Prevalence of acute coronary syndromes amongst type 2 Diabetics presenting with Ischaemic Ecg's to the Kenyatta National Hospital Accident and Emergency Department

Abstract

Background The global number of individuals with diabetes is projected to increase dramatically by 2030. The cardiovascular complications of type 2 diabetes are on the rise in the developing countries. There is very limited data available on acute coronary syndromes in Africans with the exception of the INTERHEART Africa study, which looked at cardiovascular risk factors in African patients with Acute myocardial infarction. The CVD risk factors of note in this population were: diabetes, abdominal obesity (WHR), dyslipidaemia (ApoB/Apo A1), hypertension and smoking. Locally, Kenyan data on the prevalence of coronary heart disease and acute coronary syndromes in patients with diabetes is limited. Objectives: To determine the prevalence of acute coronary syndromes amongst the type diabetics presenting with ischaemic ECG's to the Kenyatta National Hospital Accident and Emergency department. Specifically, the study sought to describe the clinical presentation, demographics and prevalence of hypertension, dyslipidaemia, central obesity (by WC and WHR) and smoking in these patients, and the prevalence of usage of statins and aspirin as primary or secondary preventive therapy amongst these patients. Study Design: Prospective cross-sectional descriptive survey over 4 months. Study Setting: Kenyatta National Hospital Accident and Emergency department Subjects: 95 type 2 diabetic patients with ischaemic ECG's. Main outcome measures: Sociodemographic characteristics, clinical presentation, presence of hypertension, dyslipidaemia, central obesity (by waist circumference and waist-hip ratio), smoking and use of aspirin and statins. Study methods: Use of questionnaires, resting 12 lead ECG, anthropometric measurements, laboratory measurements of fasting lipids and serum Troponin I. Results: A total of 95 patients were recruited. 60% of the patients were male. The mean age of the study population was 63.3 (10.1) years. 60% of the patients were hypertensive. 95% had dyslipidaemia and the most common lipid abnormality was elevated LDL-C with a prevalence of 73.7%. There was a low prevalence of smoking at 14%. The prevalence of central obesity when defined by WHR was 86.3% and when defined by waist circumference was 62.1 %. WHR and waist circumference performed equally well in defining central obesity in the female patients but in the male patients, WHR classified 88% of the males as centrally obese while WC classified only 44% of the males as centrally obese. 35.8% of the patients had an ongoing acute coronary syndrome on presentation. These patients presented mainly with atypical symptoms. The most common symptoms were fatigue (61.8%) and difficulty breathing (58.8%).47% of the patients presented with typical anginal chest pain, 17.6% presented with epigastric pain and 35% of them had silent myocardial infarction. The patients with ACS presented late with 79.4% of them presenting to the AlE more than 6 hours after the onset of symptoms, with a mean duration of symptoms of 5.5 days. The patients were haemodynamically unstable;- 79% of them had features of acute left ventricular failure (59(% with pulmonary edema and 20% had cardiogenic shock). In 87% of these patients, the distribution of ischaemic changes on the ECG corresponded to the region supplied by the left coronary artery. In the study population, there was a very low prevalence of use of statins and aspirin at 8.4°/c) and 14.7% respectively. Conclusions: The study showed that ACS accounted for 35% of the morbidity in type 2 diabetics who presented to KNH AlE with Ischaemic ECG's. The patients with ACS presented late, mainly with atypical symptoms and were haemodynamically unstable. There was a high prevalence of hypertension, central obesity and dyslipidaemia amongst these patients, with a low prevalence of smoking as a CAD risk factor. More than 80% of these patients were not on primary or secondary preventive therapy for CAD.