Background. There is an increasing prevalence of cardiovascular diseases (CVDs) and risk factors in HIV patients as the levels of AIDS-related mortality and morbidity decrease. Metabolic syndrome ...(MetS) is the accumulation of various CVD risk factors that predict the occurrence of CVDs. We investigated the prevalence of MetS and associated risk factors in HIV patients treated with combination antiretroviral therapy (cART), cART-naïve HIV patients, and non-HIV controls. Methods. In a case-control design, 158 cART-treated HIV patients, 150 cART-naïve HIV patients, and 156 non-HIV controls were recruited from a periurban hospital in Ghana. A structured questionnaire was used to collect data on demography, lifestyle, and medication. Anthropometric indices and blood pressure were measured. Fasting blood samples were collected to measure the plasma levels of glucose, lipid profile, and CD4+ cells. The presence of MetS was defined using the joint scientific statement criteria. Results. The prevalence of MetS was higher in cART-treated HIV patients compared with cART-naïve HIV patients and non-HIV controls (57.3% vs. 23.6% vs. 19.2% and p<0.001, respectively). MetS was associated with cART-treated HIV patients (odds ratio (95% CI) = 7.24 (3.41–15.39) and p<0.001), cART-naïve HIV patients (2.04 (1.01–4.15), p=0.048), and female gender (2.42 (1.39–4.23) and p=0.002). In cART-treated HIV patients, those on zidovudine (AZT)-based regimens were associated with increased likelihood (3.95 (1.49–10.43) and p<0.006), while those on tenofovir (TDF)-based had decreased likelihood (0.32 (0.13–0.8) and p=0.015) of having MetS. Conclusion. In our study population, there was a high prevalence of MetS in cART-treated HIV patients compared to cART-naïve HIV patients and non-HIV controls. HIV patients on AZT-based regimens had an increased likelihood of having MetS, while those on TDF-based regimens had a reduced likelihood of having MetS.
ObjectiveEvidence shows that the conventional cardiometabolic risk factors do not fully explain the burden of microvascular complications in type 2 diabetes (T2D). One potential factor is the impact ...of pulmonary dysfunction on systemic microvascular injury. We assessed the associations between spirometric impairments and systemic microvascular complications in T2D.DesignCross-sectional study.SettingNational Diabetes Management and Research Centre in Ghana.ParticipantsThe study included 464 Ghanaians aged ≥35 years with established diagnosis of T2D without primary myocardial disease or previous/current heart failure. Participants were excluded if they had primary lung disease including asthma or chronic obstructive pulmonary disease.Primary and secondary outcome measuresThe associations of spirometric measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio) with microvascular complications (nephropathy (albumin-creatinine ratio ≥30 mg/g), neuropathy (vibration perception threshold ≥25 V and/or Diabetic Neuropathy Symptom score >1) and retinopathy (based on retinal photography)) were assessed using multivariable logistic regression models with adjustments for age, sex, diabetes duration, glycated haemoglobin concentration, suboptimal blood pressure control, smoking pack years and body mass index.ResultsIn age and sex-adjusted models, lower Z-score FEV1 was associated with higher odds of nephropathy (OR 1.55, 95% CI 1.19–2.02, p=0.001) and neuropathy (1.27 (1.01–1.65), 0.038) but not retinopathy (1.22 (0.87–1.70), 0.246). Similar observations were made for the associations of lower Z-score FVC with nephropathy (1.54 (1.19–2.01), 0.001), neuropathy (1.25 (1.01–1.54), 0.037) and retinopathy (1.19 (0.85–1.68), 0.318). In the fully adjusted model, the associations remained significant for only lower Z-score FEV1 with nephropathy (1.43 (1.09–1.87), 0.011) and neuropathy (1.34 (1.04–1.73), 0.024) and for lower Z-score FVC with nephropathy (1.45 (1.11–1.91), 0.007) and neuropathy (1.32 (1.03–1.69), 0.029). Lower Z-score FEV1/FVC ratio was not significantly associated with microvascular complications in age and sex and fully adjusted models.ConclusionOur study shows positive but varying strengths of associations between pulmonary dysfunction and microvascular complications in different circulations. Future studies could explore the mechanisms linking pulmonary dysfunction to microvascular complications in T2D.
•Albuminuria and retinal microvascular dysfunction(RMD) were positively associated.•Severer forms of RMD were more frequent in individuals with albuminuria than without albuminuria.•Albuminuria was ...more strongly correlated with RMD in hypertension than without hypertension.•Albuminuria was more strongly correlated with RMD in suboptimal than in optimal BP control.•The above associations were independent of conventional cardiovascular risk factors.
Studies assessing the concordance of albuminuria and retinal microvascular dysfunction (RMD) in type 2 diabetes (T2D) have yielded inconsistent results. Similar to ethnicity, hypertension may be a potential explanatory variable. We compared the association between albuminuria and RMD in West Africans with T2D with and without hypertension.
This was a cross-sectional study among 177 systematically sampled Ghanaians with T2D aged ≥ 35 years. Albuminuria was based on urinary albumin-creatinine ratio≥30 mg/g. Retinal images were analyzed and graded according to the Early Treatment Diabetic Retinopathy Study criteria. Logistic regression was used to examine the associations of albuminuria and RMD with adjustments for age, sex, socioeconomic status, diabetes duration, HbA1c, smoking, systolic blood pressure (BP), BMI, and total cholesterol.
RMD was more prevalent in individuals with albuminuria than in those without albuminuria (41.7% vs. 24.0%, p = 0.026). In the fully adjusted model, albuminuria remained significantly associated with RMD (odds ratio 2.4195% CI:1.00–5.80, p = 0.049); the association between albuminuria and RMD was more pronounced in individuals with hypertension (3.10 1.01–9.50, 0.048) than without hypertension (1.700.33–8.77,0.523). In analyses stratified by BP control, albuminuria was significantly associated with RMD in individuals with suboptimal BP (2.761.07–7.14, 0.037) but not in individuals with optimal BP (0.240.00–17.04,0.512)
Our study shows positive associations between albuminuria and RMD among West Africans with T2D, with the strength of association, accentuated in individuals with hypertension/suboptimal BP. Future studies could further characterize the role of hypertension in the associations between albuminuria and RMD.
Aim
Patients with HIV have increased cardiovascular risk and pulmonary defects. We investigated the association between impaired pulmonary function (IPF) and arterial stiffening measured by the ...cardio-ankle vascular index (CAVI) in Ghanaian HIV patients.
Method
Spirometry was used to measure pulmonary indices; forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) in 79 HIV patients on treatment, 75 HIV treatment naïve patients and 78 non-HIV controls. We also used FEV1/FVC < lower limit of normal as a further index. Arterial stiffness was measured as CAVI using the Vasera device.
Results
Compared to non-HIV controls, CAVI was higher in treatment naïve (6.9 ± 1.4 vs 6.3 ± 1.1 units,
p
< 0.01) and HIV patients on treatment (8.1 ± 1.4, vs 6.3 ± 1.1,
p
< 0.01). IPF was detected in 12 (15.2%) HIV patients on treatment, 8 (10.7%) treatment naïve HIV patients and 5 (6.4%) non-HIV controls. Compared to those without IPF, IPF patients had higher CAVI in non-HIV controls (6.5 ± 1.1 vs 5.7 ± 0.8,
p
< 0.01), treatment naïve HIV patients (7.1 ± 1.8 vs 6.6 ± 1.4,
p
= 0.023) and HIV patients on treatment (7.8 ± 1.4 vs 8.7 ± 1.2,
p
< 0.01). In multivariable logistic regression analysis, IPF was independently associated with CAVI adjusted OR = 1.33 (1.15 — 1.89),
p
= 0.037 after adjustment for age 1.21 (0.98 — 2.14),
p
= 0.11, male sex 0.42 (0.32 — 0.91),
p
= 0.035, current/former smoking status 1.43 (0.47 — 4.01),
p
= 0.75 and history of tuberculosis infection 1.96 (1.08 — 3.12),
p
< 0.01.
Conclusion
Ghanaian HIV patients have a high prevalence of impaired respiratory function and arterial stiffening, and these indices are associated with each other.
Peripheral arterial disease (PAD) is common in HIV patients and can be diagnosed noninvasively using the ankle-brachial index (ABI). The burden of PAD has not been investigated in Ghanaian HIV ...patients. We investigated the prevalence and risk factors associated with PAD in HIV patients at a periurban hospital in Ghana.
In a case-control design, ABI was measured in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls with no clinical symptoms of CVDs. PAD was defined as ABI ≤ 0.9. A structured questionnaire was used to collect socio-demographic and clinical data. Fasting venous blood samples were collected to measure plasma levels of glucose, lipid profile, and CD4+ lymphocytes.
The prevalence of PAD was 13.9% among cART-treated HIV patients, 21.3% among cART-naïve HIV patients, and 15.4% among non-HIV controls. Patients with PAD had increased odds of having low CD4+ cell counts OR (95% CI) = 3.68 (1.41-12.85). In cART-treated HIV patients, those on TDF-based 5.76 (1.1-30.01), p = 0.038 and EFV-based 9.28 (1.51-57.12), p = 0.016 regimens had increased odds of having PAD.
In our study population, there was no difference in the prevalence of PAD between cART-treated HIV patients compared to cART-naïve HIV patients or non-HIV controls. Having a low CD4 cell count and being on TDF- or EFV-based regimens were associated with an increased likelihood of having PAD.
Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low‐resource settings, pregnancy is associated with significantly increased maternal and perinatal ...mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low‐resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before‐and‐after study, at the Korle‐Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric‐hematology care team for women with SCD in a combined SCD‐Obstetric Clinic. The pre‐intervention period was assessed through a retrospective chart review to identify every death and the post‐intervention period was assessed prospectively. Interventions consisted of joint obstetrician and hematologist outpatient and acute inpatient reviews, close maternal and fetal surveillance, and simple protocols for management of acute chest syndrome and acute pain episodes. Primary outcomes included maternal and perinatal mortality rates before and after the study period. A total of 158 and 90 pregnant women with SCD were evaluated in the pre‐ and post‐ intervention periods, respectively. The maternal mortality rate decreased from 10 791 per 100 000 live births at pre‐intervention to 1176 per 100 000 at post‐intervention, representing a risk reduction of 89.1% (P = 0.007). Perinatal mortality decreased from 60.8 per 1000 total births at pre‐intervention to 23.0 per 1000 at post‐intervention, representing a risk reduction of 62.2% (P = 0.20). A multidisciplinary obstetric and hematology team approach can dramatically reduce maternal and perinatal mortality in a low‐resource setting.
Physical exercise aids glycemic control and the prevention of diabetes-related complications. However, exercise beyond an individual's pulmonary functional capacity may be detrimental. To date, ...little is known about the relationship between pulmonary function and exercise capacity in people with type 2 diabetes (T2D). We investigated the relationship between pulmonary function and exercise capacity in T2D.
Spirometry and 6-min walk test (6MWT) were conducted for 263 systematically sampled adults with T2D without primary heart/lung disease. The primary measure of exercise capacity was the 6-min walk distance (6MWD); impaired exercise capacity was defined as 6MWD<400 m. Logistic regression analyses were used to assess the associations between spirometric measures and exercise capacity with adjustments for age, sex, height, body mass index, diabetes duration, glycated hemoglobin concentration, smoking, suboptimum blood pressure control, and total cholesterol concentration.
Compared with individuals with normal spirometry, those with pulmonary restriction/obstruction had significantly lower 6MWD (404.67 m vs. 451.70),p < 0.001). The proportion of individuals with impaired exercise capacity was higher in individuals with impaired pulmonary function compared with those with normal pulmonary function (39.8% vs. 20.7%,p = 0.001). In the unadjusted models, decreasing Z-score FEV1 odds ratio 1.40, 95% confidence interval (1.07–1.83),p = 0.013 and Z-score FVC 1.37 (1.06–1.76),0.016, but not Z-score FEV1/FVC ratio 1.00 (0.78–1.27),0.972 were significantly associated with impaired exercise capacity. In the fully adjusted model, the strength of association remained statistically significant for Z-score FEV1 1.60 (1.06–2.41),0.025 but not Z-score FVC 1.48 (0.98–2.23),0.065.
Our study shows inverse associations between FEV1 and impaired exercise capacity in T2D, Future research could characterize optimal exercise levels based on a patient's FEV1.
•Impaired exercise capacity was commoner in patients with type 2 diabetes with lung dysfunction than without lung dysfunction.•Lower forced expiratory volume in 1 s was positively associated with impaired exercise capacity.•The conventional cardiovascular and respiratory risk factors did not explain the observed associations.
Background: Sickle cell disease (SCD) is a major public health problem in Sub-Saharan Africa, which is home to about 70% of the affected individuals worldwide. Pregnancy is an emerging ...life-threatening complication of SCD with high rates of sickle cell specific, maternal and perinatal complications. In low-resource countries, pregnancy in women with SCD is associated with a 22-fold risk of death compared to those without SCD. Perinatal mortality rates are also increased by nearly four-fold. BJOG: An International Journal of Obstetrics & Gynaecology. 2016 Apr;123(5), 691-698 Preliminary data showed that maternal mortality ratio among pregnant women with and without SCD, at Korle-Bu Teaching Hospital, in Ghana, were 10,791 and 540 per 100,000 live births, respectively. In 2015, we created a multi-disciplinary care team including: obstetricians, hematologists, anesthesiologists with training in pulmonary medicine, pediatricians and midwives to provide care in a combined clinic visit during pregnancy for maternal and fetal surveillance. In a prior before and after study design, we demonstrated a 90% reduction in maternal mortality in SCD after instituting a combined obstetrics and SCD clinic. The odds ratio for maternal mortality in women with and without SCD is similar in high-income countries but discordant in low-income countries. The difference suggests modifiable risk factors contribute to mortalities in the latter setting. We tested the hypothesis that a combined obstetrics and SCD clinic would decrease the mortality rate in pregnant women with SCD living in a low-resource setting.
Methods: In a prospective study, pregnant women with SCD and their parity-matched non-SCD controls were enrolled from their first antenatal visit, through labor and delivery and followed until six weeks postpartum. All participants were reviewed at combined obstetrics and SCD clinic and the following care were standardized: pulse oximeters were used to measure oxygen saturation at baseline and during hospitalizations for acute pain; latex balloons were used for routine incentive spirometry during acute pain episode and post-cesarean section; two wards were designated for the participants for effective management; critically ill patients were discussed by a multi-disciplinary care team including an obstetrician, hematologist, and anesthesiologist. The primary outcome of our study was maternal mortality, defined as the death of a woman while pregnant and up to 42 days after termination of pregnancy from a cause related to or aggravated by the pregnancy or its management irrespective of the site and duration of the pregnancy but excluding incidental causes. Autopsy was performed by a pathologist to identify the cause of death. Antepartum admissions rate, pain and acute chest syndrome rates, preeclampsia, type of delivery and perinatal outcomes were compared between cohorts. Negative binomial regression was used to predict factors associated with adverse outcome. The risk was expressed as relative risk (RR) at 95% confidence interval (95% CI) with significance at p<0.05.
Results: A total of 149 pregnant women with SCD (HbSS=54, HbSC=95) and 113 without SCD were included in the analysis. The mean age 29.2yrs vrs 29.7yrs, p=0.440 and parity nulliparous 44.5% vrs42.2%, p=0.704 of the two groups were similar. Participants with SCD had a lower BMI at enrollment BMI 25.5 kg/m2 vs 30.5kg/m2,p<0.001. Maternal (1.3% vrs 0.9% p=1.00) and perinatal (7.4% vrs 3.4% p=0.164) death rates were similar between the two groups. Pregnant women with SCD had a higher incidence of hospitalization for malaria (23.5% vrs 11.4% p=0.022), preterm birth less than 37 weeks (26.4% vrs 16.2%, p=0.048) and low birth weight (<2500g) (25.2% vrs 12.9% p=0.014) than those without SCD. In a multivariable logistic regression model, SCD was associated with a 4-fold increased risk of preeclampsia when compared to women without SCD (RR 4.487 95%CI 1.501 - 10.517, p = 0.002).
Conclusion: Multi-disciplinary care of pregnant women with SCD in a combined obstetrics and sickle cell disease clinic resulted in similar maternal and perinatal death rates between women with SCD and those without SCD in low-resource setting. Pregnant women with SCD have a significantly higher risk of preeclampsia and premature delivery. Interventions for preeclampsia in women with SCD should be considered in a systematic manner.
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Oppong:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Olayemi:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Adomakoh:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Asare:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Mensah:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Swarray-Deen:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Osei-Bonsu:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Crabbe:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Musah:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Boafor:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Rodeghier:Rodeghier consultants: Consultancy.
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