Sandra N Ofori

TITLE:    Holistic approach to prevention and management of type 2 diabetes mellitus in a family setting

AUTHORS:           Sandra N Ofori and Chioma N Unachukwu (2014)

 

Abstract

 

Diabetes mellitus (DM) is a chronic, progressive metabolic disorder with several complications that affect virtually all the systems in the human body. Type 2 DM (T2DM) is a major risk factor for cardiovascular disease (CVD). The management of T2DM is multifactorial, taking into account other major modifiable risk factors, like obesity, physical inactivity, smoking, blood pressure, and dyslipidemia. A multidisciplinary team is essential to maximize the care of individuals with DM. DM self-management education and patient-centered care are the cornerstones of management in addition to effective lifestyle strategies and pharmacotherapy with individualization of glycemic goals. Robust evidence supports the effectiveness of this approach when implemented. Individuals with DM and their family members usually share a common lifestyle that, not only predisposes the non-DM members to developing DM but also, increases their collective risk for CVD. In treating DM, involvement of the entire family, not only improves the care of the DM individual but also, helps to prevent the risk of developing DM in the family members.

 

Keywords: cardiovascular disease, multifactorial management

 

FUNCTIONAL LINKS;       http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4043717/

 

 

TITLE:    Serum uric acid and target organ damage in essential hypertension

 

AUTHOR:             Sandra N Ofori and Osaretin J Odia (2014)

 

Abstract

Background

Hypertension is a major risk factor for cardiovascular mortality, as it acts through its effects on target organs, such as the heart and kidneys. Hyperuricemia increases cardiovascular risk in patients with hypertension.

Objective

To assess the relationship between serum uric acid and target organ damage (left ventricular hypertrophy and microalbuminuria) in untreated patients with essential hypertension.

 

Patients and methods: A cross-sectional study was carried out in 130 (85 females, 45 males) newly diagnosed, untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular hypertrophy was evaluated by cardiac ultrasound scan, and microalbuminuria was assessed in an early morning midstream urine sample by immunoturbidimetry. Blood samples were collected for assessing uric acid levels.

Results

Mean serum uric acid was significantly higher among the patients with hypertension (379.7±109.2 μmol/L) than in the controls (296.9±89.8 μmol/L; P<0.001), and the prevalence of hyperuricemia was 46.9% among the hypertensive patients and 16.9% among the controls (P<0.001). Among the hypertensive patients, microalbuminuria was present in 54.1% of those with hyperuricemia and in 24.6% of those with normal uric acid levels (P=0.001). Similarly, left ventricular hypertrophy was more common in the hypertensive patients with hyperuricemia (70.5% versus 42.0%, respectively; P=0.001). There was a significant linear relationship between mean uric acid levels and the number of target organ damage (none versus one versus two: P=0.012).

Conclusion

These results indicate that serum uric acid is associated with target organ damage in patients with hypertension, even at the time of diagnosis; thus, it is a reliable marker of cardiovascular damage in our patient population.

 

Keywords: essential hypertension, serum uric acid, left ventricular hypertrophy, microalbuminuria

 

FUNCTIONAL LINK:         http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014451/

 

 

TITLE:    Comparison of treatment outcomes in patients with and without diabetes mellitus attending a multidisciplinary cardiovascular prevention programme (a retrospective analysis of the EUROACTION trial)

 

AUTHOR:             Sandra N Ofori and Kornelia Kotseva (2015)

 

 

Abstract

Background

The objective was to compare the improvements in lifestyle and risk factor profiles in patients with and without diabetes mellitus (DM) in the intervention arm of EUROACTION study.

Methods

This was a retrospective analysis of the intervention arm of EUROACTION trial. Primary outcome was proportions meeting the European targets for not smoking, diet, physical activity (PA), body mass index (BMI), waist circumference (WC), blood pressure (BP), total and low-density lipoprotein (LDL) cholesterol and cardio-protective drug use at one year.

Results

179 and 777 coronary patients with and without DM, and 340 and 917 high-risk individuals (HRI) with and without DM, respectively were identified. The proportions of coronary patients achieving the lifestyle targets improved from the initial assessment (IA) except non-smoking, which reduced. At one year, significantly fewer patients with DM attained the targets for BMI (13.2% vs 31.3%, p = 0.002) and BP <140/90 mmHg (53.5% vs 74.0%, p < 0.001) compared to patients without DM despite a higher proportion of patients with DM prescribed angiotensin converting enzyme inhibitors/angiotensin receptor blockers (79.1% vs 65.3%, p = 0.021).

 

Among the HRIs, fewer patients with DM achieved targets for oily fish intake (9.3% vs 11.9%, p = 0.043), physical activity (65.8% vs 75.8%, p = 0.011), and BMI (9.9% vs 28.1%, p = 0.022) at one year. While more patients with DM achieved the targets for total cholesterol (48.2% vs 22.9%, p < 0.001) and LDL (57.9% vs 30.7%, p < 0.001).

Conclusions

Multidisciplinary intervention had a beneficial effect on several cardiovascular risk factors in both patients with and without DM. Poorer achievement of mostly lifestyle (and BP in coronary patients) targets among those with DM emphasises the need for more intensive lifestyle modification and BP management for the prevention of cardiovascular disease.

 

Keywords:          Coronary disease Diabetes mellitus Risk factors

FUNTIONAL LINK:            https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-015-0006-4

TITLE:    Risk assessment in the prevention of cardiovascular disease in low-resource settings

 

AUTHOR: Sandra N. Ofori, , Osaretin J. Odia (2014)

 

 

Abstract

Introduction

 

Cardiovascular disease (CVD) prevalence is increasing in low- and middle-income countries. Total risk assessment is key to prevention.

Methods

 

Studies and guidelines published between 1990 and 2013 were sought using Medline database, PubMed, and World Health Organization report sheets. Search terms included ‘risk assessment’ and ‘cardiovascular disease prevention’. Observational studies and randomized controlled trials were reviewed.

Results

 

The ideal risk prediction tool is one that is derived from the population in which it is to be applied. Without national population-based cohort studies in sub-Saharan African countries like Nigeria, there is no tool that is used consistently. Regardless of which one is adopted by national guidelines, routine consistent use is advocated by various CVD prevention guidelines.

Conclusions

 

In low-resource settings, the consistent use of simple tools like the WHO charts is recommended, as the benefit of a standard approach to screening outweighs the risk of missing an opportunity to prevent CVD.

 

Keywords:    Cardiovascular diseases; Risk assessment; Risk markers; Cardiovascular disease prevention

 

FUNCTIONAL LINK:         http://www.sciencedirect.com/science/article/pii/S0019483215002370

 

 

 

TITLE:    Relationship between uric acid and left ventricular mass and geometry in Nigerian patients with untreated essential hypertension

 

AUTHOR;             Sandra N Ofori, Maclean Akpa (2015)

 

Abstract                             

 

Background: Hypertension is associated with left ventricular hypertrophy (LVH). Serum uric acid is often elevated in hypertension.

Objective: To assess the relationship between serum uric acid and left ventricular mass and geometry in untreated patients with essential hypertension.

Materials and Methods: A cross-sectional study was carried out in 130 newly diagnosed untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular mass and geometry were evaluated by transthoracic echocardiography. Blood samples were collected for assessing uric acid levels.

Results: Hyperuricemia was present in 46.9% and 16.9% of cases and controls, respectively (P < 0.001). Mean serum uric acid was significantly higher among the patients with hypertension (384.79 ± 96.4 μmol/l) compared to controls (296.92 ± 89.8 μmol/l; P < 0.001). LVH was present in 55.4% of the cases and 10.8% of the controls (P < 0.001) and the commonest geometric pattern among the cases was concentric hypertrophy while the majority of the controls had normal left ventricular geometry. Among the hypertensive patients, LVH was commoner in the hypertensive patients with hyperuricemia compared to those with normal serum uric acid levels (70.5% versus 42.0%, P = 0.001) and the commonest geometry was concentric LVH. There was a significant linear relationship between mean uric acid levels and the left ventricular mass index (r = 0.346, P < 0.001). In regression analysis, uric acid was a significant independent predictor of LVH in women (β =0.406, P = 0.015) but not in men (β =0.161, P = 0.432).

Conclusion: These results indicate that serum uric acid is associated with LVH in patients with hypertension especially women even at the time of diagnosis, thus may be a reliable marker of greater cardiovascular risk.

 

Keywords: Essential hypertension, left ventricular hypertrophy, left ventricular geometry, serum uric acid

 

FUNTIONAL LINK:            http://nigjcardiol.org/article.asp?issn=0189-7969;year=2015;volume=12;issue=2;spage=129;epage=135;aulast=Ofori

TITLE:    Holistic approach to prevention and management of type 2 diabetes mellitus in a family setting

AUTHORS:           Sandra N Ofori and Chioma N Unachukwu (2014)

 

Abstract

 

Diabetes mellitus (DM) is a chronic, progressive metabolic disorder with several complications that affect virtually all the systems in the human body. Type 2 DM (T2DM) is a major risk factor for cardiovascular disease (CVD). The management of T2DM is multifactorial, taking into account other major modifiable risk factors, like obesity, physical inactivity, smoking, blood pressure, and dyslipidemia. A multidisciplinary team is essential to maximize the care of individuals with DM. DM self-management education and patient-centered care are the cornerstones of management in addition to effective lifestyle strategies and pharmacotherapy with individualization of glycemic goals. Robust evidence supports the effectiveness of this approach when implemented. Individuals with DM and their family members usually share a common lifestyle that, not only predisposes the non-DM members to developing DM but also, increases their collective risk for CVD. In treating DM, involvement of the entire family, not only improves the care of the DM individual but also, helps to prevent the risk of developing DM in the family members.

 

Keywords: cardiovascular disease, multifactorial management

 

FUNCTIONAL LINKS;       http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4043717/

 

 

TITLE:    Serum uric acid and target organ damage in essential hypertension

 

AUTHOR:             Sandra N Ofori and Osaretin J Odia (2014)

 

Abstract

Background

Hypertension is a major risk factor for cardiovascular mortality, as it acts through its effects on target organs, such as the heart and kidneys. Hyperuricemia increases cardiovascular risk in patients with hypertension.

Objective

To assess the relationship between serum uric acid and target organ damage (left ventricular hypertrophy and microalbuminuria) in untreated patients with essential hypertension.

 

Patients and methods: A cross-sectional study was carried out in 130 (85 females, 45 males) newly diagnosed, untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular hypertrophy was evaluated by cardiac ultrasound scan, and microalbuminuria was assessed in an early morning midstream urine sample by immunoturbidimetry. Blood samples were collected for assessing uric acid levels.

Results

Mean serum uric acid was significantly higher among the patients with hypertension (379.7±109.2 μmol/L) than in the controls (296.9±89.8 μmol/L; P<0.001), and the prevalence of hyperuricemia was 46.9% among the hypertensive patients and 16.9% among the controls (P<0.001). Among the hypertensive patients, microalbuminuria was present in 54.1% of those with hyperuricemia and in 24.6% of those with normal uric acid levels (P=0.001). Similarly, left ventricular hypertrophy was more common in the hypertensive patients with hyperuricemia (70.5% versus 42.0%, respectively; P=0.001). There was a significant linear relationship between mean uric acid levels and the number of target organ damage (none versus one versus two: P=0.012).

Conclusion

These results indicate that serum uric acid is associated with target organ damage in patients with hypertension, even at the time of diagnosis; thus, it is a reliable marker of cardiovascular damage in our patient population.

 

Keywords: essential hypertension, serum uric acid, left ventricular hypertrophy, microalbuminuria

 

FUNCTIONAL LINK:         http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014451/

 

 

TITLE:    Comparison of treatment outcomes in patients with and without diabetes mellitus attending a multidisciplinary cardiovascular prevention programme (a retrospective analysis of the EUROACTION trial)

 

AUTHOR:             Sandra N Ofori and Kornelia Kotseva (2015)

 

 

Abstract

Background

The objective was to compare the improvements in lifestyle and risk factor profiles in patients with and without diabetes mellitus (DM) in the intervention arm of EUROACTION study.

Methods

This was a retrospective analysis of the intervention arm of EUROACTION trial. Primary outcome was proportions meeting the European targets for not smoking, diet, physical activity (PA), body mass index (BMI), waist circumference (WC), blood pressure (BP), total and low-density lipoprotein (LDL) cholesterol and cardio-protective drug use at one year.

Results

179 and 777 coronary patients with and without DM, and 340 and 917 high-risk individuals (HRI) with and without DM, respectively were identified. The proportions of coronary patients achieving the lifestyle targets improved from the initial assessment (IA) except non-smoking, which reduced. At one year, significantly fewer patients with DM attained the targets for BMI (13.2% vs 31.3%, p = 0.002) and BP <140/90 mmHg (53.5% vs 74.0%, p < 0.001) compared to patients without DM despite a higher proportion of patients with DM prescribed angiotensin converting enzyme inhibitors/angiotensin receptor blockers (79.1% vs 65.3%, p = 0.021).

 

Among the HRIs, fewer patients with DM achieved targets for oily fish intake (9.3% vs 11.9%, p = 0.043), physical activity (65.8% vs 75.8%, p = 0.011), and BMI (9.9% vs 28.1%, p = 0.022) at one year. While more patients with DM achieved the targets for total cholesterol (48.2% vs 22.9%, p < 0.001) and LDL (57.9% vs 30.7%, p < 0.001).

Conclusions

Multidisciplinary intervention had a beneficial effect on several cardiovascular risk factors in both patients with and without DM. Poorer achievement of mostly lifestyle (and BP in coronary patients) targets among those with DM emphasises the need for more intensive lifestyle modification and BP management for the prevention of cardiovascular disease.

 

Keywords:          Coronary disease Diabetes mellitus Risk factors

FUNTIONAL LINK:            https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-015-0006-4

TITLE:    Risk assessment in the prevention of cardiovascular disease in low-resource settings

 

AUTHOR: Sandra N. Ofori, , Osaretin J. Odia (2014)

 

 

Abstract

Introduction

 

Cardiovascular disease (CVD) prevalence is increasing in low- and middle-income countries. Total risk assessment is key to prevention.

Methods

 

Studies and guidelines published between 1990 and 2013 were sought using Medline database, PubMed, and World Health Organization report sheets. Search terms included ‘risk assessment’ and ‘cardiovascular disease prevention’. Observational studies and randomized controlled trials were reviewed.

Results

 

The ideal risk prediction tool is one that is derived from the population in which it is to be applied. Without national population-based cohort studies in sub-Saharan African countries like Nigeria, there is no tool that is used consistently. Regardless of which one is adopted by national guidelines, routine consistent use is advocated by various CVD prevention guidelines.

Conclusions

 

In low-resource settings, the consistent use of simple tools like the WHO charts is recommended, as the benefit of a standard approach to screening outweighs the risk of missing an opportunity to prevent CVD.

 

Keywords:    Cardiovascular diseases; Risk assessment; Risk markers; Cardiovascular disease prevention

 

FUNCTIONAL LINK:         http://www.sciencedirect.com/science/article/pii/S0019483215002370

 

 

 

TITLE:    Relationship between uric acid and left ventricular mass and geometry in Nigerian patients with untreated essential hypertension

 

AUTHOR;             Sandra N Ofori, Maclean Akpa (2015)

 

Abstract                             

 

Background: Hypertension is associated with left ventricular hypertrophy (LVH). Serum uric acid is often elevated in hypertension.

Objective: To assess the relationship between serum uric acid and left ventricular mass and geometry in untreated patients with essential hypertension.

Materials and Methods: A cross-sectional study was carried out in 130 newly diagnosed untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular mass and geometry were evaluated by transthoracic echocardiography. Blood samples were collected for assessing uric acid levels.

Results: Hyperuricemia was present in 46.9% and 16.9% of cases and controls, respectively (P < 0.001). Mean serum uric acid was significantly higher among the patients with hypertension (384.79 ± 96.4 μmol/l) compared to controls (296.92 ± 89.8 μmol/l; P < 0.001). LVH was present in 55.4% of the cases and 10.8% of the controls (P < 0.001) and the commonest geometric pattern among the cases was concentric hypertrophy while the majority of the controls had normal left ventricular geometry. Among the hypertensive patients, LVH was commoner in the hypertensive patients with hyperuricemia compared to those with normal serum uric acid levels (70.5% versus 42.0%, P = 0.001) and the commonest geometry was concentric LVH. There was a significant linear relationship between mean uric acid levels and the left ventricular mass index (r = 0.346, P < 0.001). In regression analysis, uric acid was a significant independent predictor of LVH in women (β =0.406, P = 0.015) but not in men (β =0.161, P = 0.432).

Conclusion: These results indicate that serum uric acid is associated with LVH in patients with hypertension especially women even at the time of diagnosis, thus may be a reliable marker of greater cardiovascular risk.

 

Keywords: Essential hypertension, left ventricular hypertrophy, left ventricular geometry, serum uric acid

 

FUNTIONAL LINK:            http://nigjcardiol.org/article.asp?issn=0189-7969;year=2015;volume=12;issue=2;spage=129;epage=135;aulast=Ofori

 

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