Gaps in Management of Dyslipidaemia among Physicians in Nigeria: Report of a Web-Based Survey.

BACKGROUND: Dyslipidaemia contributes significantly to globalcoronary artery disease (CAD) and cardiovascular disease. Effective use of statins precludes adequate knowledge of its benefits. This study aimed to determine the gaps in the management of dyslipidaemia among physicians in Nigeria. METHODS: This was a web-based survey of physicians across Nigeria regarding the management knowledge and practice of dyslipidaemia. Analysis was done by SPSS 23.0. P<0.05 was taken as statistically significant. RESULTS: Three hundred and thirteen physicians across Nigeria consisting of 65.4% males responded to the survey. The majority, 57.5% were 25-40 years. While most of the participants (98.3%) believe that elevated LDL-C is an important cause of CAD, there were concerns about statins use and associated increased risk of muscle disorder (63.2%), hepatic disease (37.4%), hemorrhagic stroke (27.2%), cognitive impairment (12.6%) and new-onset diabetes mellitus (19.2%). Similarly, 41.9% of participants have concerns about hemorrhagic stroke while 32.2% also expressed concerns about lowering LDL-C and ischaemic stroke. More than a third (38.2%) indicated that >20% of their patients cannot use statins continuously due to adverse effects such as muscle symptoms, etc. The results obtained when asked about the target of LDLC in patients with or without a history of CAD and diabetes mellitus were as varied as 3-200 mg/dl. CONCLUSION: This study highlights there exist significant gaps in knowledge and practice of the management of dyslipidaemia among experts in Nigeria. Concerted efforts by relevant authorities and societies may be needed to enhance the knowledge and practice of the management of dyslipidaemia in reducing the CV risk among Nigerians.

CONTEXTE: La dyslipidémie contribue de manière significative à la coronaropathie et aux maladies cardiovasculaires dans le monde. L'utilisation efficace des statines ne peut se faire sans une connaissance adéquate de leurs avantages. Cette étude visait à déterminer les lacunes dans la gestion de la dyslipidémie chez les médecins au Nigeria. MÉTHODES: Il s'agit d'une enquête en ligne auprès de médecins nigérians concernant les connaissances et la pratique de la gestion de la dyslipidémie. L'analyse a été effectuée à l'aide de SPSS 23.0. P<0,05 a été considéré comme statistiquement significatif. RÉSULTATS: Trois cent treize médecins du Nigeria, don't 65,4 % d'hommes, ont répondu à l'enquête. La majorité d'entre eux (57,5 %) étaient âgés de 25 à 40 ans. Bien que la plupart des participants (98,3 %) pensent qu'un taux élevé de LDL-C est une cause importante de maladie coronarienne, ils s'inquiètent de l'utilisation des statines et du risque accru de troubles musculaires (63,2 %), de maladies hépatiques (37,4 %), d'accidents vasculaires cérébraux hémorragiques (27,2 %), de troubles cognitifs (12,6 %) et de diabète sucré d'apparition récente (19,2 %) qui y est associé. De même, 41,9 % des participants sont préoccupés par les accidents vasculaires cérébraux hémorragiques, tandis que 32,2 % se disent préoccupés par la réduction du LDL-C et les accidents vasculaires cérébraux ischémiques. Plus d'un tiers (38,2 %) ont indiqué que plus de 20 % de leurs patients ne peuvent pas utiliser les statines en continu en raison d'effets indésirables tels que des symptômes musculaires, etc. Les résultats obtenus lorsqu'on leur a demandé quel était l'objectif du LDL-C chez les patients avec ou sans antécédents de maladie coronarienne et de diabète sucré variaient de 3 à 200 mg/dl. CONCLUSION: Cette étude met en évidence l'existence de lacunes importantes dans les connaissances et la pratique de la prise en charge de la dyslipidémie chez les experts au Nigéria. Des efforts concertés de la part des autorités et des sociétés concernées pourraient être nécessaires pour améliorer les connaissances et la pratique de la prise en charge de la dyslipidémie afin de réduire le risque CV chez les Nigérians. MOTS-CLÉS: Dyslipidémie, gestion, écart de connaissances, médecins, Nigéria.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

Association of microalbuminuria with left ventricular dysfunction in Nigerian normotensive type 2 diabetes patients.

BACKGROUND: Diabetes mellitus (DM) is a risk factor for left ventricular (LV) dysfunction, and microalbuminuria is frequently associated with DM. This study aimed to compare LV function among normotensive type 2 diabetes (T2DM) patients with normoalbuminuria, those with microalbuminuria, and healthy controls. METHODS: This was a cross-sectional study conducted at the diabetes and cardiology clinics of the University of Uyo Teaching Hospital, Uyo, Akwa-Ibom State, Nigeria, from January 2013 to March 2014. Microalbuminuria was tested for using Micral test strips, and echocardiography-derived indices of LV function were compared among the three groups. RESULTS: Sixty-three normoalbuminuric, 71 microalbuminuric T2DM patients and 59 healthy controls were recruited. Mean age of participants was 50 ± 8 years and the three groups were age and gender matched (p = 0.23, p = 0.36, respectively). LV diastolic dysfunction (LVDD) showed a stepwise increase from the healthy controls to the normoalbuminuric to the microalbuminuric T2DM patients (16.9 vs 61.9 vs 78.9%, respectively) (p < 0.001), while E/A ratio and fractional shortening showed a significant stepwise decrease (both p < 0.001). LV systolic dysfunction was rare among the three groups. Microalbuminuria showed a strong direct association with LVDD (OR 3.58, 95% CI: 1.99-6.82, p < 0.001). Age remained independently associated with LVDD (OR 1.10, 95% CI: 1.03-1.17, p = 0.003). CONCLUSION: LV diastolic function was altered in Nigerian normotensive T2DM patients, and the presence of microalbuminuria with DM had additional effects on this abnormality. Early screening for DM and microalbuminuria could identify individuals with high cardiovascular risk and possibly abnormal LV function.