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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
24
VOLUME 16 NUMBER 1 • JULY 2019
Clinical measurements were done including:
• BP: automated Dinamap
®
, General Electric Medical Systems
(model: DPC321N-EN, item number: 2019194-001). After
resting for five minutes, the BP was measured according to the
method described in the JNC VII and South African Hypertension
Society guidelines.
2
The readings were recorded in the patients’
files.
• ECG: 12-lead digital electrocardiogram, Shenzhen Biocare
Electronics Ltd (model E.C.G-1200). A resting 12-lead ECG
was done using the technique recommended by Noble and
colleagues.
22
The ECG was interpreted by the researcher with
LVH assessed using the Romhilt–Estes five-point score. This has
been reported to yield a specificity of 99%.
23
Participants with problematic alcohol use or smoking were
counselled and referred for assistance. To compensate for time lost
due to participating in the study, all participants were attended
to by a dedicated doctor and arrangements were made with the
pharmacy to immediately dispense medications ahead of the
queue. Data were captured on Microsoft Excel spreadsheets daily
and cross-checked with the second author.
A pilot study was conducted using 30 patients at a nearby
CHC in the same sub-district to assess the feasibility of the study.
The results of the pilot study are not included in the main study
but informed minor adjustments to some questions for ease of
participants’ understanding, for example, that a drink of alcohol
should be expressed in ml and not in oz, and that three possible
responses should be allowed for the question on assessment of
hypercholesterolaemia.
Ethics clearance was obtained from the Human Research and
Ethics Committee of the University of the Witwatersrand (number
M10929). Permissionwas obtained fromthe SedibengDistrict Health
Services management. To ensure anonymity, the questionnaires
were coded using the corresponding file number and we did not
collect personal identifiable data. Patients who were found to have
a problem with alcohol use or smoking and with worrying ECG
findings were referred for further assistance.
Statistical analysis
Captureddatawere imported into STATA statistical analysis software,
version 10. A statistician assisted with analysis. Descriptive statistics
were performed to describe participants’ sociodemographic
and clinical characteristics. Chi-squared and
t
-tests were used to
compare groups, and variables that showed significant associations
on bivariate analysis were inputted into multivariate analysis.
A
p
-value < 0.05 was considered statistically significant. Main
outcome measures included: proportions of participants with each
CV risk factor (tobacco use, alcohol use, physical inactivity, diabetes,
hypercholesterolaemia, family history of hypercholesterolaemia and
fatal CV event) and the socio-demographic correlates of each CV
risk.
Results
There were 328 participants and their characteristics are shown in
Table 1. The mean age of participants was 57.7 years and most
participants were black (86.0%), female (79%) and pensioners
(43.6%). The mean systolic BP was 139/84 mmHg, with 60.7%
(199) having their BP controlled to targets.
In addition to hypertension, the 328 participants reported a
total of 1 232 cumulative CV risk factors; an average of 3.7 CV
risk factors per participant. Table 2 shows that the prevalence of
CV risk factors was as follows: abdominal obesity (80.8%), physical
inactivity (73.2%), diabetes (30.2%), alcohol use (28.0%) and
smoking (11.9%).
Table 1.
Participants’ characteristics
Variable
% (
n
)
Age, years
Gender
Female
79 (260)
Male
21 (68)
Marital status
Divorced
6.4* (21)
Living together
3* (10)
Married
51.8* (170)
Not married
12.8* (42)
Widowed
25.9* (85)
Ethnic group
Asian
0.3 (1)
Black
86.0 (282)
Coloured
0.9 (3)
White
12.8 (42)
Employment status
Employed
30.8 (101)
Pensioner
43.6 (143)
Unemployed
25.6 (84)
Educational level
None
10.7 (35)
Primary
33.5 (110)
Secondary
53.7 (176)
Tertiary
2.1 (7)
Mean age, years (SD)
57.7 (10.8)
Mean weight: study population
85.4
*The total percentage with decimals was slightly less than 100% (98.9%),
but rounded to the nearest integer, it became 100%.
Table 2.
Prevalence of cardiovascular risk factors
Variable (
n
= 328)
% (
n
)
Mean BP, mmHg
Systolic (SD)
139.0 (20.9)
Diastolic (SD)
84.3 (12.57)
BP controlled to target
60.7 (199)
Tobacco use
Current smoker
11.9 (39)
Second-hand smoker
16.0 (47)
Current snuffer
19.5 (64)
Alcohol use
Current alcohol use
28.0 (92)
Physical activity
Active
26.8 (88)
Inactive
73.2 (240)
Clinical risk factors
Diabetes mellitus
30.2 (99)
Elevated cholesterol
26.5 (87)
Family history of hypercholesterolaemia
5.2 (17)
Family history of fatal CV event (among females
14.9 (49)
< 65 years and males < 55 years)
Left ventricular hypertrophy, %
5.2 (17)
Anthropometric measures
Mean weight (kg) 85.4
Mean BMI (kg/m
2
) 33.7
Increased waist circumference (> 88 cm for
80.8 (265)
women, > 102 cm for men)