Chronic inflammatory rheumatic diseases and cardiovascular risk in Yaounde Central Hospital (Rhumatismes inflammatoires chroniques et risque cardiovasculaire à l’Hôpital Central de Yaoundé)

Mickael ESSOUMA (essmic@rocketmail.com)
Internal medicine and specialties, University of Yaounde I
June, 2014
 

Abstract

Background.- Chronic inflammatory rheumatic diseases (CIRD) are associated with an increased cardiovascular risk in developed populations. However, studies on that topic in sub Saharan Africa, and particularly in Cameroon are scarce. It is nowadays recognized that cardiovascular diseases are the leading cause of death from chronic non-communicable diseases in our country.
Objectives. – Assess the association between CIRD and cardiovascular risk in a group of CIRD patients regularly followed-up at the rheumatology unit of Yaounde Central hospital (YCH).
Methods and subjects. – It was a case-control study comparing CIRD patients to matched controls. Cases were subjects aged 18 years old and above; who gave their consent; and who presented with CIRD. Controls were apparently healthy individuals aged 18 years and above; who gave their consent; and age, sex and race matched to cases. They were recruited within the general population. The cardiovascular risk was estimated using the World Health Organization diagram designed for cardiovascular risk estimation in the general population of a group of African countries comprising Cameroon. Statistical analysis was done by using Epi-info and SPPS. The level of statistical significance was fixed at 5%.
Results.– One hundred and nine patients [76 women (69.7%), and 33 male subjects (30.3%)] were recruited, and one hundred and eleven control subjects [76 women (68.5%) and 35 male subjects (31.5%)]. The mean age of patients was 44.4 ±15.2 years, and it was 44.2 ± 15.5 years in controls. Various CIRD included: 50 cases of rheumatoid arthritis (45.9%) ; 21 cases of systemic lupus erythematosus (19.3%) ; 11 cases of ankylosing spondylitis (10.09%) and of mixed connective tissue diseases respectively; four cases (3.7%) of undifferentiated spondyloarthritides and of adult onset Still’s disease respectively ; two cases (1.8%) of systemic sclerosis and of Goujerot Sjögren’s syndrome respectively ; and one case (0.9%) of reactive arthritis, of psoriatic arthritis, and of polymyositis respectively. Cardiovascular risk factors in the case group included: increased body mass index (BMI) (63.3%) ; dyslipidemia (53.1%) ; abdominal obesity (44%) ; arterial hypertension (HTN) (27.5%) ; metabolic syndrome (22%); hyperuricemia and physical inactivity : 11% respectively ; alcoholism (8.3%) ; diabetes (7.3%) ; ischaemic heart disease (6.4%) ; past history of stroke (3.7%) ; and tobacco smoking (2.7%). In the control group, cardiovascular risk factors included : dyslipidemia (48.6%) ; an increased BMI (47.7%) ; abdominal obesity (31.5%) ; alcoholism (24.3%) ; HTN (15.3%) ; metabolic syndrome (14.4%); tobacco smoking (10%) ; and hyperuricemia (7.2%). Patients were significantly more hypertensive than controls (OR = 2.1; 95% CI = 1.07-4.08; p = 0.03). They were significantly more obese and in overweight than controls (OR = 1.89; 95% CI = 1.1-3.24; p = 0.02). They were significantly more diabetics (p = 0.003) than controls. They were more physically inactive (p = 0.00). And they were significantly less alcoholic (OR = 0.28; 95% CI = 0.12-0.63; p = 0,001). HTN was inversely associated with methotrexate treatment (OR = 0.27; 95% CI = 0.07-0.95; p = 0.04). An increased BMI occurred independently of CIRD drugs, of sex, and of age. Cardiovascular risk, comparable by proportions, was low in 79.6% and 88.1% patients and controls respectively.
Conclusion. - Cardiovascular risk factors were more frequent in cases than in controls, but the absolute cardiovascular risk estimated by World Health Organization diagrams was comparable among the two groups.


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