Faculty of Health Sciences
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Item Glyacaemic control profile in diabetic patients : a sub-analysis of the Phoenix Lifestyle Project(EuroMediterranean Biomedical Journal, 2016-03-29) Prakaschandra, Dorcas Rosaley; Naidoo, Datshana PrakashDiabetes Mellitus is regarded as an independent risk factor for cardiovascular disease and is highly prevalent in the Asian Indian community in South Africa. Poor control of blood glucose is associated with an increased risk for coronary artery disease (CAD). We determined the glycaemic control profile in a sample of known diabetic subjects from the Phoenix Lifestyle project cohort, and examined the relationship between gly-caemic control and other biochemical parameters. This is the first study in the Asian Indian community in Phoenix that determined the relationship between glycaemic control in diabetic subjects and other cardiovascular risk factors. Our study shows that significant dyslipidemia is present in the majority of diabetics with poor glycemic control, as well as in subjects with HBA1c levels demon-strative of good control. Atherogenic dyslipidemia in diabetic subjects is a substrate for the premature development of CAD in diabetes.Item Are common polymorphisms of the Lipoprotein Lipase and human Paraoxonase-1 Genes Associated with the metabolic syndrome in South African Asian Indians?(OMICS International, 2016) Prakaschandra, Dorcas Rosaley; Gordon, Michelle; Naidoo, Datshana PrakashA cross-sectional study was performed to determine the possible contribution of the Human Paraoxonase-1 (PON1) and Lipoprotein Lipase (LPL) polymorphisms to the risk of the metabolic syndrome (MetS) in 817 participants of South African Asian Indian ancestry. Demographic and anthropometric data, including fasting blood for analysis of glycaemic and lipid parameters was collected. DNA was isolated from peripheral blood and allelic polymorphisms at positions Q192R, L55M in the PON1 gene and S447X and N291S in the LPL gene were studied using real-time PCR. Melting curve analysis was used to identify homozygotes and heterozygotes. The MetS was classified using the harmonised criteria. The prevalence of the MetS was 47.99%, with the main drivers being the increased waist circumference (96.6%), raised blood pressure (76.8%) and raised triglyceride levels (72.4%). There was no significant difference (p=n/s) in the distribution of the genotypes as well as their alleles in subjects with and without MetS. Increased levels of triglycerides was found in subjects with the MetS who had the QQ (p=0.007; OR=1.19; 95%CI=1.04; 1.36) and QR (p=0.018; OR=1.73; 95% CI=1.12; 2.67) genotypes of the Q192R polymorphisms. Subjects who had both the SX genotype (S447X polymorphism) and the LM genotype (L55M polymorphism) were more likely to have the MetS than those without (p=0.016; OR 2.19; 95% CI: 1.17, 4.06). Interactions involving the PON 1 gene may predispose to the MetS and to its component risk factors such as hypertriglyceridemia in this population. Environmental factors, such as lifestyle behaviour patterns appear to be the main driver contributing to obesity-related MetS.Item High prevalence of cardiovascular risk factors in Durban South African Indians: The Phoenix Lifestyle Project(Health and Medical Publishing Group, 2016) Prakaschandra, Dorcas Rosaley; Esterhuizen, T.M.; Motala, Ayesha A.; Gathiram, P.; Naidoo, Datshana PrakashBACKGROUND: Previous studies show a high prevalence of cardiovascular (CV) risk factors in South African (SA) Asian Indians, with the emergence of premature coronary artery disease in young Indian subjects. OBJECTIVE: To determine the prevalence of CV risk factors in this population. METHODS: This was a cross-sectional study of randomly selected adults aged 15 - 64 years from the suburb of Phoenix in Durban, KwaZulu-Natal Province, SA. All participants had demographic, anthropometric and biochemical measurements using the modified World Health Organization (WHO) STEPwise survey methods. Hypertension, obesity, lipid abnormalities and diabetes mellitus (DM) were diagnosed using WHO criteria. Age-standardised frequencies for glycaemic indices were calculated according to the WHO standard world population distribution. RESULTS: Of the 1 428 subjects who responded (response rate 72.1%), complete data for analysis were available on 1 378 (1 001 women). The mean age was 45.5 (standard deviation 13) years. There were high prevalences of hypertension (47.5%), DM (20.1%), total body obesity (raised body mass index) (32.4%) and increased waist circumference (73.1%). The 'thin-fat' Asian phenotype (isolated abdominal obesity) was found in only 4.8% of participants. High prevalences of total body obesity (32.1%), increased waist circumference (31.3%) and insulin resistance (28.2%) were documented in the youngest age group. Over half of the males and 14.6% of females were current smokers. Diabetic dyslipidaemia was found in 61 subjects (4.4%). In multivariate analysis, age, triglycerides and waist circumference measurement were significant independent risk factors associated with DM and, together with fasting glucose, also predicted hypertension. CONCLUSION: Compared with Asian Indian subjects with similar environmental exposure in previous studies, the magnitude of change in risk factor prevalence over the past two decades has been of epidemic proportions.Item Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory- based risk assessment in South African populations(BioMed Central, 2013-07-24) Gaziano, Thomas A.; Pandya, Ankur; Steyn, Krisela; Levitt, Naomi; Mollentze, Willie; Joubert, Gina; Walsh, Corinna M; Motala, Ayesha A.; Kruger, Annamarie; Schutte, Aletta E.; Naidoo, Datshana Prakash; Prakaschandra, Dorcas Rosaley; Laubscher, RiaBackground All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.