Repository logo
 

Faculty of Health Sciences

Permanent URI for this communityhttp://ir-dev.dut.ac.za/handle/10321/11

Browse

Has files: YesSubject: search.filters.subject.Cardiovascular disease

Search Results

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    The spectrum and the effects of cardiovascular risk factors on the cardiac structure and function at Madadeni Provincial Hospital (Internal Medicine Department)
    (2023-05) Gambushe, Nokwanda A.; Prakaschandra, Dorcas Rosaley; Mahomed, F. A.
    Cardiovascular disease (CVD) is now a leading cause of death worldwide. According to the United Nations (UN), people who are above 60 years of age have a greater chance of developing CVD, and are projected to double in South Africa by 2050. There is clear evidence that patients with cardiovascular risk factors present with cardiac structural and functional abnormalities. Left ventricular remodelling is a major complication in patients with cardiovascular risk factors, particularly hypertension. Very few studies evaluating the structural and functional changes in response to CVD, and none, to the knowledge of the researcher, have been conducted on black Africans in South Africa in urban and rural areas Aim: The aim of the study was to determine the spectrum and the effects of cardiovascular risk factors on cardiac structure and function in patients presenting to Madadeni Provincial Hospital (Internal Medicine Department). Materials and method: The researcher systematically sampled 200 participants in the northern KwaZulu-Natal (KZN) region, presenting to Madadeni Provincial Hospital (Internal Medicine Department) and administered a questionnaire that collected their information on socio-demographic and cardiovascular risk factors. Other measurements included blood pressure, blood glucose, biochemical analysis and transthoracic echocardiography. The statistical analysis included descriptive statistics (frequency tables, bar and pie charts) and chi-squared and T tests to present the study findings and comparison between variables. A multinomial logistic regression analysis was performed to determine independent predictors for left ventricular geometry. Results: The mean age was 50.10 ± 16.188 (range: 18 – 79), with 114 (57.0%) females and 86 (43.0%) males. Black patients had the highest prevalence of cardiovascular risk factors (56, 87.0%), followed by Indians (27, 13.5%), whites (12, 6.0%) and mixed ancestry (5.4.0%). There was a high prevalence of modifiable cardiovascular risk factors with hypertension (HPT) being the leading factor (31.5%), followed by diabetes mellitus (17.0%). The prevalence of hypertension together with diabetes mellitus was 24.5%. Dyslipedemia was the lowest with 2.0%. The prevalence of left ventricular systolic function was normal in 174 (87.0%) participants and abnormal in 26 (13.0%). The prevalence of left ventricular diastolic dysfunction was 70.5% in women and 29.4% in men. There was a high prevalence of normal left ventricular geometry with 103 (51.5%), followed by concentric hypertrophy 72 (36.0%), eccentric remodelling 13 (6.5%), concentric remodelling 11 (5.5%), and eccentric hypertrophy with 0.5%. Metabolic syndrome was documented in 58.3% blacks, followed by 33.3% Indians and 8.3% whites. A multinomial logistic regression model was fitted with the dependent variable, which was left ventricle geometry. The independent variables were age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), HPT, diabetes mellitus and diastolic function. When comparing risk factors for concentric hypertrophy to the category ‘normal’, the significant variable was diastolic function (p value = 0.015). The risk factors for concentric remodelling was found to be SBP (p = 0.057) and BMI category morbid obese (p = 0.015). The risk factors for eccentric remodelling were found to be BMI category morbid obese (p = 0.002) and HPT (p = 0.016). Conclusion: The study has shown that there is a high prevalence of modifiable cardiovascular risk factors in the northern KZN region and many patients present with metabolic syndrome during the course of the disease. The study also revealed a high prevalence of left ventricular diastolic dysfunction and left ventricular geometric patterns in the studied population. The risk factors for left ventricular geometry were HPT, morbid obesity, diastolic function and SBP.
  • Thumbnail Image
    Item
    The prevalence of and risk factors for cardiovascular disease in patients seeking treatment at the Durban University of Technology Chiropractic Day Clinic
    (2018) Fillis, Lynn; Harpham, Graeme John; Korporaal, Charmaine Maria
    Introduction: Cardiovascular disease (CVD) is a major contributor to death in South Africa. Literature suggests that patients with musculoskeletal complaints frequently present with co- morbid pathologies such as hypertension and angina. However, ambiguity exists in the literature as to whether a relationship between the presence of CVD and the presence of musculoskeletal complaints exists. Methodology: This quantitative cross-sectional retrospective cohort analysis utilised a validated data sheet to collect demographic characteristics; morbidity and prevalence of cardiovascular disease and musculoskeletal complaints; and their associated risk factors from 1066 clinic files of new patients who presented to the Durban University of Technology Chiropractic Day Clinic in one year. The data were manually extracted, coded and were captured on an Excel spreadsheet and imported into IBM Statistical Package for the Social Sciences (SPSS) version 24 for analysis. A two-tailed 0.05 level of significance was used. Where associations were found, Pearson chi-square tests or Fisher exact test was used for categorical variables, and independent t-tests for quantitative variables was utilised to determine the significance of the association, indicating whether the association was greater than chance alone (i.e. a p value <0.05 being considered statistically significant) (Singh, 2014). If the data were not normally distributed a Mann-Whitney U test was utilised. Odds ratios were calculated to determine the risk of the exposure where possible (Singh 2017). Results: The patients presenting between 9 June 2015 and 9 June 2016 were predominantly Indian males; mean age of 37.87 years (SD 16.53 years); range five weeks to 86 years of age; majority within the 20-29 year age group. Most patients sought treatment for a primary musculoskeletal complaint (25% reported a secondary musculoskeletal complaint), characterised by chronic, moderate lumbar spine/abdomen pain of sharp character, with no associated pain radiation. The prevalence of cardiovascular disease was 25.2%, with hypertension and peripheral vascular disease as the most frequent. Risk factors in both the cardiovascular and non-cardiovascular disease groups included non-modifiable risk factors (viz. advancing age; gender; race/ethnicity and family history of CVD); and modifiable risk factors (viz. overweight/obesity; physical inactivity; blood pressure abnormalities; tobacco use; alcohol use; high fat and carbohydrate diet; diabetes mellitus; connective tissue disease; hypercholesterolaemia; use of non-cardiac medication and mental wellness). About 25% of patients reported the use of medication (the majority having been prescribed multiple medications (including anti-diabetics, anti-hypertensives, cholesterol-lowering drugs and anti-coagulants). Nearly 100% of CVD patients reported chronic medication use. Univariate logistic regression analysis revealed a number medications and common risk factors influenced the presentation of musculoskeletal complaints between CVD and non-CVD patients. With multivariable analysis, it was found that many of the medications lost significance after adjustment for confounders/influencing factors, although antihypertensive (OR 36.6; p=<0.001) and thyroid agents (OR 5.1; p=0.078) remained associated with CVD. Common/mutual risk factors for CVD and MSD including: increasing age (OR 1.1 p=<0.001), family history of CVD (OR 2.1; p=0.006), smoking (OR 1.9; p=0.054) and grade 1 HTN (OR 2.5; p=0.043) were significantly associated with having CVD. Furthermore, MSCs located in the SI joint/pelvis (OR 7.1; p=0.005) and head (OR 7.3; p=0.019), as well as the thoracic spine/chest/ribs (OR 4.9; p=0.015) and shoulder/brachium (OR 3.1; p=0.090) were shown to be significantly associated with CVD. Conclusion: The results of this study suggest that patients who seek treatment at the DUT CDC may present with both MSDs and CVD. Moreover, this study suggests that there may be an association between CVD and the presenting MSC. It is evident that the presentation of MSDs in CVD patients is multifactorial involving the use of cardiac and non-cardiac medication, and the presence of common CVD and MSD risk factors. However this study cannot conclusively comment on these pathophysiological changes. The current study can only speculate on causality based on known mechanisms as described in literature, however reverse causality may exist (viz. a lack of exercise, presence of MSCs may actually predispose to the CVDs). It is possible that CVD patients, who frequently sought treatment at chiropractic teaching clinics, may present with musculoskeletal side-effects associated with the use of cardiac and non-cardiac medications. This may result in the development of chronicity of musculoskeletal complaints, unresponsiveness to treatment and/or delayed recovery. It is important for chiropractic interns to be aware of this association as it affects how these patients are currently treated and managed thus affecting their prognosis. Caution needs to be applied as the outcomes of this study need to be investigated prospectively in larger sample sizes, different contexts and with some refinement of the data collection tool to confirm the outcomes of this study.