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Macrovascular Complications and Their Associated Risk Factors in Type 2 Diabetic Patients in Sana’A City, Yemen A

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Macrovascular Complications and Their Associated Risk Factors in Type 2 Diabetic Patients in Sana’A City, Yemen A املجلة الصحية لرشق املتوسط املجلد السادس عرش العدد الثامن Macrovascular complications and their associated risk factors in type 2 diabetic patients in Sana’a city, Yemen A. Al-Khawlani,1 Z.A. Atef 1 and A. Al-Ansi 1 املضاعفات يف اﻷوعية الكبرية وارتباطها بعوامل اﻻختطار لدى مرىض النمط الثاين من ّالسكري يف مدينة صنعاء، اليمن عبد الكريم حممد صالح اخلوﻻين، زايد أمحد عاطف، أمحد قاسم العنيس اخلﻻصـة: أجرى الباحثون ًمسحا ًعرضيا يف مدينة صنعاء، يف اليمن، يستهدف ُّالتعرف عىل معدل انتشار املضاعفات التي يمكن الوقاية منها يف اﻷوعية الكبرية، وارتباطها بضبط مستوى السكر وبغريها من عوامل اﻻختطار لدى مرىض النمط الثاين من ّالسكري. وﻻحظ الباحثون بعض مﻻمح أمراض اﻷوعية الكبرية لدى 79 ًمريضا )25.4%( من أصل 311 ًمريضا؛ فقد كان لدى 17.8% منهم مرض يف الرشايـني التاجية، ولدى %9.1 منهم ًمرضا باﻷوعية الطرفية، ولدى 5.8% منهم ًمرضا ًوعائيا ًدماغيا. كام وجد الباحثون ًترابطا ًإجيابيا يعتد به ً إحصائيابني مرض القلب التاجي وبني العمر، ومدة ّالسكري، وضغط الدم اﻻنقبايض، وضغط الدم اﻻنبساطي، واملعاجلة باﻷنسولني. كام ارتبط املرض الوعائي الطريف بالذكورة وبالعمر، وبمدة السكري، وبالتدخني احلايل للتبغ. أما املرض الوعائي الدماغي فقد ارتبط بضغط الدم اﻻنقبايض وضغط الدم اﻻنبساطي واملعاجلة باﻷنسولني. ABSTRACT A cross-sectional survey in Sana’a city, Yemen, aimed to determine the prevalence of preventable macrovascular complications and their association with glycaemic control and other risk factors in patients with type 2 diabetes mellitus (DM). Some features of macrovascular disease were found in 79 (25.4%) of the 311 patients: 17.8% had coronary heart disease, 9.1% had peripheral vascular disease and 5.8% had cerebrovascular disease. Significant positive associations were found between coronary heart disease and age, duration of DM, systolic blood pressure, diastolic blood pressure and insulin treatment. Peripheral vascular disease was associated with male sex, age, duration of DM and current tobacco smoking. Cerebrovascular disease was associated with systolic blood pressure, diastolic blood pressure and insulin treatment. Complications macrovasculaires et risques associés chez des patients souffrant de diabète de type 2 à Sanaa (République du Yémen) RÉSUMÉ Une étude transversale réalisée à Sanaa (République du Yémen) avait pour objectif de déterminer la prévalence des complications macrovasculaires évitables et leur association avec le contrôle de la glycémie et d’autres facteurs de risque chez des patients souffrant de diabète de type 2. Sur 311 patients, 79 présentaient des signes de maladie macrovasculaire (soit 25,4 %) : 17,8 % souffraient d’une cardiopathie coronarienne, 9,1 % d’une maladie vasculaire périphérique et 5,8 % d’une maladie cérébrovasculaire. Des associations positives significatives ont été constatées entre les cardiopathies coronariennes et l’âge, la durée du diabète de type 2, la pression artérielle systolique, la pression artérielle diastolique et le traitement par insuline. La maladie vasculaire périphérique était associée au sexe masculin, à l’âge, à la durée du diabète de type 2 et la consommation de tabac au moment de l’étude. La maladie cérébrovasculaire était associée à la pression artérielle systolique, la pression artérielle diastolique et au traitement par insuline. 1Department of Internal Medicine, Faculty of Medicine, University of Sana’a, Al-Thawra Teaching Hospital, Sana’a, Yemen (Correspondence to A. Al-Khawlani: [email protected]). Received: 08/10/08; accepted: 08/01/09 851 EMHJ • Vol. 16 No. 8 • 2010 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale Introduction complications account for approxi- The physicians took the patient’s mately 50% of all deaths among DM history of macrovascular complica- Diabetes mellitus (DM) is associated patients in industrialized countries tions by interviewing the patients using with a number of vascular complica- [9,10]. The aim of this study was to locally understood terms if necessary. tions. Microvascular complications determine the prevalence of macrov- A hospital discharge record was required such as retinopathy, nephropathy and ascular complications in Yemeni pa- to certify the event. PVD was diagnosed neuropathy are specific to DM, whereas tients with type 2 DM and to identify by manifestations of intermittent clau- macrovascular complications such as the role of glycaemic control and other dication, ulcers or gangrene or a history peripheral vascular disease (PVD), risk factors in patients with and without of amputation or when one or more foot coronary heart disease (CHD) and cer- macrovascular complications. pulses were absent during medical ex- ebrovascular disease (CVD) can occur amination. CHD was diagnosed based in the absence of DM [1,2]. Macrovascu- on definitive myocardial infarction, lar complications in DM consist mainly Methods ischaemic electrocardiographic changes of an accelerated form of atherosclerosis (Q/QS and ST/T changes) and by a that affects the coronary, carotid and This was a multi-centre, cross-sectional history of angina pectoris, myocardial peripheral arteries, thus increasing the study, conducted from July 2006 to infarction, coronary artery bypass graft risk of myocardial infarction, stroke and January 2007. The study was approved or percutaneous coronary angioplasty. diabetic foot disease [3,4]. CHD has by the ethics committee of the Faculty CVD was defined to include both a been associated with DM in numerous of Medicine and Health Sciences at the history of cerebral infarction or transient studies, notably the Framingham study University of Sana’a. ischaemic attacks and was diagnosed [5]. More recent studies have shown Sample on the basis of clinical manifestations that the risk of myocardial infarction in and findings on computed tomography Patients aged ≥ 25 years with type 2 DM people with DM is equivalent to the risk and a positive answer to the question were recruited to the study when they in nondiabetic patients with a history of “Have you ever had a stroke?” Patients visited one of the 2 primary care diabe- previous myocardial infarction [6]. with cerebral haemorrhage and embo- tes clinics in Sana’a city or visited the These discoveries have lead to new lism originating from cardiac thrombi outpatient clinics at, or were admitted were excluded from this study. recommendations by the American to, one of the 2 government hospitals Blood pressure was measured on Diabetes Association and American (Al Thawra and Al-Kuwait) in the city. the right arm, with the subject seated Heart Association that DM be con- Patients who attend clinics in Sana’a, after 10 minutes rest, using a standard sidered a coronary artery disease risk the capital city of Yemen, come from clinical mercury sphygmomanometer equivalent rather than a risk factor [7]. all regions of the country. Patients were with an appropriate cuff size. Hyper- Patients with DM are 2 to 4 times more invited to participate in the study by the tension was diagnosed according to likely to develop cardiovascular diseases physicians in the outpatient clinic and WHO criteria [13] if systolic pressure than the general population and have a were examined according to the study was ≥ 140 mmHg or diastolic pressure 2–5-fold greater risk of dying from these protocol after they had given informed ≥ 90 mmHg or if the patient was taking diseases [7]. DM is also a strong inde- consent. Type 2 DM was diagnosed antihypertensive drugs. pendent predictor of the risk of stroke based on World Health Organization and CVD [8] and patients with type 2 (WHO) criteria [12]. Patients who were Height and weight were recorded DM have a 150%–400% higher risk of diagnosed with gestational diabetes, with the patient wearing clothing and stroke [9]. Similarly, the risk of PVD type 1 DM, ketonuria or autoimmune without shoes. Body mass index (BMI) 2 in DM patients is 4 times higher than disease were excluded from the study. was defined as weight (kg)/height normal [10] and patients more com- (m2). Obesity was classified according monly have infrapopliteal arterial oc- Data collection to WHO criteria [14]. clusive disease and vascular calcification Demographic data and medical history Blood was drawn after overnight than nondiabetic cohorts [11]. DM is were obtained by a personal interview fasting for determination of the levels known to increase the risk of lower limb and by review of the patient’s medical of fasting plasma glucose, glycosylated amputation by 15–40 times compared records. Age, sex, duration of DM, type haemoglobin (HbA1c) and the lipid with the general population [9]. of treatment and family history of DM profile. A second venous blood sample The prevalence of macrovascular were recorded. Patients were also asked was taken 2 hours later, to determine complications among DM patients if they currently smoked tobacco (at the 2-hour postprandial glucose. All bio- has not been studied in Yemen. Such least 10 cigarettes per day) or chewed chemical measurements were carried data are important given that these khat leaves (daily). out on the same day as blood collection 852 املجلة الصحية لرشق املتوسط املجلد السادس عرش العدد الثامن using standard laboratory automated Results of CVD compared with patients on techniques. Plasma glucose level was insulin therapy or controlled with diet assessed by means of the glucose hex- Patients’ background alone (P < 0.037). okinase method (Roche Diagnostic, characteristics Table 2 shows the demographic, Mannheim, Germany). Serum total A total of 311 patients with type 2 DM clinical and laboratory findings for the cholesterol, high-density lipoprotein were studied. There were 155 males total sample and for males and females. (HDL) and low-density lipoprotein (49.8%) and 156 females (50.2%), Overall 79 (25.4%) DM patients had (LDL) cholesterol and serum triglyc- mean age 53.9 (SD 10.9) years (range symptoms of macrovascular complica- erides were measured using enzymatic 25–85 years). The duration of DM tions: 28 (9.1%) had PVD, 55 (17.8%) techniques (Boehringer-Mannheim, varied between 1–35 years. Of the total had CHD and 18 (5.8%) had CVD.
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