Metabolic Syndrome in Subjects with Type-2 Diabetes Mellitus: DISCUSSION
Multiple risk factors are associated with cardiovascular disease in subjects with diabetes, including hypertension, hyperlipidemia, obesity, and microalbuminuria, which are the key components of MS. They have a risk of death from cardiovascular causes that is two- to six times that among persons without diabetes. Among white Americans, the age-adjusted prevalence of coronary heart disease (CHD) is twice as high among those with type-2 diabetes as among those without diabetes.
People with MS are at increased risk for developing diabetes mellitus and cardiovascular disease, as well as increased mortality from cardiovascular disease and all causes. Because the implications of MS for healthcare are substantial, it is essential to establish the prevalence of this condition in Nigeria. Whereas the global epidemic of type-2 diabetes is now well-characterized, data on the occurrence of MS in populations are limited. The lack of an accepted internationally agreed definition has impeded epidemiological work on the prevalence and antecedents of this syndrome. Two definitions of MS have been proposed—one by the WHO, and one in the U.S. Third Report of the National Cholesterol Education Program, Adult Treatment Panel, 2001 (NCEP-ATP III). MS as defined by the NCEP was three or more of the following: fasting plasma glucose of at least 110 mg/dL (6.1 mmol/L), serum triglycerides of at least 150 mg/dL (1.7 mmol/L), serum HDL cholesterol less than 40 mg/dL (1.04 mmol/L), blood pressure of at least 130/85 mm Hg, or waist girth of more than 102 cm. However, there is only moderate agreement between the two definitions of MS, p=0.53, 0.46-0.60). There is a need for a single internationally agreed definition of MS.
When the high proportion of subjects with MS in this study (25.2%) is considered, one would expect a lot of cardiovascular events, but the study revealed only 12 (5.5%) cases of stroke, occurring more commonly among subjects with MS, seven (58.3%) vs. five (41.7%). There was no documented case of CHD. This is in keeping with observations in Nigeria and black Africa of low incidence of CHD. The general low values of cholesterol might be a contributing factor to this low prevalence. Peripheral vascular disease is the only cardiovascular event with a relatively high prevalence among this population with a frequency of 21.6% (47 out of 218 patients). This may be difficult to explain since the presence of the same cardiovascular risk factors predispose to the other known cardiovascular events. canadian antibiotics
The prevalence of MS (using the WHO definition) in Ireland was 21%. The prevalence was higher in men (24.6%) than in women (17.8%). From the available data from “the Botnia study” (using the WHO definition) and involving families of Finland and Sweden descent, the prevalence was 84% and 78% (maleifemale) in subjects with type-2 diabetes. In all subjects, a history of CHD, MI (myocardial infarction), and stroke was more common in those with MS than it was in those without MS (PO.001). In the United States, the prevalence of MS was 21.8% using the ATP III definition. Mexican Americans had the highest prevalence of MS (31.9%)). The prevalence was similar for men (24.0%) and women (23.4%). The average figure of 25.2% that was obtained in this study is comparable to that in Ireland and the United States but significantly lower than the prevalence in Mexican Americans, Finland, Sweden, and Saudi Arabia. This study showed that in Nigeria, the prevalence is similar in men and in women. Similar documented studies in Africa are lacking.
Hypertension is the most frequently occurring component of MS in these subjects with type-2 diabetes, occurring in 38.5%) (84 out of 218 subjects). This is significantly more than the Nigerian national average of 11.2%. The average figure of 38.5%) is however comparable to the prevalence rates of 10-55% quoted for diabetic patients across the continent of Africa. antibiotics online pharmacy
This study primarily investigated the prevalence of MS and its relation to cardiovascular morbidity and mortality. It has been documented that MS is a promoter of renal disease progression. It is recommended that in these patients, hypertension should be managed aggressively with angiotensin-convert-ing enzyme inhibitors or angiotensin-receptor blockers, which have been shown to decrease proteinuria, lower blood pressure, and slow down the progression of renal diseases. The control of hypertension, dyslipidemia, proteinuria, obesity—among others—are intervention strategies for preventing progression of renal diseases.
The study has demonstrated that MS occurs commonly among our local subjects with type-2 diabetes with an increased risk of occurrence of peripheral vascular disease and stroke. A long-term, targeted, intensive intervention involving multiple cardiovascular risk factors is recommended to reduce the risk of both cardiovascular and microvascular events as already documented among Caucasians.
