Philippe Lacroix

Introduction: Modifiable cardiovascular risk factors (CVRF) are highly prevalent in SubSaharan African communities. In these countries the burden of CVRF during early pregnancy has been poorly documented. Aim: The objective of this study was to describe the frequency of CVRF in pregnant women before the 20^th week of gestation in Benin Methods: Consecutive pregnant women with a gestational age < 20^th week were included in 30 maternity clinics in Benin. Univariate and multivariate analyses were used to determine characteristics associated with CVRF. Results: 1244 pregnant women were included (680 (54.7%) in urban areas and 584 (45.3%) in rural areas). The median age was 26 years. The frequencies of high blood pressure (HBP), obesity and diabetes were 18.9%, 15.0% and 3.1% respectively. Very few women (25.3%) were aware of the HBP disorder. HBP was associated with an age ≥ 35 years (OR = 1.7, 95%CI:1.1–2.7), a rural setting (OR = 2.6; 95%CI:1.9–3.5), an insufficient consumption of fruits and vegetables (OR = 3.2; 95%CI:2.0–5.3) and a history of at least 2 fetal losses (OR = 1.9; 95% CI [1.4–2.7]). The risk of being overweight was associated with an age >24 years old (OR = 1.6; 95%CI:1.1–2.2) conversely a rural setting was protective (OR = 0.7; 95%CI:0.5–0.9). Obesity was associated with an age > 35 years old (OR = 4.1; 95%CI:2.5–6.8) and a rural setting (OR = 0.3; 95%CI: 0.2–0.5). Conclusion: The frequency of CVRF in women before 20^th week of gestation was high. Most of the women were unaware of the disorder. Thus the screening of CVRF among women of reproductive age might be relevant.

Reported ranges of normal values for echocardiographic measurements are mostly issued from studies performed in Caucasians. This study is a part of TAHES, a population-based prospective cohort study in Benin and aims to establish normal reference values for echocardiographic cardiac chambers dimensions and Doppler parameters in a Sub-Saharan African population. We included 486 healthy (non-diabetic, non-obese and normotensive) individuals (202 men and 284 women, age 37[30–47] years, BSA 1.58 (1.47–1.67) m²). End-diastolic interventricular septal wall thickness, left ventricular (LV) internal diameter, posterior wall thicknesses, and systolic LV internal diameter were respectively at 10[9–12], 45[43–49], 9[8–11], 29[26–34] mm for male and 9[7–10], 43[41–46], 8[7–], 29[27–32] mm for females. LV mass was significantly greater in males even after normalization for the body surface area (98[85–117] vs. 82[71–96] g/m²). Upper limits of BSA-indexed LV mass were 145 g/m² for males and 124 g/m² for females. The allometric exponent that described the LV mass-Height relationship were 2.5 in both sexes but 1.2 for males and 1.8 for females separately. E-wave velocity was 0.79 [0.65–0.90] cm/sec in males and 0.88 [0.78–0.99]cm/sec in females (p < 0.0001) but without significant gender differences in E/A ratio (limits: 0.75 and 2.1). The e′-wave velocity (lower limit = 8 cm/sec) decreased and E/e′ ratio (Upper limit = 9) increased with aging. Upper limit of BSA-indexed left atrium volume was 38 mL/m² for both sexes. In conclusion, normal values from a general population in West Africa differ from those established in Caucasian populations with greater LV mass and wall thicknesses.

Hyperglycemia leads to serious damage to the body, especially the blood vessels and nerves. This study aimed to determine the prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019. This was a cross-sectional, descriptive and analytical study, nested in the Tanvè Health Study (TAHES) cohort. It covered all residents of the villages of Tanvè and Dékanmey, aged 25 years and above, and having given their written consent. Data were collected in the households during the fourth annual monitoring visit in 2019 using the WHO STEPS Wise approach. Hyperglycemia was defined as a fasting capillary blood glucose value ≥ 110 mg/dL. Data were analyzed with R Studio software version 3.5.1. A total of 1331 subjects were included in the study with a 60% female predominance and a sex ratio (male/female) of 0.7. The median age was 40 years (Q1 = 32 years; Q3 = 53 years) with a range of 25 and 98 years. The prevalence of hyperglycemia was 4.6%. In multivariate analysis, advanced age (AOR = 1.03; 95%CI = 1.02–1.73; p = 0.004), male sex (AOR = 2.93; 95%CI = 1.49–5.84; p = 0.023), monthly income> 105,000 FCFA (AOR = 2.63; 95%CI = 1.24–5.63; p = 0.030), abdominal obesity (AOR = 2.80; 95%CI = 1.29–6.16; p = 0.007, and obesity (AOR = 1.68; 95%CI = 0.75–3.59; p = 0.004) were statistically associated with hyperglycemia. The prevalence of hyperglycemia is not negligible in rural areas in Benin. Our study found that older age, male gender, high income, abdominal obesity, and obesity are determining factors in its occurrence.

Background: Characterisation of arterial Doppler waveforms is a persistent problem and a source of confusion in clinical practice. Classifications have been proposed to address the problem but their efficacy in clinical practice is unknown. The aim of the present study was to compare the efficacy of the categorisation rate of Descotes and Cathignol, Spronk et al. and the simplified Saint-Bonnet classifications. Methods: This is a multicentre prospective study where 130 patients attending a vascular arterial ultrasound were enrolled and Doppler waveform acquisition was performed at the common femoral, the popliteal, and the distal arteries at both sides. Experienced vascular specialists categorized these waveforms according to the three classifications. Results: of 1033 Doppler waveforms, 793 (76.8%), 943 (91.3%) and 1014 (98.2%) waveforms could be categorized using Descotes and Cathignol, Spronk et al. and the simplified Saint-Bonnet classifications, respectively. Differences in categorisation between classifications were significant (Chi squared test, p < 0.0001). Of 19 waveforms uncategorized using the simplified Saint-Bonnet classification, 58% and 84% were not categorized using the Spronk et al. and Descotes and Cathignol classifications, respectively. Conclusions: The results of the present study suggest that the simplified Saint-Bonnet classification provides a superior categorisation rate when compared with Spronk et al. and Descotes and Cathignol classifications.

Background: Due to epidemiological transitions, Sub-Saharan Africa is facing a growing burden of non-communicable diseases, including cardiovascular diseases (CVDs). Among their risk factors, hypertension is a major determinant of CVDs, but the prevalence and level of awareness and management of this condition are poorly studied in African populations. The aim of this study was to determine the prevalence of hypertension and identify its associated risk factors as well as the awareness and management of this condition in a community-dwelling cohort in Benin. Methods: A cross-sectional door-to-door study was conducted in the population over the age of 25 years in Tanve, a rural setting in Benin. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. Blood pressure was measured using standard procedures. Results: The sample included 1777 subjects (60.9% females, mean age was 42.5 ± 16.5 years). The prevalence of hypertension was 32.9%, similar in men (32.8%) and women (33.0%, p = 0.9342). Age and obesity were significantly associated with hypertension. Less than half (42%) of hypertensive people were aware about their condition and only 46.3% of them were treated. Awareness ratios differed between men and women (respectively 32.9% vs. 47.5%; p = 0.0039) and was not influenced by age, education, occupation, marital status or income. Female sex was the only factor associated with better controlled HTN, independent of socio-economic parameters. Conclusion: This large population-based study confirms the high prevalence, low awareness, and low control of hypertension in men and women in sub-Saharan Africa. Only half of the populations with hypertension are aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure in these populations.