a univariate analysis with p <0.20. These
variables were: age, gender, smoking, education, employment status,
exercise, time of going to bed and daytime napping. Backward, step-
wise multiple regression analyses demonstrated that of these vari-
ables the principal determinants of BMI (log) were: age (beta=0.003,
p <0.0001), female gender (beta=0.07, p<0.0001), smoking (beta=-
0.03, p<0.0001) and napping during the day (beta=-0.015, p=0.04).
An ANCOVA adjusted for gender and age demonstrated that subjects
who currently smoked had a lower BMI (median [interquartile range
(IQR)]: 22.6 [5.6]) than both non- (27.6 [10.5]; p<0.0001) and
ex-smokers (25.1 [12.7]; p<0.0005).
Interpretation: Our data further confirm the higher prevalence of
obesity in females than males. The negative effect of smoking on
BMI has been reported in other studies, and suggests that after smok-
ing cessation precautions should be taken to reduce weight gain. The
lower BMI in subjects who nap during the day is a novel finding and
requires further investigation.
PROGNOSTIC VALUE OF PULSE WAVE VELOCITY IN
SICKLE CELL DISEASE: THE CADRE STUDY
Ranque B*, Jouven X, et al.
Cardiology and Internal Medicine Departments, Hopital Européen
Georges Pompidou and Laboratory of Cardiovascular Epidemiology,
Inserm 970, Paris, France
Introduction: Sickle cell disease (SCD) is one of the most common
monogenic disorders worldwide. SCD is not only responsible for
acute vaso-occlusive events but also for chronic vasculopathy that
can affect many organs. It has been suggested that SCD vasculopathy
results from chronic haemolysis, but haemolysis markers have not
been consistently associated with vascular complications. Moreover,
cardiovascular events have been almost exclusively studied in the
USA or in Europe, although more than 80% of SCD patients are
living in sub-Saharian Africa, in a different environment. We have
selected the world’s largest SCD cohort to study the incidence and
predictive factors of vascular complications in Africa.
Subjects and methods: A multinational cohort of SCD patients
is ongoing in Cameroon, Gabon, Ivory Coast, Mali and Senegal.
Subjects undergo clinical exam, blood and urine sampling for haema-
tological and renal parameters, pulse wave velocity (PWV) measure-
ments and echocardiography.
Results: By the end of 2012, 3 450 SCD patients and 750 controls
had been recruited. We evidenced lower PWV in SCD patients
as compared to controls (femoral PWV: 7.8 [7–8.8] versus 9.5
[8.4–10.7] m/s), persisting after adjustment for sex, age, blood pres-
sure (BP) and body mass index (BMI) (p<0.001). In SS patients,
PWV independently correlated with age (p<0.001), BP ( p<0.001),
haemoglobin (p=0.01) but not with LDH or bilirubin. Patients
with severe genotypes (SS, Sbeta0) had lower PWV than others
(SC, Sbeta+), even after adjustment for age, BP and haemoglobin
(p<0.001). In SCD patients, the frequency of acute crises was posi-
tively correlated with PWV (p =0.04), after adjustment for age, BP,
haemoglobin, and genotype. In contrast, PWD was not associated
with pulmonary hypertension, glomerulopathy, stroke, osteonecrosis,
priapism or ulcers, but this may be due to survival bias since most
African SCD patients die during childhood.
Interpretation: CADRE cohort will provide valuable data on the
incidence of chronic vascular events in African SCD patients. PWV
is significantly lower in SCD patients than in controls but may corre-
late positively with the vascular severity in each SCD subpopulation.
The prognostic value of PWD and haemolysis markers has to be
further established in the follow-up study.
PERCEPTION DU DIABETE PAR LES PATIENTS SUIVIS
EN CONSULTATION EXTERNE DE CARDIOLOGIE DU
CENTRE HOSPITALIER ET UNIVERSITAIRE GABRIEL
TOURE
PERCEPTION OF DIABETES MELLITUS BY PATIENTS
FOLLOWED AT THE CARDIOLOGY OUTPATIENT
DEPARTMENT OF THE GABRIEL TOURE UNIVERSITY
TEACHING HOSPITAL
Bâ HO, Sangaré I*, Sidibé Noumou, Menta Ichaka, Berthé M,
Mariko B, Touré M, Traoré A, Sogodogo A, Sanogo K
Cardiologue au Centre National de Cardiologie, Faculté de Médecine,
Université de Nouakchott, Mauritanie
Introduction: Le rôle délétère du diabète sur le système cardio-
vasculaire a été depuis longtemps établi de même que son inci-
dence croissante dans les pays sous-développés, d’où la nécessité
d’informer pour prévenir. Cette prévention suppose aussi l’évaluer la
perception de la maladie par les populations. La rareté des données
sur le sujet a motivé la réalisation de cette étude pour étudier la
perception du diabète chez des patients ambulatoires.
Subjects and methods: L’étude transversale sur un échantillon de
458 patients des 2 sexes et âgés d’au moins 15 ans, a été réalisée au
CHU Gabriel Touré du 1er Décembre 2009 au 31 Janvier 2010. Une
fiche d’enquête établie a servi de support de collecte, les données ont
été traitées par Excel puis analysées avec SPSS v12.
Results: Le sex-ratio Homme: Femme était de 0.53, les moyennes
pour l’âge et l’IMC respectivement de 51.52 ans et 25.21 kg/m2. Les