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VOLUME 9 NUMBER 2 • JUNE 2012
55
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
Correspondence to: Basil Okeahialam
University of Jos, Jos, Nigeria
e-mail: basokeam@yahoo.com
Benjamin Alonge
NNPC Hospital, Kaduna, Nigeria
Fabian Puepet
Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
Stephen Pam
Department of Radiology, Jos University Teaching Hospital, Jos, Nigeria
Michael Balogun
Department of Medicine, Obafemi Awolowo University Teaching Hospital,
Ile, Nigeria
S Afr J Diabetes Vasc Dis
2012;
9
: 55–60
Abstract
Background:
Diabetes mellitus is associatedwith an increased
risk for cardiovascular morbidity and mortality. Although
most diabetics die from cardiovascular causes, clinicians tend
to pay more attention to blood sugar levels in their follow-up
care. Since hypertension has been firmly established as a
major risk factor for cardiovascular disease, we sought to
compare cardiovascular risk factors in normotensive type 2
diabetes patients and hypertensive non-diabetics. This was
to determine the level of cardiovascular morbidity in the
diabetic patients, so as to make a case for control of other
cardiovascular disease risk factors during follow up. No such
study has been done so far in our immediate environment.
Methods:
There were three groups of age- and gender-
matched subjects: 70 normotensive diabetics, 70 hypertensive
non-diabetics and 71 normotensive non-diabetic controls.
Each participant had a detailed clinical examination as well as
assessment of levels of fasting plasma glucose and two hours
postprandial glucose, as well as plasma lipid, uric acid and
creatinine levels.Microalbuminuriawasdetectedusingfreshly
voided urine. All subjects underwent electrocardiography for
left ventricular hypertrophy. Whereas 45 of the controls had
echocardiography, all the hypertensive and diabetic patients
underwent echocardiography. Risk factors such as alcohol
abuse, cigarette smoking and physical inactivity were also
documented.
Results:
The clinical characteristics resulting from significant
alcohol consumption, cigarette smoking and physical
inactivity were significantly higher in the diabetics than
in the hypertensive subjects and normal individuals. The
waist-to-hip ratio of the diabetics was significantly greater
than that of the hypertensives. Dyslipidaemia and high
low-density lipoprotein (LDL) cholesterol levels were more
prevalent in the diabetics. Hyperuricaemia was more
prevalent in the hypertensives, as was left ventricular
Cardiovascular morbidity: a comparative study on diabetes
mellitus and hypertension
BASIL OKEAHIALAM, BENJAMIN ALONGE, FABIAN PUEPET, STEPHEN PAM, MICHAEL BALOGUN
hypertrophy (LVH), diagnosed electrocardiographically and
echocardiographically. The prevalence of microalbuminuria
was similar in the diabetic and hypertensive patients.
Conclusion:
The normotensive type 2 diabetes patients were
burdenedinmostcaseswithcardiovascularriskfactorssurpassing
those of the hypertensive non-diabetic subjects. Of particular
note was diabetic dyslipidaemia, especially hypo-high-density
lipoprotein (HDL) cholesterolaemia, hyper-LDL cholesterolaemia
and hypertriglyceridaemia. The hypertensives, however, were
significantly more burdened with LVH and hyperuricaemia.
These results support the opinion that cardiovascular disease
accounts for most morbidity and mortality in diabetics.
Therefore, all diabetics should have regular and specialised
cardiovascular care to minimise disabilities.
Keywords:
cardiovascular risk factors, hypertension, dyslipidaemia,
hyperuricaemia, left ventricular hypertrophy, microalbuminuria,
type 2 diabetes mellitus
Submitted 3/10/2011, accepted 23/2/2012
Diabetes mellitus (DM) is a metabolic disorder of multiple aetiology,
characterised by chronic hyperglycaemia with disturbances of
carbohydrate, fat and protein metabolism, resulting from defects
in insulin secretion, insulin action or both.
1
Type 2 DM may range
from primarily insulin resistance with relative insulin deficiency, to a
predominantly secretory defect with or without insulin resistance.
2
In
Nigeria, the national prevalence of diabetes is estimated at 2.2%.
3
According to data from the United Kingdom Prospective Diabetes
study (UKPDS), cardiovascular disease (CVD) accounts for 80% of
mortality in diabetic patients.
4
Clinical and epidemiological studies
in Africa have clearly demonstrated that diabetic persons are at
increased risk for cardiovascular morbidity and mortality.
5
Diabetic
patients are likely to have established cardiovascular disease by the
time their diabetes is diagnosed.
6
Of the threat to health and life
that besets the person with diabetes, CVD and peripheral vascular
disease represent the heaviest burden.
In all societies, diabetes increases cardiovascular risk two-fold
or more compared with the local non-diabetic population.
7
In
Africa, three out of four diabetic patients die from cardiovascular
complications.
8
Type 2 DM may be considered a vascular disease
diagnosed by elevated blood, glucose levels.
9
Atherosclerotic disease,
andmacrovasculardiseaseand its complicationsaccount formore than
half of the deaths in patients with type 2 DM.
10
Patients with type 2
DM usually have many genetically interlinked risk factors for coronary
atherosclerosis, such as hypertension, dyslipidaema, android obesity,
hyperinsulinaemia with insulin resistance and haemorrheological
abnormalities at the time of diagnosis of diabetes.
6
Hypertension has been firmly established as a major risk factor
for cardiovascular disease
11
and is responsible for more deaths than
any other risk factor for CVD.
12
When combined with diabetes,