Cardiovascular disease risk factors of military: A comparative assessment with civilians

Background

Cardiovascular diseases are the leading cause of death in the world. Military population that seemed immune to these pathologies is now as exposed as the general population. The effective response to this public health problem first requires the identification of the level of exposure of populations. Thus, the objective of our study was to determine the prevalence of Cardiovascular Disease (CVD) risk factors of the Cameroonian military population compared to civilians.

Methods

We conducted a cross-sectional study. It involved subjects aged 18 to 58 years, recruited from October 30, 2017 to November 13, 2018 at the Fifth Military Sector Health Center. Five cardiovascular risk factors were assessed, smoking, harmful alcohol consumption, obesity/overweight, hypertension and diabetes. The STEPwise model proposed by the World Health Organization (WHO) was used to estimate the risk of cardiovascular diseases. Mann Whitney and Fisher exact tests were used for statistics comparison.

Results

The study included 489 subjects, 270 military personnel and 219 civilians. The median age of the two populations was not significantly different (30 years versus 33 years, p = 0.6939). The proportion of smokers was higher in the military (12.59% versus 9%, p = 0.0011). Alcoholism was also higher in the military population (60.74% versus 13.24%, p = 0.0000). Similarly, military personnel were more obese than civilians (58.15% versus 40.18%, p = 0.0000). Distribution of hypertension and diabetes was not significantly different between military and civilians (18.15% versus 16.89%, p = 0.8113) and (1.48% versus 3.20%, p = 0.2321) respectively. The proportion of subjects with a high cardiovascular risk was higher in the military (14.81% versus 7.76%, p = 0.0162).

Conclusions

CVD risk factors are more prevalent in Cameroonian military population than in civilians. This result suggests that, in addition to national preventive campaigns, special attention is needed for military population in Cameroon.

Key messages

Cardiovascular disease risk factors are more prevalent in Cameroonian military population than in general population. in addition to national preventive campaigns, special attention is needed for military population in Cameroon.

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

[Epidemiology of obesity in the work milieu, Douala, Cameroon]

Obesity is a worldwide public health problem, and its burden has been poorly explored in Cameroon, especially in work place. We therefore carried out in April 2010, an analytic cross-sectional study aiming to determine the prevalence of obesity, associated risk factors and health risk in six randomly selected enterprises based in Douala. Among the 552 participants, 383 (69.4%) were males. Most of the workers (55.4%) were aged less than 35 years old. There was 191 (34.60%) office staff as against 361 (65.40%) labourers. In each participant, blood pressures, and fasting blood glucose were recorded, as well as obesity indexes comprising body mass index and waist circumference. They were calculated and data analyzed using SPSS 16 and Win Pepi 11.8. The prevalence of obesity in workers was 23.4%, and was more pronounced in women than in men (36.1% vs 17.8%; P < 0.005). The workers aged > or = 45 years old exhibited highest obesity rate than other age group (P = 0.03). Importantly, the prevalence of hypertension was two fold greater in obese workers than non obese (P < 0.005; RR = 2.1; IC 95%: 1.57-2.83). 271 (49.1%) of the workers were overweight. Among the obese subjects, those with visceral obesity: 56 (43.4%) females with a waist circumference > 88 cm and 41 (31.8%) men with a waist circumference > 102 cm were at very high health risk. Obesity was significantly associated with excessive alcohol consumption (P = 0.013) and high salt diet (P = 0.022). This study reveals a high burden of obesity in the work place in Douala and outlines the urgent needs of implementation of prevention programme in that milieu.

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

Intensified large artery and microvascular response to cold adrenergic stimulation in African blacks

BACKGROUND

Arterial stiffening is more accelerated in blacks than in whites. Whether this is attributed to an enhanced vascular reactivity to environmental stress stimulation remains unknown. We therefore decided to test the hypothesis that cold pressor test (CPT) elicits a greater increase in arterial stiffness and an enhanced sympathetic skin vasoconstriction in African blacks than in whites normotensives.

METHODS

A total of 17 young normotensive African blacks and 17 normotensive whites were recruited. All underwent continuous assessment of blood pressure (BP), heart rate, and carotid-femoral pulse wave velocity (PWVc-f) at rest, during and after hand immersion in iced water (CPT). Concomitantly, skin microvascular blood flow was monitored by laser Doppler flowmetry on the opposite hand.

RESULTS

At baseline, African blacks exhibited higher values of PWVc-f than whites (7.2 +/- 0.3 vs. 6.5 +/- 0.2 m/s, respectively, P = 0.04). During CPT the increases in systolic BP and PWVc-f were greater in African blacks than in whites (systolic BP 17 +/- 2 mm Hg vs. 9 +/- 3 mm Hg, P < 0.001 and PWVc-f 0.62 +/- 0.1 m/s vs. 0.26 +/- 0.1 m/s, P = 0.03, respectively). However, there was no significant difference in the PWVc-f responses among the groups during CPT after adjustment for the increments in mean BP. Finally, CPT induced a more pronounced skin microvascular vasoconstriction in African blacks than in whites (-54.4 +/- 5 % vs. -31.3 +/- 6 %, P < 0.001).

CONCLUSIONS

CPT provokes a more pronounced increase in PWVc-f in normotensive African blacks than in whites, that appears to be due to a greater increase in mean BP. Additionally, African blacks present an intensified skin microvascular response to the CPT as compared to their whites counterparts.

[Relationship between pulse pressure, visual impairement and severity of diabetic retinopathy in sub-Saharan Africa]

OBJECTIVE

To determine the relationship between pulse pressure, traditional risk factors, vision impairment and different clinical forms of diabetic retinopathy.

METHODS

A cross-sectional study was conducted between December 1st, 2004 and July 16th, 2005 within the care centers of Kinshasa, DRC. The origin population (n=3010 diabetics) served to estimate the diabetic retinopathy prevalence while a random sample of 301 diabetics participated to this analytic study: age>or=20 years, anthropometry, components of blood pressure, fasting glycaemia, optometry, fundoscopy, stages of diabetic retinopathy.

RESULTS

The rate of diabetic retinopathy was 31.6% 95 CI: 26.3-36.9 in Kinshasa town. In the random sample, diabetic retinopathy was non proliferative in the majority (90%). Subjective decrease of acuity was associated with diabetic retinopathy in the sample (OR=2.7; 95% CI 1.1-5.4; p<0.05), among women (OR=2.7; 95% CI 1.3-5.7; p<0.05), and in patients with type 2-diabetes (OR=2; 95% CI 1.1-3.4; p<0.05). Objective decrease of acuity was associated with diabetic retinopathy in the study sample (OR=3.6; 95% CI 1.1-12.6; p<0.05). Visual impairment was significantly associated with diabetic retinopathy in women (OR=3.6; 95% CI 1.1-12.6; p<0.05) and proliferative diabetic retinopathy. Pregnancy after diabetes mellitus onset was a significant risk factor of diabetic retinopathy for women (OR=3.2; 95% CI 1.1-13.2; p<0.05). Using logistic regression analysis, family history of diabetic retinopathy (OR=3.2; 95% CI 1.2-8.8; p<0.05), diabetes duration >/=4 years (OR=3.4; 95% CI 1.4-8.5; p<0.01), and pulse pressure>or=60 mmHg (OR=5; 95% CI 2-12.8; p<0.001) were the independent and significant predictors of diabetic retinopathy.

CONCLUSION

Urgent programme of prevention and control of diabetic retinopathy and its risk factors is needed.