Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon

Abstract

Background. Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting. Objective. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon. Methods. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality. Results. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30). Conclusions. Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation.

Prevalence and etiologies of pulmonary hypertension at Somalia-Turkey Training and Research Hospital in Mogadishu

“…In a large meta-analysis, the global prevalence of PH among HIV-infected adults was found 8.3% [ 25 ]. Pulmonary hypertension due to HIV is known to be common in the African population [ 26 ]. However, this entity was detected only in three (1.2%) patients in our study, which could be due to the religious sensitivities of the Somali community.…”

Pulmonary hypertension in low- and middle-income countries with focus on sub-Saharan Africa

“…Thus, the prevalence of PH among HIV patients in the African context varies widely. Studies also report a slight female predominance (33). It would be relevant to investigate in a large cohort study the true incidence and factors that affect the occurrence of HIV-PH.…”

Pulmonary Hypertension in Children across Africa: The Silent Threat

“…Notably, alcohol abuse (21.3%) and HIV infection (8.7%) were reported in individuals with PH. In Cameroon, 7% of the 1800 patients followed up for a year had pulmonary hypertension at baseline [ 12 ]. PH tended to be more common in women above 75 years [ 12 ], and 9.8% of PAH was due to cardiac disease.…”

“…In Cameroon, 7% of the 1800 patients followed up for a year had pulmonary hypertension at baseline [ 12 ]. PH tended to be more common in women above 75 years [ 12 ], and 9.8% of PAH was due to cardiac disease. Of the HIV-infected adults in the study, 10.6% presented with cardiac-related PAH [ 9 ].…”

“…Not only is PAH found highest among patients with heart failure (32.9%), but it also takes a haul in patients undergoing hemodialysis [ 13 ]. Chronic thromboembolic disease seems to be the least common cause of PH in the African adult population [ 12 ]. Bigna and colleagues also demonstrated PAH in patients with rheumatic heart disease, systemic lupus erythematosus, and sickle cell anemia (SCA) [ 9 ].…”