Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country

BACKGROUND: The prevalence of hyperuricemia has rarely been investigated in developing countries. The purpose of the present study was to investigate the prevalence of hyperuricemia and the association between uric acid levels and the various cardiovascular risk factors in a developing country with high average blood pressures (the Seychelles, Indian Ocean, population mainly of African origin). METHODS: This cross-sectional health examination survey was based on a population random sample from the Seychelles. It included 1011 subjects aged 25 to 64 years. Blood pressure (BP), body mass index (BMI), waist circumference, waist-to-hip ratio, total and HDL cholesterol, serum triglycerides and serum uric acid were measured. Data were analyzed using scatterplot smoothing techniques and gender-specific linear regression models. RESULTS: The prevalence of a serum uric acid level >420 μmol/L in men was 35.2% and the prevalence of a serum uric acid level >360 μmol/L was 8.7% in women. Serum uric acid was strongly related to serum triglycerides in men as well as in women (r = 0.73 in men and r = 0.59 in women, p < 0.001). Uric acid levels were also significantly associated but to a lesser degree with age, BMI, blood pressure, alcohol and the use of antihypertensive therapy. In a regression model, triglycerides, age, BMI, antihypertensive therapy and alcohol consumption accounted for about 50% (R2) of the serum uric acid variations in men as well as in women. CONCLUSIONS: This study shows that the prevalence of hyperuricemia can be high in a developing country such as the Seychelles. Besides alcohol consumption and the use of antihypertensive therapy, mainly diuretics, serum uric acid is markedly associated with parameters of the metabolic syndrome, in particular serum triglycerides. Considering the growing incidence of obesity and metabolic syndrome worldwide and the potential link between hyperuricemia and cardiovascular complications, more emphasis should be put on the evolving prevalence of hyperuricemia in developing countries

Primary Medical Care in Seychelles

This paper describes some of the current health problems faced by a tropical country whose standard of living and lifestyle is approaching that of many countries in Western Europe. Long-term health problems such as cardiovascular diseases and diabetes have become at least as important as infectious diseases. A change in approach to a more proactive style of primary care is needed to allow the contribution of community doctors to be effective. The system of primary care in the Republic of Seychelles is based on the UK model of general practice where recent improvements in education and organization are raising standards. How some of these improvements might be transferred elsewhere is discussed.</p

The Seychelles Heart Study II: methods and basic findings.

Cardiovascular disease (CVD) has become the leading cause of death in Seychelles and a previous survey in 1989 showed high levels of several major CVD risk factors. A second population survey, the Seychelles Heart Study II, was carried out to (1) examine trends in population levels of CVD risk factors, (2) investigate selected CVD outcomes, and (3) examine selected other variables related to CVD such as knowledge, attitudes and practices (KAP) related to chronic diseases and indicators of impact of an ongoing prevention program. The study was conducted between July and December 1994 on a sex- and age-stratified random sample of the Seychelles population aged 25-64 years. Overall, 1067 (87.0%) out of the eligible 1226 individuals attended the study. All participants were administered a face-to-face structured interview, a rapid physical examination, an electrocardiography and a blood collection. A thorough echocardiography and a high-performance ultrasonographic investigation of the carotid and femoral arteries were performed in a random subsample of approximately half of the participants. This paper details the methods and sampling procedures used in the survey and provides relevant background variables including socio-economic variables, dietary habits, and KAP data relevant to CVD. The distribution in the population of important CVD risk factors is also provided including blood pressure, smoking habits, total cholesterol, HDL-cholesterol, lipoprotein(a), apoproteins, impaired glucose intolerance, physical activity, body mass index, and alcohol consumption. Electro-cardiographic data, prevalence in the population of atherosclerotic plaques in the carotid and femoral arteries, as well as selected echocardiography indices including left ventricular hypertophy are presented

The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles

Objective: To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries. Design: A Markov chain cohort simulation. Subjects: Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy. Intervention: Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling. Main outcome measures: Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications. Results: Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was US$599 for gum and$227 for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: $3712 for nicotine gum,$1982 for nicotine patch, $4597 for nicotine spray,$4291 for nicotine inhaler, and $1324 for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality. Conclusion: Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices

High prevalence of cardiovascular risk factors in the Seychelles (Indian Ocean).

In recent years, increasingly high rates of cardiovascular diseases have been recorded in the Seychelles. A survey was performed to investigate the prevalence of cardiovascular risk factors in that population, which is shifting from its traditional habits to a westernized lifestyle. The Seychelles population is of predominantly black African origin. A sex- and age-stratified random sample of 1,309 subjects was drawn from 21,256 people aged 25-64 years. A response rate of 86% was achieved. The data showed a high prevalence of hypertension (25%) and cigarette smoking (54%) in men and a high prevalence of hypertension (20%) and obesity (21%) in women. Hypercholesterolemia (greater than 6.5 mmol/l) was found in 9% of men and 15% of women. High density lipoprotein cholesterol levels (mean +/- SD) were higher in men (1.42 +/- 0.49 mmol/l) than in women (1.36 +/- 0.34 mmol/l). High levels of lipoprotein(a) (mean +/- SD) were found both in men (319 +/- 362 mg/l) and women (328 +/- 415 mg/l). The high prevalence of cardiovascular risk factors identified in the Seychelles indicates a pressing current need for effective preventive strategies

Plasma aldosterone is independently associated with the metabolic syndrome.

The aim of this study was to analyze the associations of plasma aldosterone and plasma renin activity with the metabolic syndrome and each of its components. We analyzed data from a family based study in the Seychelles made up of 356 participants (160 men and 196 women) from 69 families of African descent. In multivariable models, plasma aldosterone was associated positively (P &lt; 0.05) with blood pressure in older individuals (interaction with age, P &lt; 0.05) and with waist circumference in men (interaction with sex, P &lt; 0.05) and negatively with high-density lipoprotein cholesterol, in particular in individuals with elevated urinary potassium excretion (interaction with urinary potassium, P &lt; 0.05); plasma renin activity was significantly associated with triglycerides and fasting blood glucose. Plasma aldosterone, but not plasma renin activity, was associated with the metabolic syndrome per se, independently of the association with its separate components. The observation that plasma renin activity was associated with some components of the metabolic syndrome, whereas plasma aldosterone was associated with other components of the metabolic syndrome, suggests different underlying mechanisms. These findings reinforce previous observations suggesting that aldosterone is associated with several cardiovascular risk factors and also suggest that aldosterone might contribute to the increased cardiovascular disease risk in individuals of African descent with the metabolic syndrome