Prevalence of Obesity and Cardiovascular Risk Factors Among Type 2 Diabetes Mellitus Patients in Al-Khobar, Saudi Arabia.

BACKGROUND: The prevalence of obesity has grown significantly worldwide. It is considered a major cardiovascular risk factor among type II diabetes mellitus (T2DM) patients. OBJECTIVES: The main objective of this study is to determine the prevalence of obesity in patients with T2DM at King Fahd University Hospital (KFUH), Al-Khobar, and to assess the relationship between T2DM and cardiovascular risk factors with body mass index (BMI) and waist to hip ratio (WHR). METHODS: A retrospective, cross-sectional study, included T2DM patients from the Internal Medicine department at KFHU. The investigators recorded patient demographics (age and gender), weight (kg), height (cm), body mass index (Kg/m2), waist and hip circumference (cm), smoking status, physical activity, blood pressure measurements (mmHg) and laboratory results of fasting blood glucose (FBG), glycated haemoglobin (HbA1c) and lipid profile. RESULTS: Among 346 patients, the prevalence of obesity and overweight was 62.4% and 27.2%, respectively. The relationship between BMI and demographic data including age and gender was statistically significant (P<0.05). The correlation between the BMI with cardiovascular risk factors including smoking, physical activity and WHR found to be statistically significant (P<0.05). CONCLUSION: Our study showed that obesity and overweight affect 89.6% of patients with T2DM. Therefore, it is important to take into consideration weight control strategies to effectively manage diabetic patients.

Prevalence of Microalbuminuria and Cardiovascular Risk Factors in Patients With Diabetes Mellitus Type-II in Al-Khobar, Kingdom of Saudi Arabia.

Background Type 2 diabetes mellitus (T2DM) is a common disorder worldwide. Impaired control of glucose levels predisposes to renal dysfunction, detected by a diagnosis of microalbuminuria. Several other risk factors have been identified in the development of microalbuminuria, such as hypertension, smoking, dyslipidemia, and obesity. Objective Assessment of microalbuminuria and cardiovascular risk factors in type-II diabetic patients who attended the outpatient clinic for the internal medicine department at King Fahd University Hospital, Al-Khobar. Methods A retrospective cross-sectional and an observational study included data from 2014 to 2022 collected from medical records. Patients with diabetes type-II and aged ≥18 years were included. The following were reviewed (age, sex, height, weight, body mass index, waist, hip, waist-hip ratio, systolic and diastolic blood pressure, smoking, sedentary lifestyle, diagnosis of dyslipidemia/hypertension, diabetes duration in years) and laboratory results (fasting blood glucose, HbA1C%, estimated glomerular filtration rate, serum creatinine, serum cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides). Microalbuminuria was measured by the urine albumin to creatinine ratio and was diagnosed if levels were 30-300 mg/g. Results Among 301 studied patients, the prevalence of microalbuminuria was found at 36.8%. The mean age was 57.8 ± 12.6 years, and females were 45%. The mean ± SD fasting blood glucose was 165.9 ± 71.9 mg/dL, while HbA1C% was 8.8 ± 5.6. Microalbuminuria was significantly associated with age, diabetes duration, systolic blood pressure, HbA1C%, fasting blood glucose, and triglyceride levels (p≤0.05).  Conclusion Microalbuminuria in T2DM patients was high in this study, which emphasizes the need for early detection of microalbuminuria. The study suggests the need for effective diabetes control and the prevention of associated cardiovascular risk factors.

Prevalence of Cardiovascular Risk Factors Among Patients With Diabetes Mellitus Type 2 at King Fahad University Hospital, Saudi Arabia.

Background Diabetes mellitus is considered a major risk factor for cardiovascular diseases. Patients with diabetes mellitus type 2 (DM-II) are at twice as high risk for the development of cardiovascular diseases than the general population. Thus, we aimed to assess the most prevalent cardiovascular risk (CVR) factors among DM-II patients in the Eastern province of Saudi Arabia. Method This is a cross-sectional, retrospective, and observational study conducted on DM-II patients at King Fahad University Hospital (KFUH) Al Khobar, Saudi Arabia, from January 2016 to December 2021. The total number of participants was 373 who were patients with DM-II. The patients' demographic information (age, sex, marital status, height, weight, body mass index (BMI), waist, hip circumference, and waist-hip ratio were calculated or obtained from hospital electronic records as were the CVR factors, age, gender, smoking habits, physical activity, BMI, haemodynamic measurements, glycosylated haemoglobin (HbA1C) levels and lipid profile. The collected data were analyzed by using SPSS Statistics v.28 (IBM Corp., Armonk, NY). The descriptive statistics were reported using mean±SD for numerical data and relative frequencies (%) for categorical data. P < 0.05 were counted significant. Quantitative data were analyzed using the ANOVA test to compare the means of the three groups. Qualitative data were analyzed and compared using the chi-square test. Fisher's exact test was also used to study the statistical significance of variables. Spearman rank correlation was used to study the relationship between HbA1C and other CV risk factors.  Results The mean age was 58 (± 13) years; females were 57% of the sample. Around 92% were smokers, 84% had a sedentary lifestyle, 72% had dyslipidemia, 58% were obese, 30% were overweight, 58% reported poorly control of their diabetes, 50% had hypertension and 32% had pre-hypertension. Furthermore, 89% of participants had two or more CVR factors other than DM-II. We found a significant association between high body mass index, dyslipidemia, high systolic blood pressure and pulse pressure (p<0.05) with HbA1C. Conclusion The majority of participants had two or more cardiovascular risk factors in addition to DM-II. Poor control of DM-II and cardiovascular risk factors cannot be ignored and primary to tertiary prevention must be the top priority when managing the diabetic population in order to prevent devastating outcomes and progression of reversible morbidity.

Assessment of Hydration Status and Blood Pressure in a Tertiary Care Hospital at Al-Khobar.

Background High blood pressure is a major cardiovascular risk factor. It is a leading cause of increasing morbidity and mortality worldwide. One-third of the adult population worldwide suffers from hypertension. Salt intake, obesity, decreased physical activity, and smoking are well known to increase blood pressure. Fluid retention is the main contributing factor to primary hypertension and adversely affects the cardiovascular system. The emerging evidence suggests a relationship between blood pressure and hydration status. Our study aims to assess the correlation between hydration status and blood pressure. We aim to assess the hydration status in subjects with normal and high blood pressure and to investigate the association of hydration status with hemodynamic measurement. Methodology This cross-sectional and observational study included adult (>18 years) male and female subjects who agreed to participate. In total, 235 subjects were recruited by convenience sampling from (1) patients and caregivers attending geriatric and internal medicine clinics, and (2) visitors coming to King Fahad University Hospital at Al-Khobar. There were five patients on oral diuretics who were excluded from the study. Data were collected from September 2021 to March 2022. Hydration status was measured by a bioelectrical impedance analyzer (Bioscan 920, Maltron International Ltd. Rayleigh, UK). Hemodynamic measurements included heart rate per minute, systolic blood pressure, diastolic blood pressure, pulse pressure (the difference between systolic and diastolic blood pressure), and mean arterial pressure calculated as blood diastolic pressure plus one-third of pulse pressure. Statistical analyses were performed using SPSS statistics for windows, version 28.0 (IBM Corp., Armonk, NY, USA). Descriptive data were reported using means with standard deviations for numerical data and relative frequencies (percentage) for categorical data. P-values of less than 0.05 were considered statistically significant. Comparison between groups was done using a one-way analysis of variance test. Results Extracellular water percentage was higher in hypertensive (45.0 ± 2) than prehypertensive (43.5 ± 3) or normotensive (43.0 ± 2) (p = 0.001) subjects. In contrast, intracellular water percentage and total body water percentage were significantly negatively related to hypertension status. Conclusions Our results have shown a strong association between hypertension status and hydration parameters. In our study, hypertensive subjects tended to have lower total body water percentage and intracellular water percentage (bioimpedance value) than normotensive subjects. This might promote more research regarding the relationship between hypohydration and cardiovascular disease pathophysiology. This outcome should raise awareness about proper hydration as hypohydration can be a causative factor for hypertension.

Effect of nocturnal hypoxemia on glycemic control among diabetic Saudi patients presenting with obstructive sleep apnea.

Background: Obstructive sleep apnea (OSA) is a prevalent disease that is associated with an increased incidence of type II diabetes mellitus (DM) if left untreated. We aimed to determine the association between glycosylated hemoglobin (HbA1c) levels and both nocturnal hypoxemia and apnea-hypopnea index (AHI) among a Saudi patients with OSA. Methods: A cross-sectional study that enrolled 103 adult patients diagnosed with DM and confirmed to have OSA by full night attended polysomnography between 2018 and 2021. Those who presented with acute illness, chronic obstructive pulmonary disease (COPD)/restrictive lung diseases causing sleep-related hypoxemia, or no available HbA1c level within 6 months before polysomnography were excluded from the study. Univariate and multivariate linear regression analyses between HbA1c levels and parameters of interest were tested. Results: Sixty-seven (65%) of the studied population had uncontrolled DM (HbA1c ≥7%). In univariate regression analysis, there was a significant positive association between HbA1c, and sleep time spent with an oxygen saturation below 90% (T90), female gender, and body mass index (BMI) (p<0.05) but not AHI, or associated comorbidities (p>0.05). In the multivariate analysis, HbA1c was positively associated with increasing T90 (p<0.05), and ODI (p<0.05), but not with AHI (p>0.05). Conclusion: Nocturnal hypoxemia could be an important factor affecting glycemic control in patients with OSA suffering from DM irrespective of the severity of both diseases.

The Association of Blood Glucose Levels and Arterial Stiffness (Cardio-Ankle Vascular Index) in Patients With Type 2 Diabetes Mellitus.

INTRODUCTION:  Diabetes mellitus causes a major burden on healthcare systems all around the world. It has been documented that type 2 diabetes mellitus (T2DM) is associated with long-term vascular complications including micro-vascular, macro-vascular, and mixed-vascular disorders. Several studies have concluded that the increment of arterial wall stiffness is correlated with an increase in the risk of cardiovascular adverse events and the mortality associated with it. AIMS:  This study purposed to evaluate the arterial stiffness measurements, using Cardio-Ankle Vascular Index (CAVI), in T2DM patients, and the relationship with the fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and other factors that may increase the risk of elevated arterial stiffness in T2DM patients. METHODOLOGY:  A total of 200 patients were recruited from the outpatient setting at King Fahd Hospital of the University, Al Khobar. A total of 181 patients fit the inclusion criteria. The charts of the patients who fit the inclusion criteria were reviewed and data related to age, gender, body mass index, smoking history, FBG, HbA1c levels, blood pressure (mmHg) measurements, and CAVI scores were collected. RESULTS:  The elevation in CAVI readings was noted to be more prominent in the senior age group. Hypertensive patients also showed a significant increase in CAVI readings. In addition, higher CAVI readings were more associated with the male gender rather than females. All of which showed a significant correlation. Furthermore, although it was not significant, higher FBG levels and HbA1c readings were correlated with higher CAVI readings. CONCLUSION:  The results of the study suggest that factors like age, smoking status, gender, and the increase in blood pressure as well as the increase in blood glucose levels are correlated with higher CAVI readings in T2DM patients. This demonstrates their important effect on arterial wall stiffness while showing that CAVI can be used in predicting the prognosis of arterial wall health in patients with diabetes.

Seasonal influenza vaccination coverage and its association with COVID-19 in Saudi Arabia.

Coronavirus Disease 2019 (COVID-19) pandemic is still on-going worldwide. The available information regarding the seasonal influenza vaccine (SIV) coverage during the COVID-19 pandemic and its impact on SARS-CoV-2 spread are limited. Moreover, it is argued that SIV may or may not lessen the COVID-19 severity. No previous studies have been revealed SIV coverage among COVID-19 patients and its association with COVID-19 spread and severity, especially in Saudi Arabia. Hence, this study aimed to estimate the influenza vaccine uptake in confirmed COVID-19 patients and investigate its impact on COVID-19 spread and severity. Accordingly, 1734 COVID-19 confirmed patients were included from three government hospitals in Saudi Arabia (SA). The data were collected electronically through a newly formed, self-administrated questionnaire. Among those patients, 335 were covered with SIV (19.31%), and the coverage rate of females and males was 23.4% and 15.8%, respectively. Severe COVID-19 cases were less in vaccinated patients than in non-vaccinated (2.69% vs. 3.5%, respectively). Additionally, the results showed a significant decrease in getting infected by SARS-CoV-2 after receiving SIV (P = 0.022). Even with the tremendous efforts to promote SIV uptake among the general population and high-risk groups, the SIV coverage in SA is not optimal yet. Nevertheless, there is a significant decrease in the probability of getting infected with SARS-CoV-2 after receiving SIV. Such findings with the continuous progression of the COVID-19 pandemic call for a novel approach regarding vaccination policies to increase SIV and COVID-19 vaccine uptake.

Assessment of Cerebrovascular Accident and Transient Ischemic Attack Risk Factors in Elderly vs. Non-Elderly Patients at a Tertiary Care Hospital in Eastern Province, Saudi Arabia.

Background The survivors of cerebrovascular accidents (CVA) or stroke are often left with several mental and physical disabilities which create a major social and economic burden. However, research addressing the risk factors of CVA and transient ischemic attacks (TIA), and their complications are insufficient.  Aim of the study To assess the CVA and TIA risk factors (hypertension, diabetes mellitus type 2, dyslipidemia, coronary artery disease, atrial fibrillation, obesity, hypercoagulopathy, anti-platelet and anticoagulant use, carotid artery stenosis, and hypothyroidism) and complications (pneumonia, urinary tract infection and deep venous thrombosis) among a sample of elderly patients compared to non-elderly adult patients receiving care at King Fahd Hospital of the University in Al-Khobar, Saudi Arabia. Methods A retrospective observational study was conducted at King Fahd Hospital of the University in Al-Khobar, Saudi Arabia. Multiple risk factors and complications of CVA and TIA were retrieved from the medical records of the studied patients that fulfilled the inclusion criteria of patients diagnosed with CVA and TIA aged ≥ 60 years (elderly sample) and 18-59 years old (comparison non-elderly sample), who were followed up by internal medicine, neurology, and geriatric medicine departments. The total participant size was 259 patients, of which 149 were elderly. Results The occurrence of risk factors was more common in the senior age group. Hypertension was the most frequent risk factor in both age groups, while dyslipidemia, atrial fibrillation, and obesity were significantly associated with the development of CVA and TIA in the elderly. Moreover, post-CVA and TIA complications were more frequent in the group with elderly patients, with urinary tract infections being the most reported complication. Conclusion This study concluded that the most frequent risk factors were hypertension and type 2 diabetes mellitus. The findings of this study call for providing extra preventive care for elderly patients with dyslipidemia, atrial fibrillation, and obesity, and for more aggressive prevention of post-CVA and TIA complications in older age groups.

Stroke Prevention Therapy and Prevalence of Risk Factors Among Patients With Atrial Fibrillation at King Fahad University Hospital in Al Khobar: A Retrospective, Single-Center Study.

Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. It represents a significant health impact as it is greatly associated with increased risk of mortality and morbidity, most importantly stroke and systemic thromboembolism.  Aim This study aims to determine the risk factors of atrial fibrillation, to identify stroke and bleeding risk factors among patients with atrial fibrillation, to assess the trend of stroke prevention management and the influence of CHA2DS2-VASc and HAS-BLED scores on choosing the treatment. Methods This study was performed using all the medical records of 395 patients with Atrial fibrillation who were admitted between 2011-2019 at King Fahd University Hospital, Al-Khobar, Saudi Arabia. The review process included demographic data of the patients and the calculation of stroke and bleeding risk by CHA2DS2-VASc and HAS-BLED scores. Results The median age of the population was 72 years old. Hypertension was the most common risk factor for atrial fibrillation (78.2%), followed by diabetes mellitus (61.0%), dyslipidemia (60.0%), coronary artery disease (41.0%), myocardial infarction (18.7%), and congestive heart failure (29.4%). Regarding the management, (42.5%) of the patients were on a combination of both anticoagulants and antiplatelet therapy, while (33.2%) were on anticoagulant therapy only, (17.5%) were on antiplatelets only, and (5.8%) were not on medication. The increased use of anticoagulants and combined therapy was related to the percentage of a high-risk group of thromboembolic events reaching up to (34.5%) and (45.7%), respectively, which is statistically significant. Moreover, the prescription of warfarin declined in the last five years of our study, while the use of non-vitamin K antagonist oral anticoagulants increased. Conclusion Atrial fibrillation is more prevalent in females, hypertension was the most common risk factor for atrial fibrillation, followed by diabetes mellitus, and dyslipidemia. Most of the studied population was categorized as a high risk of stroke and bleeding according to CHA2DS2-VASc and HAS- BLED scores. The majority of the atrial fibrillation patient were taking anticoagulants and combined treatment as a stroke prevention therapy. Non-vitamin K antagonist oral anticoagulant prescription increased over warfarin in recent years.

Sexual Health Implications of COVID-19 Pandemic.

INTRODUCTION: A novel coronavirus (COVID-19) reached pandemic levels by March 11th, 2020, with a destructive impact across socioeconomic domains and all facets of global health, but little is known of its impact on sexual health. OBJECTIVE: To review current knowledge on sexual health-related containment measures during pandemics, specifically COVID-19, and focus on 2 main areas: intimacy and relational dynamics and clinical effects on sexual health. METHODS: We carried out a literature search encompassing sexual health and pandemic issues using Entrez-PubMed and Google Scholar. We reviewed the implications of the COVID-19 pandemic on sexual health regarding transmission and safe sex practices, pregnancy, dating and intimacy amid the pandemic, benefits of sex, and impact on sexual dysfunctions. RESULTS: Coronavirus transmission occurs via inhalation and touching infected surfaces. Currently, there is no evidence it is sexually transmitted, but there are sexual behaviors that pose a higher risk of infectivity due to asymptomatic carriers. Nonmonogamy plays a key role in transmission hubs. New dating possibilities and intimacy issues are highlighted. Sexual activity has a positive impact on the immune response, psychological health, and cognitive function and could mitigate psychosocial stressors. COVID-19 pandemic affects indirectly the sexual function with implications on overall health. CONCLUSION: Increased awareness of health-care providers on sexual health implications related to the COVID-19 pandemic is needed. Telemedicine has an imperative role in allowing continued support at times of lockdown and preventing worsening of the sexual, mental, and physical health after the pandemic. This is a broad overview addressing sexual issues related to the COVID-19 pandemic. As this is an unprecedented global situation, little is known on sexuality related to pandemics. Original research is needed on the topic to increase the understanding of the impact the current pandemic may have on sexual health and function. Pennanen-Iire C, Prereira-Lourenço M, Padoa A, et al. Sexual Health Implications of COVID-19 Pandemic. Sex Med Rev 2021;9:3-14.

Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine.

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.