Cardiovascular risk factors in rural Kenyans are associated with differential age gradients,but not modified by sex or ethnicity

Abstract

Background: The relationship between metabolic disease and the non-modifiable risk factors sex, age and ethnicity in Africans is not well-established.

Aim: This study aimed to describe sex, age and ethnicity differences in blood pressure (BP) and lipid status in rural Kenyans.

Subjects and methods: A cross-sectional study was undertaken among rural Kenyans. BP and pulse rate (PR) were measured while sitting and fasting blood samples were taken for analysis of standard lipid profile. Standard anthropometric measurements were collected. Physical activity energy expenditure was obtained objectively and lifestyle data were obtained using questionnaires.

Results: In total, 1139 individuals (61.0% women) participated aged 17–68 years. Age was positively associated with BP and plasma cholesterol levels. Sitting PR was negatively associated with age in women only (sex-interaction p?<?0.001). Ethnicity did not modify any of the age-associations with haemodynamic or lipid outcomes. Differences in intercept between women and men were found in all parameters except for diastolic BP (p?=?0.154), with men having lower HDL-C but higher values in all other cardiovascular risk factors.

Conclusion: BP and plasma cholesterol levels increase with age at a similar gradient in men and women, but absolute levels of the majority of the risk factors were higher in men.     

Facteurs de risque cardio-vasculaires en Algérie. Une analyse du sous-groupe de l’étude « Africa/Middle East Cardiovascular Epidemiological »

ObjectivesThis cross-sectional epidemiological study aimed at determining the prevalence of cardiovascular risk factors (CVRF; including obesity, dyslipidaemia, hypertension, diabetes and smoking), among patients from the Algerian sub-population of the “Africa/Middle East Cardiovascular Epidemiological” study attending general practitioners at primary healthcare facilities, and stratified according to their environment (rural/urban), sex and age.Patients and methodsThe study sites, located in 10 wilayas (administrative regions), were situated in urban and rural areas (rural populations defined as living at least 50 km away from urban centres, or lacking access to suburban transport).ResultsFour hundred and ten subjects (262 female, 148 male) were enrolled; 287 subjects were from an urban environment and 123 from a rural environment. Mean age was 50.4 years. Ninety one point eight percent of patients had ≥ 1 CVRF; 48.2% had ≥ 3 CVRF. Prevalence for the different CVRF was: 61.7% for dyslipidaemia; 39.5% for hypertension; 25.0% for diabetes; 10.0% for smoking, 70.0% for abdominal obesity and 32.0% for a body mass index ≥ 30 kg/m².ConclusionThe high prevalence of all CVRF observed in the Algeria sub-group, especially among the rural population, should encourage us to develop a carefully planned strategy for primary prevention, opportunistic screening and early management, in both urban and rural settings, and with particular attention to young adults. These actions should involve all state bodies and those active in civil society, in order to guarantee full achievement of set goals.The ACE trial is registered under NCT01243138.     

Lipid profile and atherogenic indices in patients with stable chronic obstructive pulmonary disease

Background and aimsLimited number of studies investigated lipid profile in chronic obstructive pulmonary disease (COPD) with inconsistent results. This study aimed to investigate lipid parameters in sera of patients with stable COPD and their associations with disease severity, smoking, comorbidities and therapy.Methods and resultsThe study included 137 COPD patients and 95 controls. Triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were assessed. Non-HDL-C (NHC), atherogenic coefficient (AC), TG/HDL-C, atherogenic index of plasma (AIP), Castelli's risk index I and II (CRI-I, CRI-II), and monocyte to HDL ratio (MHR) were calculated.HDL-C and MHR were increased, while other lipid parameters and indices were decreased in COPD patients compared to healthy individuals. Smoking did not influence lipid parameters. However, lipid profile was altered only in more severe disease stages. AC, CRI-I and CRI-II showed positive association with lung function parameters in COPD patients, and negative with COPD multicomponent indices (ADO, BODCAT, BODEx, CODEx and DOSE). Combined model that included CRI-II, C-reactive protein, fibrinogen and white blood cells showed great diagnostic performances, and correctly classified 72% of study participants with an AUC of 0.800 (0.742–0.849), P < 0.001. Bronchodilator monotherapy and statins have opposite impact on TC, LDL-C and NHC, while TG, TG/HDL-C and AIP were increased in COPD patients with cardiovascular diseases.ConclusionLipid disbalance is present in COPD, and it seems to occur later as the disease progresses. Further studies are needed to illuminate the underlying mechanism of dyslipidaemia.     

One-carbon metabolism markers are associated with cardiometabolic risk factors

Background and aims

Alterations to one-carbon metabolism, especially elevated plasma homocysteine (Hcy), have been suggested to be both a cause and a consequence of the metabolic syndrome (MS). A deeper understanding of the role of other one-carbon metabolites in MS, including s-adenosylmethionine (SAM), s-adenosylhomocysteine (SAH), and the methylation capacity index (SAM:SAH ratio) is required.

Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults

Background and aimsSimple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk.Methods and resultsBlack South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m², men 20.9 ± 4.3 kg/m²); median WC women 81.9 cm (interquartile range 61–103), men 74.7 cm (63–87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men.ConclusionsThe WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa.     

肥胖症及脂代谢紊乱的诊断

随着对脂肪细胞代谢的病理生理基础的进一步研究,以脂肪转移学说和脂肪细胞储存信号张力反馈学说为基础,为肥胖症及脂代谢紊乱的诊断提供了新的思路。腰围、甘油三酯水平作为腹型肥胖的主要评判标准,与肥胖、脂代谢紊乱密切相关。     

Natural sources of antidyslipidaemic agents: is there an evidence-based approach for their prescription?

Numerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the anti-Numerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the antihypercholesterolaemic, and antihypertriglyceridaemic properties of aged garlic powder, artichoke leaf extracts, guggul, and fenugreek. Single small clinical trials have also suggested that Korean ginseng, green tea, onion, yarrow, holy basil and arjun have an antihypercholesterolaemic effect.     

Possible Link Between a Low Prevalence of Cardiovascular Disease and Mild Dyslipidaemia: a Study in Japanese Patients with Type 2 Diabetes

In 98 Japanese patients with Type 2 diabetes mellitus, serum total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), free fatty acid (FFA), and apolipoproteins (apo) A-I, A-II, B, C-II, C-III, and E were determined. The data were compared with those in 47 normolipidaemic normal controls. The total cholesterol value of the diabetic patients was also compared to that of a general population (n = 2227). The diabetic patients were separated into those with cardiovascular disease (n = 20) and without it (n = 78) and a comparison of clinical characteristics and dyslipidaemia was also performed. The diabetic patients had slightly but significantly higher FFA, LDL-C, apo B, C-II, C-III, E, and B/A-I, and lower apo A-I and A-II compared to the normal controls. The total cholesterol level of the diabetic patients (5.17 ± 0.96 mmol^?1) was not significantly higher than that of the general population (5.12 ± 0.91 mmol^?1). By multivariate stepwise discriminant analyses, only total cholesterol significantly discriminated the patients with and without cardiovascular disease. In Japanese patients with Type 2 diabetes, a diabetic population with a very low prevalence of cardiovascular disease, high total cholesterol ís a risk factor for developing cardiovascular disease. Nevertheless, a markedly low prevalence of cardiovascular disease in Japanese with Type 2 diabetes compared to Caucasian counterparts may partly be due to the mildness of dyslipidaemia.