Task Sharing and Task Shifting (TSTS) in the Management of Africans with Hypertension: A Call For Action-Possibilities and Its Challenges.

Hypertension is a leading cause of mortality globally and one of the most common risk factors for cardiovascular disease. Diagnosis, awareness, and optimal treatment rates are suboptimal, especially in low- and middle-income countries, with attendant high health consequences and grave socioeconomic impact. There is an enormous gap between disease burden and physician-patient ratios that needs to be bridged. Task sharing and task shifting (TSTS) provide a viable temporary solution. However, sociocultural, demographic, and economic factors influence the effective uptake of such interventions. This review discusses the dynamics of TSTS in the African context looking at challenges, feasibility, and approach to adopt it in the management of hypertension in Africa.

Atrial Fibrillation in Heart Failure: Epidemiology, Quality of Life and Clinical Characteristics in the Iron Deficiency and ANaemia in Heart Failure (IDAN-HF) Study in Ogbomoso, Nigeria.

Background: The cluster of atrial fibrillation (AF) with heart failure (HF) may be associated with a poorer prognosis. Its epidemiology and impact on clinical outcomes and quality of life among HF subjects in Africa have not yet been fully described. This study aimed at describing the epidemiology of AF among HF subjects, its impact on quality of life, clinical characteristics, and associations. Methods: 140 HF subjects were recruited by stratified random sampling method, and 12-lead electrocardiography was done to diagnose AF. Statistical analysis was done with SPSS 21.0. Informed consent was obtained from all participants. Results: The frequency occurrence of AF was 28 (20.0%) of the HF subjects and were similar in age, systolic blood pressure, diastolic blood pressure, right ventricular internal dimension, packed cell volume, and gender distribution with those in sinus rhythm. The mean (S.D) six minutes walk test distance was significantly lower among HF subjects with AF compared to those without AF (171.1± 88.9 vs. 225.8 ± 102.1m respectively, p <0.05). Pulmonary hypertension, intracardiac clots, and kidney dysfunction were more frequent among HF subjects with AF than among those without AF. HF subjects with AF had a higher frequency of clusters of comorbidities than those without AF. AF was most prevalent and left atrial dimension was highest among subjects who had HF with reduced ejection fraction, compared to other HF phenotypes. Conclusion: AF is common in HF among Nigerians and is associated with poor quality of life and poorer functional status compared to those with sinus rhythm.

Prevalence of echocardiographic left atrial enlargement among hypertensive Nigerian subjects.

Background: Left atrial enlargement (LAE) predispose to arrhythmias, atrial thrombogenesis and cardioembolic stroke. Whether LAE constitute a major risk among African hypertensive subjects is not well described. This study was aimed to describe the epidemiologic pattern of LAE among hypertensive subjects and determine their correlates. Methods: Clinical and demographic details of 414 hypertensive subjects used were taken. Echocardiography was done. LAE was defined as Left atrial dimension (LAD)>3.7 cm. Statistical analysis was done using SPSS 17.0. Result: 414 subjects including 258 (62.3%) males were recruited. The mean age was 56.8±16.8 years. LAE was present in 57.73% of hypertensive subjects. Those with LAE were likely to be older (58.23±14.5 vs. 54.8 ±19.7 years, p<0.05), had a higher waist circumference (88.1 ±26.8 ±75.8 ±28.4 cm, p<0.05), left ventricular mass index (79.2 ± 12.4 vs. 48.7 ±15.5g/m2.7, p<0.05) and a higher frequency of left ventricular hypertrophy (LVH) (65.3% vs. 40.0 %, p<0.05) respectively than those without LAE. LAD was significantly higher among those with LVH than those without LVH (41.4 ±8.4 vs. 35.6 ±5.9 mm respectively, p<0.05). Conclusion: LAE is common among Nigerian hypertensive subjects. Age, waist circumference, left ventricular wall dimension and mass index are the important correlates of LAE in hypertensive Nigerians.

Determinants of metabolic syndrome and its prognostic implications among stroke patients in Africa: Findings from the Stroke Investigative Research and Educational Network (SIREN) study.

BACKGROUND: The prognostic implications of metabolic syndrome (METS) among African stroke patients are poorly understood. This study aimed to investigate the determinants of METS and its prognostic implications among Africans with newly diagnosed stroke in the SIREN study. METHODS: We included stroke cases (adults aged >18 years with CT/MRI confirmed stroke). The validated tools comprehensively evaluated vascular, lifestyle, and psychosocial factors. We used logistic regression to estimate adjusted odds ratios (OR) with 95% CIs for the association between METS and risk factors. We also computed the prediction power of the domain of covariates in a sequential manner using the area under the receiver operating curve (ROC) curve. RESULTS: Among 3998 stroke subjects enrolled in the study, 76.8% had METS by at least one of the clinical definitions. Factors associated with METS were age > 50 years (OR- 1.46, CI-1.19-1.80), male gender (OR 4.06, CI- 3.28-5.03), income >100USD (OR1.42, CI-1.17-1.71), stress (OR1.46, CI-1.14-1.87), family history of diabetes mellitus (OR1.38, CI-1.06-1.78), and cardiac disease (OR1.42, CI-1.18-1.65). Stroke severity was higher among those with METS (SLS = 5.8 ± 4.3) compared with those without METS (6.2 ± 4.5) at p = 0.037. METS was associated with higher odds (aOR 1.31, CI-1.08-1.58) of one-month fatality after adjusting for stroke severity, age > 50 years, and average monthly income >100USD. CONCLUSION: METS is very common among African stroke patients and is associated with stroke severity and worse one-month fatality. Lifestyle interventions may prevent METS and attenuate its impact on stroke occurrence and outcomes.

The impact of systemic hypertension on outcomes in hospitalized COVID-19 patients - a systematic review.

Background: Several observational reports from different parts of the world have shown that systemic hypertension (hypertension) was the single commonest comorbid condition in hospitalized COVID-19 patients. Hypertension is also the most prevalent comorbidity reported among patients who developed severe disease, were admitted to Intensive Care Unit, needed mechanical ventilatory support, or who died on admission. The objective of this systematic review is to study the association between hypertension and specific clinical outcomes of COVID-19 disease which are- development of severe COVID-19 disease, need for admission in the intensive care unit (ICU) or critical care unit (CCU), need for mechanical ventilation or death. Methods: We searched the PubMed, SCOPUS, and Google Scholar databases up till June 28, 2020 for original research articles that documented the risk factors of mortality in patients with COVID-19 using the PRISMA guideline. Results: One hundred and eighty-two articles were identified using pre-specified search criteria, of which 33 met the study inclusion criteria. Only three were prospective studies. Most studies documented hypertension as the most prevalent comorbidity. The association of hypertension with development of severe COVID-19 disease was not conclusive, majority of studies however found an associated with mortality. Conclusion: Hypertension affects the clinical course and outcome of COVID-19 disease in many cohorts. Prospective studies are needed to further understand this relationship.

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

BACKGROUND AND PURPOSE: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. METHODS: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. RESULTS: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001). CONCLUSIONS: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

Assessment of Ventricular Repolarization in Sickle Cell Anemia Patients: The Role of QTc Interval, Tp-e Interval and Tp-e/QTc Ratio and Its Gender Implication.

BACKGROUND: Many specific and non-specific electrocardiographic abnormalities including ventricular arrhythmias have been reported in subjects with sickle cell anemia (SCA). In SCA patients, cardiac electrical abnormalities may be the leading cause of increased risk of arrhythmias. The corrected QT (QTc) interval, peak to the end of the T wave (Tp-e) interval and associated Tp-e/QTc ratio are promising measures of altered ventricular repolarization and increased arrhythmogenesis risk. AIM: This study assessed ventricular repolarization abnormalities in subjects with SCA using the QTc interval, Tp-e interval and Tp-e/QTc ratio, and also evaluated the gender differences in these parameters, as well as their determinants. METHODS: Sixty subjects with SCA and 60 healthy control subjects, matched for age and gender, were studied. All participants underwent physical examination, hematological and biochemical evaluation, and 12-lead electrocardiography (ECG) recording. QT and Tp-e intervals were measured from the ECG, and the QTc interval was calculated using Bazett's formula. Tp-e/QT and Tp-e/QTc ratios were also derived. RESULTS: QT and QTc intervals were prolonged in subjects with SCA. Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were prolonged in male SCA subjects, with a paradoxical shortening in female SCA subjects. Plasminogen activator inhibitor-1 (PAI-1) was an independent determinant of QTc, while body mass index (BMI) was an independent determinant of both Tp-e interval and Tp-e/QTc ratio. CONCLUSION: Our results suggest an elevated risk for ventricular arrhythmogenesis in male SCA subjects. Furthermore, increased BMI and PAI-1 level are possible markers of ventricular repolarization abnormalities in SCA subjects.

Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study.

Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1-month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1-month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1-month disability (unadjusted relative risk, 1.80; 95% CI , 0.97-5.73). Severe LV systolic dysfunction was significantly associated with increased 1-month mortality (unadjusted relative risk, 3.05; 95% CI , 1.36-6.83). Conclusions Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.

Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action.

INTRODUCTION: Stroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA. PURPOSE: In this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education. METHODS: Stroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman's Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes. RESULTS AND DISCUSSION: The major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana.

Lung function abnormalities among garri processing workers in Ogbomoso, Nigeria.

BACKGROUND: Local production of garri (cassava crisps) is associated with air pollution and consequently lung function abnormalities among garri processing workers. This study was aimed at describing lung function abnormalities among Nigerians engaged in cassava crisps (garri) processing. METHODS: A total of 351 workers and 351 controls were recruited at garri factories in Ogbomoso, Nigeria by multistage random sampling technique. Lung functional abnormalities were defined according to standardised European Respiratory Society/American Thoracic Society guidelines. Data analysis was performed using the IBM SPSS statistics version 22.0. RESULTS: The mean age of patients was similar to that of controls (41.7 ± 14.9 vs. 41.6 ± 14.7 yearsP = 0.960). Larger proportion (46.2%) of cassava crisps factory workers had abnormal ventilatory function parameters compared to 6.8% in controls (P < 0.001). The mean peak expiratory flow among garri factory workers was significantly lower than that of the controls; 268.25 ± 86.20 versus 349.04 ± 97.21 (L/min) (P < 0.001), likewise the mean forced vital capacity (FVC) (litres) and forced expiratory volume (FEV1) (litres) of garri factory workers and controls were significantly lower than those of the controls; 2.55 ± 1.07 versus 2.87 ± 0.79 (P < 0.001) and 2.00 ± 0.76 versus 2.41 ± 0.83 (P < 0.001) with FEV1/FVC ratio of 0.82 ± 0.16 versus 0.87 ± 0.06 (P < 0.001), respectively. The restrictive pattern of ventilatory functional abnormality was predominant among garri factory workers, 92 (26.2%). Sixty-two (17.7%) and 8 (2.3%) of garri factory workers had an obstructive and mixed pattern of ventilatory function abnormalities, respectively. CONCLUSION: Garri processing workers had significant ventilatory function impairment. Preventive strategies should be encouraged to reduce occupational hazards associated with garri processing in Nigeria.

Renin Activity and Aldosterone Assay Among Nigerians with Hypertension and Normotension: An Insight into Normative Values and Clinical Correlates.

OBJECTIVES: Plasma renin activity (PRA) and aldosterone tend to differ between Blacks and Caucasians and studies are very scarce among Africans. We therefore aimed to determine the normative value of plasma renin activity and serum aldosterone among school teachers in Nigeria with normal blood pressure compared with their hypertensive counterparts and relevant clinical/ demographic associations. METHODS: Plasma renin activity and serum aldosterone were measured using the kits provided by Diagnostic Biochem, Canada among randomly selected school teachers recruited as part of a study to assess their total cardiovascular risks. Mean serum values were compared between normotensive and hypertensive participants and were correlated with clinical and demographic parameters. Statistical analysis was done using SPSS 17.0, Chicago, Ill, USA. P <0.05 was taken as statistically significant. RESULT: The mean PRA level of all study participants was 0.80 ± 0.85 ng/mL.h (mean ± SD) while the mean serum level of aldosterone was 93.9 ± 60.9 pg/ml. The mean aldosterone: renin ratio was 446.5 ± 958.2. The frequency of occurrence of hypertension was 29%. Only plasma renin activity was significantly correlated with systolic and diastolic blood pressure, age and the rate pressure product (a measure of cardiovascular risk). The finding of a higher mean PRA among hypertensive subjects is definitely related to the antihypertensive medications being taken including beta blockers and angiotensin converting enzyme inhibitors among others. The prevalence of high aldosterone/ renin ratio which could reflect the proportion of primary aldosteronism was 10.8%. CONCLUSION: Nigerians have a low renin activity compared to their Caucasian counterpart. PRA may be an important determinant of blood pressure among Nigerians. Appropriate drugs that target phenotypic status of PRA and aldosterone may be useful in the management of hypertension and the choice of pharmacotherapy among Nigerians.

Right ventricular function in patients with heart failure in a cardiac clinic in Southwest Nigeria.

BACKGROUND: Right ventricular (RV) function is an important entity in heart failure. Patients with RV dysfunction (RVD) have poorer prognosis and exercise tolerance than those with preserved RV systolic function. Tricuspid annular plane systolic excursion (TAPSE) has been proposed as a simple and reproducible parameter for the qualitative assessment of RV systolic function/ejection fraction (EF). This study aims at describing RV function/RVD among heart failure patients in a specialized cardiac facility in Southwestern Nigeria. MATERIALS AND METHODS: One hundred and thirty-two patients with clinical diagnosis of heart failure were recruited into the study between June 2011 and December 2014. Baseline data, laboratory investigations, electrocardiography, and echocardiography were taken for the participants. RV function was assessed with TAPSE. Statistical analysis was done using Statistical Package for Social Sciences 16.0 (Chicago Ill. USA). P < 0.05 was considered statistically significant. RESULTS: The mean age of study participants was 62.1 ± 14.2 years. RV systolic dysfunction (TAPSE <20 mm) was found in 86 (65.2%) of all patients while moderate-to-severe RVD (TAPSE <15 mm) was found in 26 (19.7%) patients. Those with RVD are more likely to be older and had a larger left ventricular internal diastolic dimension than those without RVD. Systolic blood pressure, diastolic blood pressure, and EF were significantly lower among patients with RVD than those with normal RV function. CONCLUSION: RVD is common and is associated with more advanced heart failure and possibly worse prognosis among Nigerians with heart failure. Screening for RVD is encouraged to identify and aggressively treat to reduce the associated increased mortality.

Association between insulin resistance and total plasma homocysteine levels in type 2 diabetes mellitus patients in south west Nigeria.

AIM: To determine the levels of serum homocysteine and its association with insulin resistance among T2DM patients at Obafemi Awolowo University Teaching Hospital, Ile Ife Nigeria. METHODS: It was a cross sectional study. It involved consecutive recruitment of 100 T2DM subjects with 100 age and sex matched controls. The fasting plasma glucose, serum creatinine, fasting lipid profile, glycosylated haemoglobin levels, fasting serum insulin and plasma homocysteine concentration were done. Insulin resistance was also determined. SPSS version 17.0 was used for data analysis. RESULTS: The mean age of subjects was not significantly different from controls. (58.9±8.3 vs. 59.0±8.3years, p=0.926 respectively). Mean Homocysteine level (tHcy) was significantly higher among T2DM subjects compared to controls (27.4±12.1 and 8.3±3.2µmol/L respectively, p=0.0001). Hyperhomocystinaemia was commoner among diabetic subjects compared with controls (81% vs. 5%, p<0.0001). T2DM with hyperhomocystinaemia were more likely to have poorer glucose control profile using glycated haemoglobin (7.4±1.9 vs 6.4±1.4%, p=0.04) and fasting blood glucose 8.6±2.2 vs 7.5±2.4mmol/L p=0.047 and insulin resistance (4.4±4.3 vs. 2.0±0.6, p=0.02) compared with T2DM with normohomocystenaemia. There were significant associations between hyperhomocystinaemic T2DM patients and IR, HbA1c, TC, TG and LDL cholesterol. CONCLUSION: The study showed higher homocysteine levels in T2DM than controls. Homocysteine level is worsened by increasing insulin resistance, dyslipidaemia and poor glucose control. Homocysteine level is a potential cardiovascular risk marker in type 2 diabetic mellitus subjects.

Physiological Phenotyping for Personalized Therapy of Uncontrolled Hypertension in Africa.

OBJECTIVES: African and African American hypertensives tend to retain salt and water, with lower levels of plasma renin and more resistant hypertension. We tested the hypothesis that physiological phenotyping with plasma renin and aldosterone would improve blood pressure control in uncontrolled hypertensives in Africa. METHODS: Patients at hypertension clinics in Nigeria, Kenya, and South Africa with a systolic blood pressure >140 mm Hg or diastolic pressure > 90 mm Hg despite treatment were allocated to usual care (UC) vs. physiologically individualized care (PhysRx). Plasma renin activity and aldosterone were measured using ELISA kits. Patients were followed for 1 year; the primary outcome was the percentage of patients achieving blood pressure <140 mm Hg and diastolic <90 mm Hg. RESULTS: Results are presented for the 94/105 participants who completed the study (42 UC, 52 PhysRx). Control of both systolic and diastolic pressures was obtained in 11.1% of UC vs. 50.0% of PhysRx (P = 0.0001). Systolic control was achieved in 13.9% of UC vs. 60.3% of PhysRx (P = 0.0001); diastolic control in 36.1% of UC vs. 67.2% of PhysRx, vs. (P = 0.003). Number of visits and total number of medications were not significantly different between treatment groups, but there were differences across the sites. There were important differences in prescription of amiloride as specified in the PhysRx algorithm. CONCLUSIONS: Physiologically individualized therapy based on renin/aldosterone phenotyping significantly improved blood pressure control in a sample of African patients with uncontrolled hypertension. This approach should be tested in African American and other patients with resistant hypertension. Registered as ISRCTN69440037.

High Frequency of Variants of Candidate Genes in Black Africans with Low Renin-Resistant Hypertension.

OBJECTIVES: Black subjects tend to retain salt and water, be more sensitive to aldosterone, and have suppression of plasma renin activity. Variants of the renal sodium channel (ENaC, SCNN1B) account for approximately 6% of resistant hypertension (RHT) in Blacks; other candidate genes may be important. METHODS: Six candidate genes associated with low renin-resistant hypertension were sequenced in Black Africans from clinics in Kenya and South Africa. CYP11B2 was sequenced if the aldosterone level was high (primary aldosteronism phenotype); SCNN1B, NEDD4L, GRK4, UMOD, and NPPA genes were sequenced if the aldosterone level was low (Liddle phenotype). RESULTS: There were 14 nonsynonymous variants (NSVs) of CYP11B2: 3 previously described and associated with alterations in aldosterone synthase production (R87G, V386A, and G435S). Out of 14, 9 variants were found in all 9 patients sequenced. There were 4 NSV of GRK4 (R65L, A116T, A142V, V486A): at least one was found in all 9 patients; 3 were previously described and associated with hypertension. There were 3 NSV of SCNN1B (R206Q, G442V, and R563Q); 2 previously described and 1 associated with hypertension. NPPA was found to have 1 NSV (V32M), not previously described and NEDD4L did not have any variants. UMOD had 3 NSV: D25G, L180V, and T585I. CONCLUSIONS: A phenotypic approach to investigating the genetic architecture of RHT uncovered a surprisingly high yield of variants in candidate genes. These preliminary findings suggest that this novel approach may assist in understanding the genetic architecture of RHT in Blacks and explain their two fold risk of stroke.

Cardiovascular disease risk factors in a Nigerian population with impaired fasting blood glucose level and diabetes mellitus.

BACKGROUND: Diabetes is a risk factor for cardiovascular diseases (CVDs) and there are reports of increasing prevalence of prediabetes in Nigeria. This study therefore characterised CVDs risk factors in subjects with impaired fasting glucose (IFG) and diabetes. METHODS: Data from 4 population-based cross-sectional studies on 2447 apparently healthy individuals from 18 - 89 years were analysed. Anthropometric, blood pressure and biochemical parameters were collected and classified. Individuals with IFG (prediabetes) and diabetes were merged each for positive cases of dyslipidaemia, high blood pressure (HBP) or obesity. Optimal Discriminant and Hierarchical Optimal Classification Tree Analysis (HO-CTA) were employed. RESULTS: Overall prevalence of IFG and diabetes were 5.8% (CI: 4.9 - 6.7%) and 3.1% (CI: 2.4 - 3.8%), respectively. IFG co-morbidity with dyslipidaemia (5.0%; CI: 4.1 - 5.8%) was the highest followed by overweight/obese (3.1%; CI: 2.5 - 3.8%) and HBP (1.8%; CI: 1.3 - 2.4%). The predicted age of IFG or diabetes and their co-morbidity with other CVD risk factors were between 40 - 45 years. Elevated blood level of total cholesterol was the most predictive co-morbid risk factor among IFG and diabetes subjects. Hypertriglyceridaemia was an important risk factor among IFG-normocholesterolaemic-overweight/obese individuals. CONCLUSION: The higher prevalence of co-morbidity of CVD risk factors with IFG than in diabetes plus the similar age of co-morbidity between IFG and diabetes highlights the need for risk assessment models for prediabetes and education of individuals at risk about factors that mitigate development of diabetes and CVDs.

Metabolic syndrome and occupation: Any association? Prevalence among auto technicians and school teachers in South West Nigeria.

AIMS: To determine occupational association with metabolic syndrome among auto technicians and school teachers. METHODS: One hundred and sixty six subjects were selected for this study. Clinical data was obtained while laboratory investigations including plasma glucose and lipid profile were performed. Statistical analysis was done with SPSS 20.0. P<0.05 was taken as statistically significant. RESULTS: School teachers had significantly higher mean total cholesterol and LDL-cholesterol compared to auto technicians. Mean serum triglycerides was significantly higher among auto-technicians compared to school teachers in this study. The prevalence of some conventional cardiovascular risk factors was significantly higher among auto-technicians compared to school teachers: Impaired blood glucose (9.6% vs. 1.2%, p<0.05), hypertriglyceridaemia (18.1% vs. 7.2%, p<0.05) and low HDL-Cholesterol (47.0% vs. 37.3%, p<0.05) respectively. However elevated LDL-cholesterol (56.6% vs. 32.5%, p<0.05) was significantly more common among school teachers compared to auto-technicians. Based on the WHO and the Harmonized criteria, metabolic syndrome was more frequent among auto-technicians compared to school teachers. (8.4% vs. 1.2% and 19.3% vs. 7.2% respectively, p<0.05) CONCLUSION: The prevalence of metabolic syndrome appears to be significantly higher among auto technicians despite their high level of physical activity, exertion and education compared to teachers. This may be related to the increased occupational exposure to organic and inorganic materials from dust particles, oil and oil related matter and particulate matter among auto technicians. Prompt definitive evaluation of this concept and appropriate health education to encourage safety mechanism can reduce this burden of metabolic syndrome among auto technicians in Nigeria.

Comparison of Neuropsychological Patterns in Nigerians with different Heart Failure Phenotypes.

OBJECTIVE: The aim of this study was to determine the influence of left ventricular dysfunction type on the pattern of neuropsychological dysfunctions among heart failure (HF) subjects. METHOD: A sub-analysis of the data of subjects recruited in a cross-sectional survey of cognitive dysfunction among Nigerians with HF was performed. Cognitive performance on the Community Screening Interview for Dementia (CSI'D), Word List Learning Delayed Recall (WLLDR), Boston Naming Test (BNT), and Modified Token Test (MTT) were compared between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Clinical and echocardiographic correlation analysis with cognitive performance was performed. RESULTS: Subjects with HFpEF were impaired on the WLLDR (71.4% vs. 34.6%, p = .026). The group with HFpEF scored lower on the language domain (definition subscale) of CSI'D (p = .036), and WLLDR (p = .005). The performance on the MTT (p = .185) and BNT (p = .923) were comparable between the two groups. An inverse relationship was found between pulse pressure and delay recall (r = -.565 p = .003) among the cohort with HFpEF whereas body mass index, BMI (r = -.737, p = .023) and tricuspid valve E/A ratio, TVEA (r = -.650, p = .042) showed an inverse relationship with the total CSI'D score in the cohort with HFrEF. CONCLUSIONS: Cognitive dysfunction is largely similar between the two groups. Delay recall is however poorer among subjects with HFpEF. Regular cognitive screening is advocated among HF subjects to prevent non-adherence with therapeutic options.

Volume Measurements in Aortic Root Assessment Using Two-Dimensional Echocardiography.

BACKGROUND: Aortic dilatation is associated with the presence of aortic diseases. Current guidelines for assessing the aortic root (AoR) depend on linear measurements acquired by two-dimensional (2D) echocardiography. We considered that real-time three-dimensional echocardiography, which correlates better with AoR volume obtained by computed tomography, is widely unavailable, and therefore, there is a need to determine the AoR volume using 2D echocardiography. METHODS: Fifty-one consecutive apparently healthy volunteers were recruited and subsequently divided into three age groups. Specified planes of acquisition and previously defined landmarks were identified, and phases of the cardiac cycle that allowed for measurement standardization were used. Volume was determined by the modified Simpson's method. RESULTS: Although the average diastolic and systolic volume measurements of the AoR dimensions were not significantly different across the three age groups in the study population, a highly significant difference was observed in the volume measurements between male and female normotensive persons, P < 0.01 in each case. AoR volume measurements were five times in the diseased compared with the normotensive individuals; however, linear measurements were only 1.5 times in size of the normal individuals. Both point and interval estimates of the volume measurements of AoR in adult normotensives in three age groups were presented as baseline information. CONCLUSIONS: We hereby present a novel way to determine the AoR volume using 2D echocardiography and the normal reference range with respect to age and gender. We also established the relevance of our measurement by comparing the normal population with two isolated diseased aortas.

Maximum accuracy obesity indices for screening metabolic syndrome in Nigeria: A consolidated analysis of four cross-sectional studies.

BACKGROUND: In sub-Saharan Africa, there is no precise use of metabolic syndrome (MetS) definitions and risk factors screening indices in many clinical and public health services. Methods proposed and used in Western populations are adopted without validation within the local settings. The aim of the study is to assess obesity indices and cut-off values that maximise screening of MetS and risk factors in the Nigerian population. METHOD: A consolidated analysis of 2809 samples from four population-based cross-sectional study of apparently healthy persons≥18 years was carried out. Optimal waist circumference (WC) and waist-to-height ratio (WHtR) cut points for diagnosing MetS and risk factors were determined using Optimal Data Analysis (ODA) model. The stability of the predictions of the models was also assessed. RESULTS: Overall mean values of BMI, WC and WHtR were 24.8±6.0kgm(-2), 84.0±11.3cm and 0.52±0.1 respectively. Optimal WC cut-off for discriminating MetS and diabetes was 83cm in females and 85cm in males, and 82cm in females and 89cm in males, respectively. WC was stable in discriminating diabetes than did WHtR and BMI, while WHtR showed better stability in predicting MetS than WC and BMI. CONCLUSION: The study shows that the optimal WC that maximises classification accuracy of MetS differs from that currently used for sub-Saharan ethnicity. The proposed global WHtR of 0.50 may misclassify MetS, diabetes and hypertension. Finally, the WC is a better predictor of diabetes, while WHtR is a better predictor of MetS in this sample population.