Clinical characterization, cardiovascular risk factor profile and cardiac strain analysis in a Uganda cancer population: The SATRACD study.

Wanzhu Zhang,Emmy Okello,James Kayima,Victoria Walusansa,Karen Sliwa,Jackson Orem,Joseph Leeta,Isaac Sinabulya,Feriel Azibani,Otavio R Coelho-Filho

doi:10.1371/journal.pone.0249717

Wanzhu Zhang, Emmy Okello + Show 8 more

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https://doi.org/10.1371/journal.pone.0249717

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Abstract

BackgroundThe link between cancer and cardiovascular disease is firmly established. We sought to investigate the prevalence of cardiovascular disease (CVD) risk factors in Uganda cancer patients, their pre-chemotherapy left ventricular strain echocardiographic pattern and its associations with the CVD risk factors.Methods and resultsBaseline pre-chemotherapy data of patients who were enrolled in the SATRACD study (a cancer cohort, who were planned for anthracycline therapy), were analyzed. The prevalence of cardiovascular risk factors and baseline strain echocardiographic images were assessed. Among the 355 patients who were recruited over a period of 15 months, 283 (79.7%) were female, with a mean age of 43 years. The types of cancer of the study patients included breast cancer (70.6%), lymphomas, sarcomas, leukemias and hepatocellular carcinoma. Hypertension was the most common comorbidity (27.0%). The prevalence of obesity was 12.1% and that of HIV was 18.3%. All patients had a normal left ventricular ejection fraction (LVEF). The mean global longitudinal strain (GLS) was -20.92 ±2.43%, with females having a significantly higher GLS than males (-21.09±2.42 vs -20.25±2.39, p = 0.008). Fifty-three patients (14.9%) had suboptimal GLS (absolute GLS≤18.00%), which was associated with obesity (POR = 3.07; 95% CI, 1.31–6.98; p = 0.003), alcohol use (POR = 1.94; 95% CI, 1.01–3.74; p = 0.044), long QTc interval in electrocardiogram (POR = 2.54; 95% CI, 1.06–5.74; p = 0.015,) and impaired left ventricular relaxation (POR = 2.24; 95% CI, 1.17–4.25; p = 0.007). On multivariable logistic regression analysis, obesity (POR = 2.95; 95% CI, 1.24–7.03; p = 0.014) was the only independent factor associated with suboptimal GLS.ConclusionThere is high prevalence and a unique pattern of cardiovascular risk factors in Uganda cancer patients. In cancer patients with cardiovascular risk conditions, there is reduction in GLS despite preserved LVEF. Longitudinal research is needed to study the predictive value of cardiovascular risk factors and baseline GLS for post chemotherapy cardiac dysfunction.

Highlights

As in many low-middle income countries (LMICs), the growing burden of non-communicable diseases (NCDs) in Uganda is part of an epidemiologic shift catalyzed by demographic and nutritional transitions [1]
We sought to investigate the prevalence of cardiovascular disease (CVD) risk factors in Uganda cancer patients, their pre-chemotherapy left ventricular strain echocardiographic pattern and its associations with the Cardiovascular disease (CVD) risk factors
Fifty-three patients (14.9%) had suboptimal global longitudinal strain (GLS), which was associated with obesity (POR = 3.07; 95% CI, 1.31–6.98; p = 0.003), alcohol use (POR = 1.94; 95% CI, 1.01–3.74; p = 0.044), long QTc interval in electrocardiogram (POR = 2.54; 95% CI, 1.06– 5.74; p = 0.015,) and impaired left ventricular relaxation (POR = 2.24; 95% CI, 1.17–4.25; p = 0.007)

Summary

Introduction

As in many low-middle income countries (LMICs), the growing burden of non-communicable diseases (NCDs) in Uganda is part of an epidemiologic shift catalyzed by demographic and nutritional transitions [1]. Cardiovascular disease (CVD) and cancer are the two leading causes of death from NCDs in the country [2]. The link between these two major NCDs is firmly established through shared risk factors, such as aging, tobacco use, physical inactivity, obesity, unhealthy diet, harmful use of alcohol and HIV status [1]. Cancer can directly or indirectly cause CVDs such as pericardial effusion, infiltrative cardiac disease and venous thromboembolic phenomenon. The link between cancer and cardiovascular disease is firmly established. We sought to investigate the prevalence of cardiovascular disease (CVD) risk factors in Uganda cancer patients, their pre-chemotherapy left ventricular strain echocardiographic pattern and its associations with the CVD risk factors

Methods

Results

Conclusion