Burden of cardiometabolic risk factors and preclinical target organ damage among adults in Freetown, Sierra Leone: a community-based health-screening survey.

OBJECTIVE: To investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage (TOD) and its associated factors among adults in Freetown, Sierra Leone. DESIGN: This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants. SETTING: The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Sierra Leone. PARTICIPANTS: A total of 2394 adult Sierra Leoneans aged 20 years or older were enrolled. OUTCOME MEASURE: Anthropometric data, fasting lipid profiles, fasting plasma glucose, TOD, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to TOD. RESULTS: The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidaemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by ECG, 14.2% had LVH by two-dimensional echo and 11.4% had chronic kidney disease (CKD). The odds of developing ECG-LVH were higher with diabetes (OR=1.255, 95% CI (0.822 to 1.916) and dyslipidaemia (OR=1.449, 95% CI (0.834 to 2.518). Associated factors for higher odds of Left Ventricular Mass Index by echo were dyslipidaemia (OR=1.844, 95% CI (1.006 to 3.380)) and diabetes mellitus (OR=1.176, 95% CI (0.759 to 1.823)). The odds of having CKD were associated with diabetes mellitus (OR=1.212, 95% CI (0.741 to 1.983)) and hypertension (OR=1.163, 95% CI (0.887 to 1.525)). A low optimal cut-off point for ECG-LVH (male 24.5 mm vs female 27.5 mm) was required to maximise sensitivity and specificity by a receiver operating characteristics curve since the odds for LVH by ECG were low. CONCLUSIONS: This study provides novel data-driven information on the burden of CMRF and its association with preclinical TOD in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management in Sierra Leonean.

Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Ivabradine is a heart rate-lowering drug that selectively inhibits the funny (If) current of the sinoatrial node. It is currently recommended in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in sinus rhythm and a heart rate of ≥ 70 beats per minute (bpm) at rest. To investigate whether ivabradine has an effect on diastolic dysfunction, exercise tolerance and quality of life (QOL), we conducted a systemic review and meta-analysis of randomized controlled trials (RCTs). METHODS: We searched PubMed, EMBASE and Cochrane Central Register of Clinical Trials for studies on the effect of ivabradine on left ventricular (LV) diastolic dysfunction, exercise tolerance, QOL, readmission for worsening HF and mortality in both patients with HF with preserved ejection fraction (HFpEF) and HFrEF. RESULTS: Thirteen RCTs with 881 patients met the inclusion criteria. According to the pooled analysis, for the HFpEF subgroup, treatment with ivabradine resulted in a decrease in early diastolic mitral inflow to late diastolic flow ratio (E/A) (standardized mean difference (SMD): -0.53; 95% confidence interval (CI): -0.99, -0.07; P < 0.000) and increase in peak oxygen uptake during exercise (VO2) (SMD: 0.05; 95% CI: -0.35, 0.45; P < 0.00; I2 = 95.1%). Similar effect was seen in the HFrEF subgroup with decrease in E/A ratio (SMD: -0.33; 95% CI: -0.59, -0.06; P < 0.000) and early diastolic mitral inflow to annular velocity ratio (E/e') (SMD: -1.01; 95% CI: -1.49, -0.54; P < 0.012). Ivabradine therapy increased peak VO2 and 6-min walk test (6MWT) in HFrEF patients (SMD: 0.83; 95% CI: 0.35, 1.32; P < 0.00; I2 = 97.5% and SMD: 1.11; 95% CI: 0.82, 1.41; P < 0.000, respectively). There was also significant reduction in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (SMD: -0.68; 95% CI: -0.91, -0.45; P < 0.000). However, there was no significant difference in readmission for worsening HF and all-cause mortality between ivabradine and control (risk ratio (RR): 1.44; 95% CI: 0.73, 2.16; P < 0.148 and RR: 0.76; 95% CI: 0.19, 1.33; P < 0.907, respectively). CONCLUSIONS: Ivabradine therapy is associated with improved LV diastolic function, increases exercise tolerance and hence QOL, but it has no significant effect on readmission for worsening HF and all-cause mortality.