Cardiovascular disease among patients attending a specialist diabetes clinic in Jamaica

Abstract

Trevor S Ferguson1, Marshall K Tulloch-Reid1, Novie OM Younger1, Rosemarie A Wright-Pascoe2, Michael S Boyne1, Shelly R McFarlane1, Damian K Francis1, Rainford J Wilks11Epidemiology Research Unit and Tropical Metabolism Research Unit, Tropical Medicine Research Institute, 2Department of Medicine, The University of the West Indies, Mona, Kingston, JamaicaBackground: This study aimed to estimate the prevalence of cardiovascular disease (CVD) among patients attending The University Hospital of the West Indies diabetes clinic and to examine the relationship between prevalent CVD and its risk factors.Methods: We analyzed data from 174 patients selected from the University Hospital of the West Indies diabetes clinic using gender-stratified random sampling. An interviewer-administered questionnaire was used to obtain data on self-reported CVD (coronary heart disease [CHD], cerebrovascular disease, and peripheral vascular disease [PVD]), physical activity, alcohol consumption, and smoking. Trained nurses performed blood pressure and anthropometric measurements. A capillary blood sample was collected to measure glycosylated hemoglobin, and urine was tested for protein and microalbumin. Means and proportions for patient characteristics, CVD outcomes, and risk factors were calculated. Logistic regression was used to identify factors independently associated with CVD.Results: Data from 129 women and 45 men (mean age 55.7 ± 14.7 years) were analyzed. The prevalence of any self-reported CVD (CHD, cerebrovascular disease, or PVD) was 34.5% (95% confidence interval [CI] 27.4–41.6). PVD had the highest prevalence (25.9%), compared with CHD (6.9%) and cerebrovascular disease (16.1%). There were no gender differences in the prevalence of CVD. Prevalence of CVD was higher among people ≥50 years, and those with high blood pressure, central obesity, high total cholesterol, and duration of diabetes ≥20 years. In multivariable models, duration of diabetes was the most consistent factor associated with CVD, odds ratio 1.41 (95% CI 1.15–1.73, P = 0.001) per five-year increment. Having blood pressure at the goal of <130/80 mmHg and at least three physical activity sessions/week were associated with lower odds of CVD, odds ratios 0.42 (95% CI 0.20–0.87, P = 0.020) and 0.37 (95% CI 0.16–0.82, P = 0.014), respectively.Conclusion: In this Jamaican setting, 35% of patients with diabetes have at least one CVD. Odds of CVD increased with diabetes duration, while good blood pressure control and increased physical activity were ameliorating factors.Keywords: cardiovascular disease, diabetes, Jamaica, diabetic complications, Caribbean