High prevalence of dyslipidaemia among persons with diabetes mellitus and hypertension at a tertiary hospital in Blantyre, Malawi

Abstract

Background Dyslipidaemia drives the process of atherosclerosis, and hence a significant modifiable risk factor complicating hypertension and diabetes. In Malawi, the prevalence, screening and management of dyslipidaemia among persons with diabetes mellitus have not been reported. This study aimed to investigate the prevalence, biochemical characteristics, screening and management practices for dyslipidaemia among persons with diabetes mellitus, hypertension, and diabetes mellitus and hypertension comorbidity at Queen Elizabeth Central hospital in Blantyre, Malawi. Methods This was a cross-sectional study conducted in 2021. A total of 256 adult participants (diabetes mellitus = 100); hypertension = 100; both conditions = 56) were included. Medical data and anthropometric measurements were recorded. Blood samples were analysed for HbA1C and serum lipids. Associated risk factors for dyslipidaemia were also assessed. Results Dyslipidaemia was prevalent in 58%, 55%, and 70% of participants with diabetes mellitus, hypertension, and both conditions. Low-density lipoprotein cholesterol (LDL-C) dyslipidaemia was the most common in all participant groups. Participants with both diabetes and hypertension had 2.4 times (95% CI 1.2–4.6) increased risk of LDL-C dyslipidaemia than those with diabetes alone (p < 0.02). Being overweight or obese and age over 30 years were risk factors for dyslipidaemia in participants with diabetes mellitus alone (OR 1.3 (95% CI 1.1–1.6), p < 0.04, and OR 2.2 (95% CI 1.2–4.7) (p < 0.01), respectively. Overweight and obesity predicted LDL-C dyslipidaemia in hypertensive patients (OR 3.5 (95% CI 1.2–9.9) p < 0.001). Poorly controlled hypertension and the use of beta-blockers and thiazide diuretics predicted dyslipidaemia among patients with both diabetes mellitus and hypertension (OR 6.50 CI 1.45–29.19; and OR 5.20 CI 1.16–23.36 respectively). None of the participants had a lipogram performed before the study or were on lipid-lowering therapy. Conclusions Dyslipidaemia with LDL-C derangement was highly prevalent, especially in individuals with both diabetes mellitus and hypertension, and there was absent use of lipid-lowering therapy. Screening and managing dyslipidaemia should be reinforced to reduce the risk of cardiovascular complications in this population at increased risk.

Prevalence, patterns and associated risk factors for dyslipidaemia among individuals attending the diabetes clinic at a tertiary hospital in Central Malawi

“…The study's high prevalence of dyslipidaemia is comparable to other studies among individuals with DM in other Sub-Saharan African countries ( 3 , 10 , 13 ). These results are consistent with the previously reported high prevalence of dyslipidaemia at another public tertiary referral hospital in Malawi among individuals with DM and hypertension ( 14 ). Dyslipidaemia is a significant modifiable determinant of ASCD globally and in Africa ( 5 , 15 ) and requires proactive screening and management, especially among individuals at high risk, such as those living with DM.…”

“…Dyslipidaemia is a significant modifiable determinant of ASCD globally and in Africa ( 5 , 15 ) and requires proactive screening and management, especially among individuals at high risk, such as those living with DM. Sadly, there is a lack of aggressive efforts towards addressing dyslipidaemia among individuals with DM ( 14 ). Plausibly, the poor screening and management of dyslipidaemia contribute to the escalating rates of ASCDs in such LMICs ( 16 ).…”

“…In the present study, we did not investigate the proportion of participants who were on lipid-lowering pharmacotherapy, as it was beyond the scope of this study. However, dyslipidaemia treatment rates among people with DM were reported at 0% at another public tertiary hospital in Malawi ( 14 ). Factors such as frequent stock-outs of lipogram reagents, unavailability of local guidelines for the management of dyslipidaemia and inexperience healthcare personnel hinder the efforts towards addressing dyslipidaemia among people with DM in Malawi and other LMICs ( 14 , 20 , 21 ).…”

Prevalence, knowledge, and lifestyle‐associated risk factors of dyslipidemia among Ghanaian type‐2 diabetes mellitus patients in rural and urban areas: A multicenter cross‐sectional study

“…Overall, prevalence of dyslipidemia was 34.7%. This corresponds to a prevalence of 34.4%–94.0% recorded in numerous studies conducted across the world 35–39 . In Malawi, Katundu and colleagues found a much higher prevalence (58%) of dyslipidemia among persons with diabetes mellitus 36 .…”

Identification of subgroups with poor lipid control among patients with dyslipidemia using decision tree analysis: the Korean National Health and Nutrition Examination Survey from 2019 to 2021

“…2020년 국내 만성질환 관련 통계자료 [1]에 의하면 우리나라 성인의 경우 20세 이상의 성인 약 40%가 이상지질혈증을 가지고 있을 정도로 유병율이 높은데 구체적으로 고콜레스테롤혈증 유병율은 2005년 8.0%에서 2020년 23.9%까지 증가하였고, 고LDL-콜레스테롤혈증 또한 2007년 8.75%에서 2020년 19.1%로 급속하게 증가한 양상을 보이고 있다. 이러한 이상지질혈증은 비만, 흡연, 음주, 운동부족 등의 생활습관으로 발생할 위험이 높고 [1,3], 당뇨병, 고혈압, 관상 동맥 질환, 대사증후군, 죽상경화증 발병과도 밀접하게 관련이 있 는 것으로 알려져 있다 [1,3,4].…”