Atherosclerotic Cardiovascular Disease Risk Among Patients with Type 2 Diabetes in Uganda

Download Article

DOI: 10.21522/TIJAR.2014.08.02.Art007

Authors : William Lumu, Ronald Mutebi, Emmanuel Ssendikwanawa, Davis Kibirige, Ronald Wesonga, Silver Bahendeka

Abstract:

While atherosclerotic cardiovascular disease risk is increased in patients with type 2 diabetes, the magnitude and socio-demographic determinants of this risk are not known in Uganda. We aimed to establish the magnitude of the predicted 10-year atherosclerotic cardiovascular risk and describe its socio-demographic determinants among patients with type 2 diabetes in Uganda. This was a cross-sectional study conducted in eight (8) diabetes clinics from November 2020 to February 2021. We enrolled 500 patients with type 2 diabetes aged between 40 to 79 years. Patients were interviewed on their socio-demographic characteristics. Anthropometric and laboratory measurements were performed. The predicted 10-year atherosclerotic cardiovascular risk was categorized using the Pooled Cohorts Risks Equations. Bivariate and multivariate logistic regression was conducted to establish associated socio-demographic factors. The majority of participants were females (78%), with a mean age of 55.14years (SD±8.96). Of the patients studied, 20% were at low risk (score <5%), 14.2% borderline risk (score 5-≤7.5%), 45.2% intermediate risk (score7.5-<20) and 20.6% high risk (score 20%). Elevated risk of score ≥7.5% was found in 65.8%. The male gender (AOR= 5.456, 95% CI 2.998-9.932, p=0.001), at least 50 years of age (AOR=7.841 95% CI 4.863-12.642, p=0.001), part-time employment (AOR=1.726, 95% CI 1.221-2.441, p=0.002) and being widowed (AOR=2.4, 95% CI 1.192-4.833, p=0.002) were significantly associated with cardiovascular disease risk. The cardiovascular disease risk among patients with type 2 diabetes is high. The male gender, age of at least 50years, part-time employment, and being widowed are socio-demographic factors that should be prioritized at primary level management of cardiovascular disease.

References:

[1] Vergès B. Pathophysiology of diabetic dyslipidaemia: where are we? Diabetologia [Internet]. 2015/03/01. 2015 May;58(5):886–99. Available from: https://pubmed.ncbi.nlm.nih.gov/25725623.

[2] Hu G, Jousilahti P, Barengo NC, Qiao Q, Lakka TA, Tuomilehto J. Physical activity, cardiovascular risk factors, and mortality among finish adults with diabetes. Diabetes Care. 2005;28(4):799–805.

[3] Haffner SM, Lehto S, Rönnemaa T, Kalevi P, Laakso M. Mortality from Coronary Heart Disease in Subjects with and Without T Type 2 Diabetes Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and Without Prior Myocardial Infarction. N Engle J Med. 1998;339(4):229–34.

[4] Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Is diabetes a coronary risk equivalent? Systematic review and meta-analysis: Original Article: Epidemiology. Diabet Med. 2009;26(2):142–8.

[5] Rana JS, Liu JY, Moffet HH, Jaffe M, Karter AJ. Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events. J Gen Intern Med. 2016;31(4):387–93.

[6] Bertoluci MC, Rocha VZ. Cardiovascular risk assessment in patients with diabetes. Diabetol Metab Syndr. 2017;9(1):1–13.

[7] Tesfaye A, Josef H, Bizuayehu Wube T, Girma Z, Negasa B, Muche T, et al. Magnitude of and factors associated with cardiovascular disease among type two diabetes mellitus patients. Diabetes, Metab Syndr Obes Targets Ther. 2020; 13:4123–9.

[8] Meththananda HM, Weerarathna TP, Umesha D. Cardiovascular risk assessment in type 2 diabetes mellitus: Comparison of the world health organization/international society of hypertension risk prediction charts versus UK prospective diabetes study risk engine. Vasc Health Risk Manag. 2015; 11:583–9.

[9] Wiegand H. Kish, L.: Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s. Biom Z [Internet]. 1968;10(1):88–9. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/bimj.19680100122

[10] Guwatudde D, Mutungi G, Wesonga R, Kajjura R, Kasule H, Muwonge J, et al. The Epidemiology of Hypertension in Uganda: Findings from the National Non- Communicable Diseases Risk Factor Survey. 2015;1–13.

[11] Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research? Indian journal of psychological medicine, 35(2), 121–126. doi:10.4103/0253-7176.116232No Title.

[12] Chobanian A V, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Joseph L. J, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure the JNC 7 Report. JAMA [Internet]. 2003 May 21;289(19):2560–71. Available from: https://dx.doi.org/10.1001/jama.289.19.2560.

[13] Preiss D, Kristensen SL. The new pooled cohort equations risk calculator. Can J Cardiol [Internet]. 2015;31(5):613–9. Available from: http://dx.doi.org/10.1016/j.cjca.2015.02.001.

[14] Yadlowsky S, Hayward RA, Sussman JB, McClelland RL, Min Y-I, Basu S. Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk. Ann Intern Med [Internet]. 2018;169(1):20–9. Available from: http://europepmc.org/abstract/MED/29868850.

[15] Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American college of cardiology/American heart association task force on practice guidelines. Circulation. 2014;129(25 SUPPL. 1):49–73.

[16] Karmali KN, Goff DC, Ning H, Lloyd-Jones DM. A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2014;64(10):959–68.

[17] Zhao Y. Cardiovascular risk assessment and screening in diabetes. Cardiovasc Endocrinol. 2017;6(1):17–22.

[18] Lumu W, Kampiire L, Akabwai GP, Ssekitoleko R, Kiggundu DS, Kibirige D. Dyslipidaemia in a Black African diabetic population: burden, pattern and predictors. BMC Res Notes. 2017;1–7.

[19] D’Agostino RB et al. 2013 Report on the Assessment of Cardiovascular Risk: Full work Group Report Supplement. Natl Hear Lung Blood Inst. 2013;1–184.

[20] Al-yafei A, Osman SO, Selim N, Alkubaisi N, Singh R. Assessment of Cardiovascular Disease Risk among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centers, 2014. Open Diabetes J. 2020;10(1):1–10.

[21] Echouffo-Tcheugui JB, Ogunniyi MO, Kengne AP. Estimation of Absolute Cardiovascular Risk in Individuals with Diabetes Mellitus: Rationale and Approaches. ISRN Cardiol. 2011; 2011:1–5.

[22] Al-lawati JA, Barakat MN, Al-lawati NA, Al-maskari MY, Elsayed MK, Mikhailidis DP, et al. Cardiovascular Risk Assessment in Diabetes Mellitus: Comparison of the General Framingham Risk Profile Versus the World Health Organization / International Society of Hypertension Risk Prediction Charts in Arabs — Clinical Implications. 2012;64(5):336–42.

[23] Hiran S, Singh A, Sial P. Cardiovascular risk stratification in new-onset diabetes by qrisk2 risk score and conventional risk score within 3 months of diagnosis of diabetes. J Diabetol. 2018;9(2):39.

[24] Udenze I, Amadi C. Cardiovascular disease risk assessment in Nigerian adults with type 2 diabetes and metabolic syndrome using the Framingham’s risk score. Int J Noncommunicable Dis [Internet]. 2018 [cited 2019 Mar 21];3(1):15. Available from: http://www.ijncd.org/text.asp?2018/3/1/15/230360.

[25] Masyuko SJ, Page ST, Kinuthia J, Osoti AO, Polyak SJ, Otieno FC, et al. Metabolic syndrome and 10-year cardiovascular risk among HIV-positive and HIV-negative adults: A cross-sectional study. Medicine (Baltimore) [Internet]. 2020 Jul 2;99(27): e20845–e20845. Available from: https://pubmed.ncbi.nlm.nih.gov/32629671.

[26] Azevedo T dos A, Moreira MLV, Nucera APC dos S. Cardiovascular Risk Estimation by the ASCVD Risk Estimator Application in a University Hospital. Int J Cardiovasc Sci. 2018;31(5):492–8.

[27] Lang T, Lepage B, Schieber A-C, Lamy S, Kelly-Irving M. Social Determinants of Cardiovascular Diseases. Public Health Rev [Internet]. 2011;33(2):601–22. Available from: https://doi.org/10.1007/BF03391652.

[28] Steptoef A, Feldman PJ, Kunz S, Owen N, Willemsen G, Marmot M. Stress responsivity and socioeconomic status: A mechanism for increased cardiovascular disease risk? Eur Heart J. 2002;23(22):1757–63.

[29] Nie J, Wang J, Aune D, Huang W, Xiao D, Wang Y, et al. Association between employment status and risk of all-cause and cause-specific mortality: a population-based prospective cohort study. J Epidemiol Community Health [Internet]. 2020 May 1;74(5):428 LP – 436. Available from: http://jech.bmj.com/content/74/5/428.abstract.

[30] Wong CW, Kwok CS, Narain A, Gulati M, Mihalidou AS, Wu P, et al. Marital status and risk of cardiovascular diseases: A systematic review and meta-analysis. Heart. 2018;104(23):1937–48.