Cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital

Background: Rheumatoid arthritis is associated with excessive cardiovascular morbidity and mortality. This is predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis. Traditional cardiovascular risk factors as well as extra articular disease have been associated with occurrence of myocardial infarction. Objective: To identify cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital and compare with healthy controls. Design: This was a comparative cross sectional survey. Setting: Kenyatta National Hospital medical outpatient clinic. The study population were patients with rheumatoid arthritis and the controls were individuals without RA age and sex matched staff of KNH. All those who consented were enrolled and a clinical evaluation was done as per the study protocol. Results: One hundred patients with RA were screened out of which 80 were enrolled. The prevalence of hypertension among RA patients was 41.3%, diabetes 6.3%, dyslipidemia 71.3%, smoking 5%, obesity 22.5%, abnormal WHR 33.8%, family history of sudden death 5%, no family history of stroke or heart attack was reported. In the control group one hundred and five were screened and twenty five were excluded. The prevalence of hypertension was 22.5%, diabetes 5%, dyslipidemia 73.8%, smoking 2.5%, obesity 32.5%, abnormal WHR 33.8% family history of sudden death 10%, stroke 1.3% no history of heart attack was reported. Eighty percent of patients with RA were on at least one DMARD, 57.5% were on steroids and 37.5% were on NSAIDS. Conclusion: There was a high prevalence of hypertension among RA patients (41.3%) than in the controls (22.5%) and this was statistically significant (OR 2.42 (95 CI 1.22-4.81) P = 0.017). Hypertension was also significantly associated with the use of DMARDS OR 2.189 (95% CI 1.111-4.312) P= 0.022 and steroids OR 2.06(95% CI 1.008-4.207) P= 0.022. No significant difference between patients with RA and controls in other risk factors including diabetes, dyslipidemia, smoking, obesity, abnormal waist hip ratio and family history of cardiovascular events was found. Recommendations: Clinicians should keenly look out for hypertension in patients with RA for early identification and if necessary aggressive management of hypertension. Screening of cardiovascular risk factors in patients with RA should be done routinely and a larger study with normal controls from the general population should be undertaken in order to measure this cardiovascular risk factors and cardiovascular disease in this population. Key words: Cardiovascular, rheumatoid arthritis, Kenyatta National Hospita

Patterns of homocysteine in Kenyans with type 2 diabetes without overt cardiovascular disease at Kenyatta National Hospital, Nairobi

Background: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes. Objective: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. Design: Cross-sectional, prospective study. Setting: Outpatient diabetic clinic of the Kenyatta National Hospital. Subjects: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease. Main outcome measures: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. Results: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85(8.96) years and of the females was 55.68(8.93) years. The mean (sd) total serum homocysteine for males of 12.97(6.06) µmol/l was significantly higher than that of the females of 10.64(4.41) µmol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably. Conclusion: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention. East African Medical Journal Vol. 82(12) 2005: S180-S18

Cardiovascular risk factors in patients with type 2 diabetes mellitus in Kenya: levels of control attained at the outpatient diabetic clinic of Kenyatta National Hospital, Nairobi

Objectives: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them.Design: Prospective, cross-sectional study over a six month period. Setting: Out-patient diabetic clinic of the Kenyatta National Hospital. Subjects: Two hundred and eleven patients with type 2 diabetes. Main outcome measures: Sociodemographic attributes, duration of diabetes, levels of glycaemia, body weight, blood pressure, fasting lipids and modes of treatment. Results: A total of 211 patients were enrolled, 57.3% were females. The mean (SD) age for women was 54.45 (9.44) and that of men was 55.8 (9.02) years. About 77% of the study population were on oral glucose-lowering agents with or without insulin but less than 30% achieved HbA1

Echocardiographic abnormalities in systemic lupus erythematosus patients at Kenyatta National Hospital

Background: The cardiovascular system is frequently affected in patients with Systemic Lupus Erythematosus (SLE). Involvement of the pericardium, endocardium, myocardium, coronary and pulmonary vessels has been found in several clinical and autopsy studies in patients with SLE; most of which can be detected by noninvasive two dimensional and Doppler echocardiography. More than half of SLE patients experience clinical cardiovascular manifestation during the course of the disease and cardiovascular complications are among the leading causes of morbidity and mortality in patients with SLE.Objective: To determine the prevalence and spectrum of cardiac abnormalities; determined by echocardiography in SLE patients at Kenyatta National Hospital (KNH).Methods: This was a cross-sectional descriptive study of SLE patients attending clinic at KNH. A targeted history and physical examination and a detailed trans-thoracic echocardiography were performed for all patients. The independent variables included; age, sex, duration of disease and medications. The echocardiogram outcome variables included; pericardial effusion, thickening and calcification, systolic and diastolic dysfunction, mitral valve thickening, stenosis and regurgitation, aortic valve thickening, stenosis and regurgitation, and pulmonary hypertension.Results: Sixty three SLE patients participated in the study, the mean age was 36.7 years, with a female to male ration of 20:1 and a meadian duration of disease of 36 months. Over 70% of participants were on at least 2 disease modifying medication. The overall prevalence of echocardiographic abnormalities was 88.9%, the major drivers of this high prevalence being pericardial and valvular thickening. The single moast common cardiac lesion was pericardial thickening at 77.8%. The mitral valve was the most commonly affected valve with 69.8% and 30.2% having mitral thickening and regurgitation respectively. Aortic valve thickening and regurgitation was found in 25.4% and 6.3% of participants respectively. Diastolic dysfunction was found in 50.8% of participants and was found to be associated with older age at diagnosis. Pulmonary hypertension was found in 22.2% of participants.Conclusion: The study demonstrates a high prevalence of cardiac abnormalities among SLE patients despite being on disease modifying medications. Even though the majority of these abnormalities comprised of clinically insignificant pericardial and valvular thickening, the prevalence of valvular insufficiency and pulmonary hypertension are substantially high and relatively higher than the prevalence seen in other studies in the case of pulmonary hypertension

Lipid profile of ambulatory patients with type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi

Background: Patients with type 2 diabetes are at high of cardiovascular events because they have abnormal lipid status compared to their non-diabetic counterparts. Objective: To determine the quantitative lipid profile of ambulatory patients with type 2 diabetes mellitus. Design: Prospective, cross-sectional descriptive study. Setting: Out-patient diabetic clinic of the Kenyatta National Hospital. Subjects: Ambulatory patients with type 2 diabetes but without obvious cardiovascular, renal or foot complications. Results: A total of 213 patients with type 2 diabetes were studied, 56.8% were females. The age range of the study population was 34 to 86 years, mean(sd) age of females was 54.45(9.4) years and that of males was 55.83(9.3) years. The mean body mass index (BMI) of females was 27.85(6.2) kg/m2 and 25.98(5.8) kg/m2 for males. The female subjects were more obese than the males in this study. Over 70% of the study participants had total cholesterol >4.2mmol/l, 43.8% and 57.6% of the females and males respectively had LDL-C >2.6 mmol/l , 25.6% of the females and 30% of the males had HDL-C 1.7 mmol/l. The LDL-C showed a significant positive correlation with age, duration of diabetes, fasting blood glucose, and total cholesterol but no correlation with glycated haemoglobin, body mass index, gender and the mode of glucose-lowering treatment. Conclusion: There was significant proportion of quantitative dyslipidaemia in the study population especially with the Total - and LDL- cholesterols. Although treatment goals and lipid thresholds for cardiovascular risk in diabetes are not yet well-defined, even by the large randomized trials, high-risk patients with significant quantitative dyslipidaemia would require deliberate effort to correct the abnormal values to reduce the risk status. These high-risk patients without complications but already had significant dyslipidaemia, which enhances the risk of cardiovascular events, certainly required therapeutic intervention. East African Medical Journal Vol. 82(12) 2005: S173-S17

May measurement month 2018: an analysis of blood pressure screening from Kenya.

Hypertension (HTN) is highly prevalent and the leading cardiovascular risk factor for death globally. A large proportion of individuals with high blood pressure (BP) are unaware leading to under treatment and poor control. To address this, the International Society of Hypertension (ISH) initiated a global mass screening campaign, the May Measurement Month 2017 (MMM17), in which Kenya participated. Following the success of the campaign, its successor MMM18 was launched. Here, we present the Kenyan results for MMM18. Opportunistic screening of consenting adults was done in various sites across Kenya in May 2018, by volunteers trained using ISH material, under the co-ordination of the Kenya Cardiac Society. Blood pressure, pulse rate, weight, and height were measured by standard methods. Definitions of HTN and statistical methods all adhered to the standard MMM protocol. We screened 49 548 subjects, mean age 39.95 (15.3) years. In total, 49.4% had never had a BP measurement taken. After multiple imputation, 17.1% were hypertensive and of those who were hypertensive, 30.7% were aware, 26.6% were on antihypertensive treatment, and 13.0% had controlled BP. Alcohol use, excess weight, and treatment for HTN were associated with higher BP. The Kenyan MMM18 sites successfully screened more than three times the number screened in 2017, hence improving public awareness. Less than half the population had ever had a BP check. Less than a third of the hypertensives were aware with correspondingly poor treatment and control rates. Opportunistic mass screening is useful in raising public awareness

May Measurement Month 2019: an analysis of blood pressure screening results from Kenya

Elevated blood pressure (BP) is the leading cause of global mortality, but control rates remain poor because most patients, especially in Africa, are unaware. May Measurement Month (MMM) is an annual global BP screening campaign that was initiated by the International Society of Hypertension (ISH) in 2017 to raise awareness of raised BP. Following participation in 2017 and 2018, Kenya participated again in 2019 and the results are reported here. Screening was carried out in 30 sites by volunteers coordinated by the Kenya Cardiac Society. Participants had three BP readings by standard methods with the last two being averaged and recorded. Heart rate, weight, height, socio-demographic parameters, and co-morbidities were documented. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg and/or a diastolic BP (DBP) ≥90 mmHg or being on treatment with at least one antihypertensive medication. A total of 33 992 participants were screened, mean age was 42.5 (SD 16.8) years and 58.7% of participants were female. Only 27.3% had their BPs checked within the preceding 12 months. After multiple imputation, 26.1% were hypertensive, of whom 34.5% were aware of their hypertension and 31.5% were on treatment. Of those on treatment, 59.7% were controlled translating to 18.8% of all hypertensives. Being on treatment for hypertension, overweight, obese or having had hypertension in previous pregnancy were associated with increased SBP and DBP, while diabetes was associated with raised SBP. Two-thirds of hypertensives were unaware. Only a third of those aware were on treatment, with about 60% of these controlled. Lack of awareness remains a significant barrier to BP control. Programmes to raise awareness such as MMM are significant in raising population awareness

Rationale and design of the comparison of 3 combination therapies in lowering blood pressure in black Africans (CREOLE study): 2 × 3 factorial randomized single-blind multicenter trial

BACKGROUND: Current hypertension guidelines recommend the use of combination therapy as first-line treatment or early in the management of hypertensive patients. Although there are many possible combinations of blood pressure(BP)-lowering therapies, the best combination for the black population is still a subject of debate because no large randomized controlled trials have been conducted in this group to compare the efficacy of different combination therapies to address this issue. METHODS: The comparison of 3 combination therapies in lowering BP in the black Africans (CREOLE) study is a randomized single-blind trial that will compare the efficacy of amlodipine plus hydrochlorothiazide versus amlodipine plus perindopril and versus perindopril plus hydrochlorothiazide in blacks residing in sub-Saharan Africa (SSA). Seven hundred two patients aged 30-79 years with a sitting systolic BP of 140 mm Hg and above, and less than 160 mm Hg on antihypertensive monotherapy, or sitting systolic BP of 150 mm Hg and above, and less than 180 mm Hg on no treatment, will be centrally randomized into any of the 3 arms (234 into each arm). The CREOLE study is taking place in 10 sites in SSA, and the primary outcome measure is change in ambulatory systolic BP from baseline to 6 months. The first patient was randomized in June 2017, and the trial will be concluded by 2019. CONCLUSIONS: The CREOLE trial will provide unique information as to the most efficacious 2-drug combination in blacks residing in SSA and thereby inform the development of clinical guidelines for the treatment of hypertension in this subregion