Spectrum of sub-clinical cardiovascular diseases among adult patients with diabetes in out-patient clinic at the University Teaching Hospital in Zambia
Date
2018
Authors
Gupta, Meenakshi
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
Cardiovascular disease, the major cause of mortality and morbidity in modern societies, is set to overtake infectious diseases in the developing world as the most common cause of death. The increasing prevalence of major and emerging cardiovascular risk factors accounts for this growing burden. Diabetes in all its forms is one of the main cardiovascular risk factors. Two out of three diabetic patients will die because of cardiovascular complications. The association between Diabetes and Cardiovascular disease has been established in many studies. However, information is still lacking on subclinical disease as well as its associated risk factors in this population. This study aimed at establishing the prevalence of subclinical cardiovascular disease (ScCVD) among clinically stable patients with diabetes attending their regular out- patient visits. It also looked at risk factors as well as the association of ScCVD to blood glucose control. A total of 208 diabetic patients from the Outpatient Clinic 5 at the UTH (Lusaka, Zambia) were recruited based on their eligibility. Data collected included demographic characteristics, duration of diabetes, anti-diabetes drug type and cardiovascular risk factors (hypertension, BMI and smoking). Clinical data included blood pressure, BMI, Average Fasting Blood Sugar, Glycated Hemoglobin (HbA1c), Total Cholesterol and Triglycerides. ScCVD was tested using 3 tools: Ankle Brachial Index (ABI) to measure for the presence of peripheral artery disease, 12 lead Electrocardiogram (ECG) for electrical abnormalities and transthoracic Echocardiography (ECHO), to measure abnormalities in cardiac structure and function. Participants characteristics were as follows: the mean age was 54 years (SD±2.99); 160 (77%) were females; mean HbA1c was 9.6% with 75.96% of patients having raised HbA1c. 49.04% of patients were on oral hypoglycemics while 45.67% of the patients were on insulin with a small minority (5.29%) being on both oral and insulin. 61.54% of the patients were known hypertensives. The mean systolic blood pressure was 146mmHg while the mean diastolic pressure was 87mmHg. Both were above the normal blood pressure values. Mean BMI was 27 (±5.09). Use of alcohol was noted to be at 49.52%. High cholesterol was seen in 38.46% of the patients while high triglycerides was seen in only 14.9%. On ECG and ECHO abnormalities were found in 29.81% and 70.87% respectively. The commonest cardiac lesion on ECG and ECHO was T wave abnormality (17.3%) and impaired diastolic dysfunction (49%) respectively with concentric left ventricular hypertrophy being commonly found on both tools (7.2% and 35.4% respectively). Hypokinesia was noted in 5% of patients. Hypertension was found to be
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the only significant confounding factor. We found level of glucose control in our patients in the Out-patient Clinic 5 was poor and prevalence of subclinical Cardiovascular diseases in self-reported healthy diabetic patients was high. We suggest all patients with diabetes presenting to the OPD at UTH do baseline and follow up ECG and Echocardiography until target glycemic control is achieved. A prospective study should be carried out to determine the true nature of ScCVD in patients with tight control of diabetes versus usual level of care.
Keywords: Diabetes, Glycemic control, Subclinical Cardiovascular Disease
Description
Thesis
Keywords
Diabetes--Treatment--Zambia , Cardiovascular disease--Zambia