RESUMO

Background: Ethnic variations have been reported in allelic frequencies of the leptin receptor gene (LEPR) with population-specific effects. We aimed to explore the association of LEPR polymorphisms with obesity, metabolic syndrome (MetS), and leptin levels in Afro-Caribbean nondiabetic subjects. Methods: Genotypic analysis of three LEPR polymorphisms (K109R, Q223R, and K656N) was performed using TaqMan allelic discrimination assays. Associations were measured with phenotypic variables, including body mass index (BMI), waist circumference (WC), and leptin levels. Linear and logistic regressions were performed to evaluate the effects of single-nucleotide polymorphisms (SNPs). Results: Mean age was 46 ± 12 years. Among the 375 participants, 29.3% were obese, 36.3% had abdominal obesity, and 18.1% had MetS. Significant association between BMI (P < 0.002) and WC (P < 0.005) was observed for K656N, whereas the associations were not statistically significant for the other two SNPs. No association was found with leptin levels for the three SNPs. The variant allele frequencies for LEPR 109R, 223R, and 656N were 0.16, 0.46, and 0.20, respectively. In dominant models, the variant allele 656N (GC/CC vs. GG) was associated with prevalence of obesity [odds ratio (OR) 1.82; P = 0.012] and abdominal obesity (OR 2.00; P = 0.007), but not significantly with prevalence of MetS (OR 1.72; P = 0.029). Individuals carrying four variant alleles of the three SNPs had a significantly higher risk of obesity (OR 2.86; P = 0.032) than those carrying none variant allele. Conclusion: Our results suggest an influence of K656N polymorphism in the LEPR gene on obesity and abdominal obesity in this Afro-Caribbean population.

Assuntos

Síndrome Metabólica/genética , Obesidade/genética , Polimorfismo de Nucleotídeo Único , Receptores para Leptina/genética , Adulto , África , Alelos , População Negra , Índice de Massa Corporal , Região do Caribe , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Guadalupe/epidemiologia , Humanos , Leptina/sangue , Modelos Lineares , Masculino , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade Abdominal/genética , Sobrepeso/genética , Fenótipo , Análise de Regressão , Circunferência da Cintura

RESUMO

Context: The population of Guadeloupe Island exhibits a high prevalence of obesity. Objective: We aimed to investigate whether rare genetic mutations in genes involved in monogenic obesity (or diabetes) might be causal in this population of Afro-Caribbean ancestry. Design and Setting: This was a secondary analysis of a study on obesity conducted in schoolchildren from Guadeloupe in 2013 that aimed to assess changes in children's profiles after a lifestyle intervention program. Through next-generation sequencing, we sequenced coding regions of 59 genes involved in monogenic obesity or diabetes in participants from this study. Participants and Interventions: A total of 25 obese schoolchildren from Guadeloupe were screened for rare mutations (nonsynonymous, splice-site, or insertion/deletion) in 59 genes. Main Outcome Measures: Correlation between phenotypes and mutations of interest. Results: We detected five rare heterozygous mutations in five different children with obesity: MC4R p.Ile301Thr and SIM1 p.Val326Thrfs*43 mutations that were pathogenic; SIM1 p.Ser343Pro and SH2B1 p.Pro90His mutations that were likely pathogenic; and NTRK2 p.Leu140Phe that was of uncertain significance. In parallel, we identified seven carriers of mutations in ABCC8 (p.Lys1521Asn and p.Ala625Val) or KCNJ11 (p.Val13Met and p.Val151Met) that were of uncertain significance. Conclusions: We were able to detect pathogenic or likely pathogenic mutations linked to severe obesity in >15% of this population, which is much higher than what we observed in Europeans (∼5%).

Assuntos

População Negra , Obesidade Infantil/epidemiologia , Obesidade Infantil/genética , Adolescente , População Negra/genética , População Negra/estatística & dados numéricos , Região do Caribe/etnologia , Criança , Estudos de Coortes , Análise Mutacional de DNA , Feminino , Guadalupe/epidemiologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Mutação , Obesidade Infantil/etnologia , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos

RESUMO

BACKGROUND: Despite excessive rates of cardiovascular risk factors such as hypertension, diabetes, and obesity, Afro-Caribbeans have lower mortality rates from coronary heart disease (CHD) than do whites. This study evaluated the association of genetic risk markers previously identified in whites and CHD in Afro-Caribbeans. METHODS: We studied 537 Afro-Caribbean individuals (178 CHD cases and 359 controls) who were genotyped for 19 CHD-related single-nucleotide polymorphisms (SNPs). A genetic risk score (GRS) incorporating the 19 SNPs was calculated. These participants were compared with 1360 white individuals from the Second Northwick Park Heart Study. RESULTS: In Afro-Caribbeans, patients with CHD had higher rates of hypertension (78.7% vs 30.1%), hypercholesterolemia (52.8% vs 15.0%), and diabetes (53.9% vs 14.8%) and were more often men (64.0% vs 43.7%) and smokers (27.5% vs 13.4%) compared with non-CHD controls (all P < 0.001). The GRS was higher in Afro-Caribbeans with CHD than in those without CHD (13.90 vs 13.17; P < 0.001) and was significantly associated with CHD after adjustment for cardiovascular risk factors, with an odds ratio of 1.40 (95% confidence interval, 1.09-1.80) per standard deviation change. There were significant differences in allelic distributions between the 2 ethnic groups for 14 of the 19 SNPs. The GRS was substantially lower in Afro-Caribbean controls compared with white controls (13.17 vs 16.59; P < 0.001). CONCLUSIONS: This study demonstrates that a multilocus GRS composed of 19 SNPs associated with CHD in whites is a strong predictor of the disease in Afro-Caribbeans. The differences in CHD occurrence between Afro-Caribbeans and whites might be a result of significant discrepancies in common gene variant distribution.

Assuntos

População Negra/genética , Doença das Coronárias/etnologia , Doença das Coronárias/genética , Polimorfismo de Nucleotídeo Único , Medição de Risco , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Guadalupe/etnologia , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fumar/epidemiologia , População Branca/genética

RESUMO

BACKGROUND: Traditional risk factors are strong predictors of the incidence of coronary artery disease (CAD), but their association with disease severity remains controversial and could differ across ethnic groups. AIMS: In this study, we assessed the prevalence of cardiovascular risk factors (CRFs) in Afro-Caribbean patients with documented CAD, and sought to identify which of these factors are related to disease severity. METHODS: We retrospectively studied 420 consecutive patients with CAD. Disease severity was determined from the results of invasive coronary angiography, based on the presence or absence of multiple (two or three) diseased vessels and the myocardial jeopardy (MJ) score. RESULTS: In the studied population (mean age 64.7 ± 12.4 years), hypertension, diabetes and dyslipidaemia were the most frequent modifiable CRFs, present in 75.9, 47.8 and 37.8% of patients, respectively. Multiple logistic regression analysis showed that diabetes, male sex and personal cardiovascular history significantly increased the risk of multivessel CAD: odds ratios (ORs) of 1.53 (1.01-2.33; P=0.048), 1.61 (1.02-2.55; P=0.043) and 1.68 (1.11-2.56; P=0.015), respectively. Obesity was an independent negative predictor, with an OR of 0.48 (0.29-0.79; P=0.004). Other traditional CRFs (hypertension, dyslipidaemia, smoking, age and family history of vascular disease) were not associated with CAD severity. For high-risk lesions (MJ score ≥8), both diabetes and hypertension were independent predictors of disease severity, whereas obesity was no longer a protective factor. CONCLUSION: Diabetes emerged as the strongest modifiable risk factor predictor of multivessel disease in Afro-Caribbean patients, whereas obesity was an independent protective factor. The underlying mechanisms of these associations should be relevant to disease prevention.

Assuntos

Doença da Artéria Coronariana/etnologia , Idoso , População Negra , Distribuição de Qui-Quadrado , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Diabetes Mellitus/etnologia , Guadalupe/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/etnologia , Razão de Chances , Prevalência , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença

RESUMO

BACKGROUND: Vitamin D (vitD) insufficiency is common in end-stage renal disease. Seasonal and ethnic differences in vitD status have been reported previously. We hypothesized that vitD status in Afro-Caribbean patients on hemodialysis (HD) living in a country with a constant sunny climate would be better than that in African-American HD patients living in countries with a winter season. METHOD: A cross-sectional study was conducted in 152 Afro-Caribbean HD patients in a dialysis center located in Guadeloupe. We evaluated the prevalence of vitD insufficiency, defined as serum 25-hydroxyvitamin D (25(OH)D) levels below 30 ng/mL, compared with those results previously reported in African-American HD patients (88%). RESULTS: Prevalence of vitD insufficiency was 60% and thus lower than that in the African-American patients considered as the reference population (p<0.001). In our diabetic patients, this prevalence was 72.4%. Globally, 9.2% of patients had 25(OH)D below 15 ng/mL. Alfacalcidol therapy was prescribed in 29%. Mean 25(OH)D levels were higher in treated than in untreated patients (32 vs. 27 ng/mL; p=0.009). Patients with vitD insufficiency had dyslipidemia and diabetes more frequently. No significant differences were found between patients with and without vitD insufficiency for serum calcium, phosphorus and parathyroid hormone (PTH). In untreated patients, no significant correlation was found between 25(OH)D and PTH levels. CONCLUSION: Prevalence of vitD insufficiency in Afro-Caribbean HD patients was lower than that previously reported in African Americans undergoing HD in the United States. This finding may be due to the constantly sunny weather with a high intensity of UVB radiation in Guadeloupe.

Assuntos

População Negra/estatística & dados numéricos , Nefropatias/terapia , Diálise Renal , Pigmentação da Pele , Luz Solar , Deficiência de Vitamina D/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Análise de Variância , Biomarcadores/sangue , Cálcio/sangue , Distribuição de Qui-Quadrado , Comorbidade , Estudos Transversais , Diabetes Mellitus/etnologia , Dislipidemias/etnologia , Feminino , Guadalupe/epidemiologia , Humanos , Hidroxicolecalciferóis/uso terapêutico , Nefropatias/sangue , Nefropatias/etnologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fósforo/sangue , Prevalência , Diálise Renal/efeitos adversos , Estados Unidos/epidemiologia , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico

RESUMO

BACKGROUND: The atrial natriuretic peptide (ANP) is known mainly for its effects on kidney function and blood pressure homeostasis. We investigated the association between two ANP polymorphisms and pre-existing coronary artery disease (CAD) in patients of African descent with type 2 diabetes (T2D). METHODS: We conducted a cross-sectional and retrospective study of 218 volunteer Afro-Caribbean patients with T2D. Two polymorphisms (rs5064, 708C>T; and rs5065, 2238T>C) of ANP were genotyped using PCR-restriction fragment length polymorphism analysis. ANCOVA, χ2-test, and logistic regression were used for statistical analysis. RESULTS: Among these patients (92 men; 128 women), 67 (30.7%) had CAD, of whom 75% had had myocardial infarction. The frequency of rs5065-C carriers (TC/CC) was significantly lower in patients with CAD than in those without CAD (24 vs. 41%, P = 0.01). The frequency of hypertension did not differ significantly according to genotype. Univariate logistic regression revealed that male sex, age, dyslipidemia, hypertension, and rs5065-C carrier status were associated significantly with CAD. After adjustment for the variables of interest, the odds ratio (ORs) of CAD for rs5065-C carriers (TC/CC) was 0.50 (0.26-0.96; P = 0.038). No association was found between the rs5064 (708C>T) single-nucleotide polymorphisms (SNPs) and pre-existing CAD or cardiovascular risk factors. CONCLUSIONS: The ANP rs5065 (2238T>C) C allele seems to exert a protective effect against CAD in T2D patients of African descent. The relevance of ANP polymorphisms for CAD should be determined in different populations.

Assuntos

Fator Natriurético Atrial/genética , População Negra/genética , Doença da Artéria Coronariana/genética , Diabetes Mellitus Tipo 2/genética , Polimorfismo de Nucleotídeo Único/genética , Idoso , População Negra/etnologia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etnologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Índias Ocidentais

RESUMO

Ethnic differences may affect the association of adiponectin (Ad) multimers with coronary artery disease (CAD). We analyzed the associations of total Ad, Ad multimers, and T45G polymorphism of ADIPOQ gene with pre-existing CAD. We carried out a cross-sectional study of 216 Afro-Caribbean type 2 diabetic (T2D) subjects. Levels of total Ad, high molecular weight (HMW), middle molecular weight (MMW), and low molecular weight (LMW) isoforms were measured. Subjects were genotyped. Of the subjects studied, 57 had pre-existing CAD, 77% of whom have had myocardial infarction. Subjects with CAD had lower Ad levels (total and multimers) and a higher frequency carried the minor allele 45G, GG/TG, (18% vs. 8%, P = 0.03) than subjects without CAD. In logistic regression analysis, the models used evaluate Ad in the context of adjustment for metabolic syndrome characteristics. The adjusted odds ratio (OR) of CAD was increased significantly (by factors of 1.05-3.27) for males, older subjects, low high-density lipoprotein cholesterol (HDL-C), high triglycerides (TGs), and carriers of the 45 G allele. For Ad, in model 1 (including only total Ad) the adjusted OR was 2.30; P = 0.03 and, in model 2 (including the three multimers, but not total Ad), the adjusted ORs were 0.73; P = 0.52 (HMW), 2.90; P = 0.01 (MMW), and 2.08; P = 0.09 (LMW). The T45G polymorphism in the ADIPOQ gene and hypoadiponectinemia were associated with CAD in our T2D subjects of predominantly African background. This effect of Ad level was mainly related to the MMW Ad form.

Assuntos

População Negra/genética , Doença da Artéria Coronariana/etnologia , Doença da Artéria Coronariana/genética , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/genética , Adiponectina/química , Adiponectina/genética , Idoso , População Negra/estatística & dados numéricos , HDL-Colesterol/sangue , Doença da Artéria Coronariana/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Peso Molecular , Polimorfismo Genético , Triglicerídeos/sangue , Índias Ocidentais/epidemiologia

RESUMO

Pulmonary hypertension (PH) is a severe complication of sickle cell disease (SCD). The main purpose of this study was to evaluate the prevalence of PH in an adult SCD population in Guadeloupe. Echocardiography findings of 427 patients with SCD were analyzed. Subjects with a pulmonary artery systolic pressure (PASP) >30 mm Hg, at rest, were studied. PH was found in 49 (11.5%) SCD patients. Mean age was 37 years and mean PASP was 40 mm Hg. The most frequent symptom was exertional dyspnea. Thirteen subjects (26%) had left heart diseases. In the overall study population, 22 (5%) patients died. Seven (14%) patients had PH and 15 (4%) were PH free, p = 0.006. An early PH screening is recommended in SCD patients at steady state owing to the absence of specific symptoms and to the significant mortality rate related to this complication.

Assuntos

Anemia Falciforme/mortalidade , Hipertensão Pulmonar/mortalidade , Adulto , Guadalupe/epidemiologia , Humanos , Prevalência

RESUMO

BACKGROUND: Inverse associations between risk factors and mortality have been reported in epidemiological studies of patients on maintenance hemodialysis (MHD). OBJECTIVE: The aim of this prospective study was to estimate the effect of the dual variable pulse pressure (PP) - body mass index (BMI) on cardiovascular (CV) events and death in type 2 diabetic (T2D) subjects on MHD in a Caribbean population. METHODS: Eighty Afro-Caribbean T2D patients on MHD were studied prospectively from 2003 to 2006. Proportional-hazard modeling was used. RESULTS: Of all, 23.8% had a high PP (PP > or = 75th percentile), 76.3% had BMI < 30 Kg/m(2), 21.3% had the dual factor high PP - absence of obesity. During the study period, 23 patients died and 13 CV events occurred. In the presence of the dual variable and after adjustment for age, gender, duration of MHD, and pre-existing CV complications, the adjusted hazard ratio (HR) (95% CI) of CV events and death were respectively 2.7 (0.8-8.3); P = 0.09 and 2.4 (1.1-5.9); P = 0.04. CONCLUSIONS: The dual factor, high PP - absence of obesity, is a prognosis factor of outcome. In type 2 diabetics on MHD, a specific management strategy should be proposed in nonobese subjects with wide pulse pressure in order to decrease or prevent the incidence of fatal and nonfatal events.

Assuntos

Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/terapia , Diálise Renal , Idoso , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Índias Ocidentais/epidemiologia

RESUMO

Dactylitis or hand-foot syndrome is related to intravascular sickling and classically occurs around 6 months of life when haemoglobin S levels reach pathological significance. It has been hypothesised as a possible predictive factor of adverse outcome. The objective of this study was to estimate the survival without severe events (acute chest syndrome, stroke or death) according to early occurrence of dactylitis in the sickle cell paediatric cohort of Guadeloupe. The study period was 1 January 1984 to 31 December 1999. Medical data were recorded from birth for children with sickle cell anaemia diagnosed before 6 months of age. The Kaplan-Meier method was used to estimate the severe event-free survival and to draw related curves. We used proportional-hazard modelling to assess the risk of severe events (stroke or acute chest syndrome or death) in children with early dactylitis (before 6 months of age). The study sample comprised 114 children. The incidence [95% confidence interval] of clinical events per 100 child-years were 10.0 [7.63, 13.07] for dactylitis, 0.73 [0.33, 1.62] for stroke, 10.88 [8.35, 14.17] for acute chest syndrome and 1.06 [0.56, 2.05] for death. Thirteen of the 14 children who had dactylitis before 6 months of age had at least one severe event later in life. The median severe event-free survival time was 2.1 [1.6, 2.7] years in children with dactylitis before 6 months compared with 6.3 [4.5, 8.1] years in the other children; P < 0.0005. After adjustment for haemoglobin level 19 000/mm3 (75th percentile), transfusion before age of one year, acute splenic sequestration before the age of one year, the adjusted hazard ratio of severe event for children with early dactylitis was 2.13 [1.06, 4.40]; P < 0.03. Dactylitis occurring before 6 months of life identifies children at risk of severe complications who should benefit from close management.

Assuntos

Anemia Falciforme/epidemiologia , Dor no Peito/epidemiologia , Eritema/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idade de Início , Anemia Falciforme/complicações , Anemia Falciforme/mortalidade , Dor no Peito/complicações , Criança , Pré-Escolar , Estudos de Coortes , Intervalo Livre de Doença , Eritema/complicações , Feminino , Pé , Guadalupe/epidemiologia , Mãos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Fatores de Risco , Acidente Vascular Cerebral/complicações , Síndrome

RESUMO

BACKGROUND: The aims of this study were to examine systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) in patients with type 2 diabetes undergoing hemodialysis (HD), and to assess the relationships between these parameters and cardiovascular (CV) events such as coronary heart disease and congestive cardiac failure. METHODS: A total of 80 Afro-Caribbean type 2 diabetic patients undergoing hemodialysis in three centers in Guadeloupe, French West Indies, were included in this cross-sectional study. Pre- and postdialysis BP were recorded. Logistic regression methods and areas under the receiver operating characteristic curves were used. RESULTS: The mean age (+/- standard deviation) was 62.2 years (+/-10.2 years). A total of 24 subjects (30%) had one or more CV events. Sixteen (20%) had coronary disease, 15 (18.8%) cardiac failure, and seven (8.8%) had both. The medians [interquartile ranges] for predialysis PP was higher in patients with CV comorbidity than in patients without a history of CV at 84.5 mm Hg [74.5 to 92.3]v 69.5 mm Hg [61.0 to 79.5], P = .003. Areas under the ROC curves (95% confidence intervals) predialysis were significant only for SBP and PP at 0.70 (0.58 to 0.82) v 0.71 (0.59 to 0.83) without statistical differences. After adjustment for gender, age, body mass index, antihypertensive use, time on hemodialysis (>or=2 years), and hemoglobin rate, the odds ratio was significant only predialysis, and a higher odds ratio was found for PP at 2.25 (1.22 to 4.18), P = .01, than for SBP 1.97 (1.12 to 3.49), P = .02. CONCLUSIONS: Our results suggest that the strongest association of PP with CV morbidities should be considered in therapeutic strategies. These results show the necessity of targeting antihypertensive treatment to patients' predialysis blood pressure values.

Assuntos

Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Diálise Renal , Idoso , Doenças Cardiovasculares/epidemiologia , Comorbidade , Doença das Coronárias/epidemiologia , Doença das Coronárias/fisiopatologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Guadalupe/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pulso Arterial

RESUMO

Hypertension, dyslipidemia and type 2 diabetes, important cardiovascular risk factors, are strongly linked to obesity. Body mass index (BMI) and waist circumference (WC) are measures of obesity that can be useful in identifying individuals with these risk factors. We assessed which of the two measures is more informative at the population level. The study population included 5,149 consecutive women aged 18 to 74 recruited in an Health Center of Guadeloupe (FWI) in 1999. The areas under the ROC curves of BMI and WC and their 95% CI were computed and compared. Logistic regression analysis of BMI and WC and the areas under the ROC curves in two separate age groups (18-39 years and 40-74 years) showed that age modifies the discriminant ability of these parameters in identifying the CVD risk factors. Sensitivity equalled specificity at levels between 52-70% for BMI and 55-80% for WC. ROC areas for identifying each risk factors by BMI varied from 0.52 to 0.84 and by WC from 0.55 to 0.88. For the identifying of women with at least one CVD risk factor, in the whole population, the areas under the curves for BMI and WC (respectively, 0.71; 95% CI: 0.69-0.73 and 0.76; 95% CI: 0.74-0.78) were both significantly greater than 0.5. The difference between these correlated areas was 0.04, 95% CI [-0.05, -0.03]. The lowest values of the areas were noted in detecting women with dyslipidemia and the highest in detecting those with type 2 diabetes. Waist circumference, a practical tool that had a higher discriminant ability than BMI in identifying presence or absence of all these risk factors, appears as the best screening tool in this population.

Assuntos

Constituição Corporal , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/diagnóstico , Hiperlipidemias/diagnóstico , Hipertensão/diagnóstico , Programas de Rastreamento/métodos , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Guadalupe , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade

RESUMO

The electrocardiogram remains the most commonly used method of cardiac assessment in developing countries. To determine the prevalence of electrocardiographic left ventricular hypertrophy (LVH) and the clinical significance of Sokolow-Lyon voltage criteria in sickle cell patients, echocardiographic and ECG findings were studied in 112 patients (71 with haemoglobin SS disease and 41 with haemoglobin SC disease). Electrocardiographic left ventricular hypertrophy (ECGLVH) defined as Sokolow-Lyon voltage greater than or equal to 35 mm was detected in 39 (55 percent) SS patients and 11 (27 percent) SC patients. This prevalence was higher in men than in women. There were statistically significant trends for increasing prevalence of ECGLVH with height (p<0.007 in SS, and p<0.01 in SC patients). But no significant trend was found with increasing posterior wall (PWT) or interventricular septal thickness (IVST). Sensitivity of Sokolow-Lyon criteria for detection of echocardiographic left ventricular hypertrophy was 63 percent and 33 percent in SS and SC patients, respectively, and specificity was 51 percent and 74 percent, respectively. Sokolow-Lyon voltage correlated with left ventricular mass in SS and SC patients (r = 0.44, p < 0.01 and r = 0.32, p < 0.05) and with left ventricular internal dimension (r = 0.2, p < 0.01 and r = 0.32, p < 0.05) but not significantly with PWT and IVST. We conclude that, in sickle cell patients, the electrocardiographic LVH mainly indicates the existence of an eccentric echocardiographic LVH with increase of left ventricular internal dimension.(AU)

Assuntos

Adulto , Feminino , Humanos , Masculino , Técnicas de Patch-Clamp/estatística & dados numéricos , Anemia Falciforme/terapia , Eletrocardiografia , Interpretação Estatística de Dados , Ecocardiografia , Guadalupe

RESUMO

Stroke is frequent in Guadeloupe and represents the first cause of mortality in the >35 year age group. A major risk factor of stroke, hypertension, is also very common (23 percent of the adult population). The French West Indies (FWI) has specific demographic characteristics because its population originated from various regions of the world, mainly Africa, and has a higher socioeconomic level than the other tropical regions. These circumstances provide an interesting background for the study of the epidemiology of stroke and its risk factors. A case control study with 90 stroke patients and 77 controls matched for age and ethnicity was carried out during six months at the University Hospital of Pointe-a-Pitre, FWI. A questionnaire was used to collect information on demographics, history of smoking and alcohol use and current medical history. Serum creatinine, C-reactive protein and lipid profile were quantified. Among stroke patients 48/90 (63.6 percent) were ischaemic, and 58/90 (75.3 percent) had previous hypertension. Obesity and diabetes were more frequent in the cases than in the controls. Serum creatinine concentration, serum total cholesterol, and apolipoprotein-B were significantly higher in patients than controls [83 umol/l vs 73 (p<0.0003) for creatinine, 5.7 mmol/l vs 5.2 (p<0.008) for cholesterol, and 1.2 g/l vs 1.0 (p<0.001) for apolipoprotein-B]. A multiple logistic regression analysis revealed that, in addition to hypertension and obesity, a high serum apolipoprotein-B concentration (>75 umol/l), and a high serum apolipoprotein-B concentration (>Ig/I) were independent and significant risk factors of stroke.(AU)

Assuntos

Adulto , Humanos , Transtornos Cerebrovasculares/epidemiologia , Fatores de Risco , Região do Caribe/epidemiologia