Thyroid Hormone Levels And Cardiometabolic Risk Factors In Hypertensive Adult Ghanaians
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Date
2011-05-18
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Abstract
Metabolic syndrome can be found in approximately one-third of patients who do
not have diabetes but have hypertension. There are numerous correlations between
the metabolic syndrome and hypertension, although this is not always the case. As
metabolic syndrome and thyroid dysfunction are independent risk factors for the
same disease process, namely cardiovascular disease, it is possible that patients
suffering from both these disease entities may have a compounded risk. Our study
will therefore attempt to determine the prevalence of metabolic syndrome and
investigate the proposed association between these two disease entities and
identify the factors that increase the risk of this association. This cross-sectional
study was conducted at the Hypertension Clinic of the Department of Medicine,
Komfo Anokye Teaching Hospital (KATH), Kumasi between April 2010 and November
2010. A total of 300 participants comprising of 200 hypertensives and 100
normotensives were enrolled. The prevalence of MetS among the hypertensive
patients were significantly higher than the normotensive control (56.5% vrs 9.0%,
54.5% vrs 5.0% and 65.5%vrs15.0%, p<0.001) using NCEP ATP III, WHO and IDF
criteria respectively. Irrespective of the criteria applied, all the components of
MetS were significantly higher among the hypertensive patients as compared to
the normotensive control. Among the hypertensive patients, the highest prevalence
of cardiovascular risk factor was abdominal obesity as measured by WHR
(77.0%), followed by reduced HDL-cholesterol (74.0%). From the univariate
analysis, females were at about 3 times at risk of developing hypertension as
compared to the male counterpart (OR = 2.7; 95% CI = 1.6-4.4; p = 0.0000). Reduced
apolipoprotein A1 served as a risk factor (aOR = 13.4; 95% CI = 1.5-121.4; p =
0.0210) whilst high apolipoprotein A1 protects the individual from developing
hypertension (aOR = 0.1; 95% CI = 0.0-0.2; p = 0.0000). High apolipoprotein B
poses about 9 times risk of developing hypertension as compared to the normal
level (aOR = 9.3; 95% CI = 4.2-20.9; p = 0.0000). Both Impaired fasting glucose and
diabetes each pose more than 10 times risk of developing hypertension as
compared to normoglycaemia. fT4 levels were positively associated to BMI and
Apo A1 after adjustment for age. fT4 levels were however negatively associated to
TC (β= -0.275; p<0.05), LDL-C (β= -0.337; p<0.05) and FBG (-0.121; p<0.05). We also
demonstrated that, low normal FT4 levels were significantly associated with three
of the cardiovascular risk factors. These findings are consistent with an increased
cardiovascular risk in subjects with low normal thyroid function. In conclusion,
the study demonstrated that, hypertension is more than just elevated blood
pressure; it is intimately associated with the metabolic syndrome. There is
therefore the need for metabolic screening of all hypertensives and increase
awareness creation on the critical importance of public health strategies aimed at
reducing risk factors in the entire population. Early detection and treatment
(Multi-target approach) of the global risk profile should thus become a priority.
Description
A thesis submitted to the Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, in partial fulfillment of the requirements for the degree of Master of Philosophy, May-2011