FACULTY OF PUBLIC HEALTH

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Author: search.filters.author.Agunloye, A. M.Subject: search.filters.subject.hypertension

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    Carotid IMT is more associated with stroke than risk calculators
    (John Wiley & Sons Ltd., 2015) Owolabi, M. O.; Akpa, O. M.; Agunloye, A. M.
    Background – It is unclear whether a natural marker of atherosclerosis (carotid intima-media thickness: CIMT) or calculated risk score is more associated with stroke. We therefore comparatively examined the relationship between CIMT as well as two cardiovascular risk calculators (Omnibus Risk Score -ORS and Framingham Risk Score- FRS) and the occurrence of stroke among hypertensive African patients. Methods – CIMT was measured in 555 consecutive consenting hypertensive adults (377 stroke patients and 178 strokefree subjects). The 10-year cardiovascular risk was calculated for each participant with the FRS and ORS. The strengths of association between FRS, ORS, CIMT, and stroke occurrence were examined using logistic regression. The discriminative capacity of FRS, ORS, and CIMT for stroke occurrence was assessed with c-statistics. Results – Higher average CIMT (OR 11.71; 95% CI 1.65–83.07; P = 0.01) was strongly associated with stroke after adjusting for age, sex, blood pressure, serum cholesterol, and blood sugar. Neither the FRS (OR: 1.03; CI: 0.89–1.19, P = 0.68) nor the ORS (OR: 1.08; CI: 0.90–1.30; P = 0.41) was significantly associated with stroke. CIMT had a higher c-statistic for differentiating stroke patients from hypertensive controls (right: c = 0.63, P < 0.001; left: c = 0.67, P < 0.001; average: c = 0.66, P < 0.001) than some conventional risk factors. Neither FRS (P = 0.39) nor ORS (P = 0.55) was able to independently differentiate between stroke and hypertensive patients. Conclusion – CIMT, but neither FRS nor ORS, is independently associated with stroke among Nigerian African hypertensive patients. CIMT may be a better tool for estimating the overall risk of stroke than FRS or ORS in this population.
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    Can common carotid intima media thickness serve as an indicator of both cardiovascular phenotype and risk among black Africans?
    (Sage publications, 2014) Owolabi, M. O.; Agunloye, A. M.; Umeh, E. O.; Akpa, O. M.
    Background: It is not known whether common carotid intima media thickness (CIMT) can serve as a surrogate marker of cardiovascular risk among black Africans. Therefore, we examined whether CIMT differed significantly among individuals with distinct cardiovascular phenotype and correlated significantly with traditional cardiovascular risk factors in a black African population Methods: CIMT was measured in 456 subjects with three distinct cardiovascular phenotypes – 175 consecutive Nigerian African stroke patients, 161 hypertensive patients without stroke and 120 normotensive non-smoking adults. For each pair of cardiovascular phenotypes, c-statistics were obtained for CIMT and traditional vascular risk factors (including age, gender, weight, waist circumference, smoking, alcohol, systolic and diastolic blood pressures, fasting plasma glucose, fasting total cholesterol). Pearson’s correlation coefficients were calculated to quantify bivariate relationships. Findings: Bilaterally, CIMT was significantly different among the three cardiovascular phenotypes (right: p < 0.001, F ¼ 33.8; left: p < 0.001, F ¼ 48.6). CIMT had a higher c-statistic for differentiating stroke versus normotension (c ¼ 0.78 right; 0.82 left, p < 0.001) and hypertension versus normotension (c ¼ 0.65 right; 0.71 left, p < 0.001) than several traditional vascular risk factors. Bilaterally, combining all subjects, CIMT was the only factor that correlated significantly (right: 0.12 r 0.41, 0.018 p < 0.0001; left: 0.18 r 0.41, 0.005 p < 0.0001) to all the traditional cardiovascular risk factors assessed. Conclusion: Our findings support CIMT as a significant indicator of both cardiovascular risk and phenotype among adult black Africans. However, specific thresholds need to be defined based on prospective studies.