Study of factors associated with silent myocardial ischemia in hypertensive diabetic patients followed-up in the cardiology department of Yalgado Ouédraogo Teaching Hospital

Main Article Content

Koudougou Jonas KOLOGO
Anna TALL-THIAM
Laurence Eudoxie KABORE-BENON
Geoges Rosario Christian MILLOGO
Yibar KAMBIRE
Larissa Justine KAGAMBEGA
Elisé Guetawendé KABORE
Martin Zoubadar SOME
Sékou TRAORE
Koulibi Julien NABI
Wendkonta Reine Lydie Flora KOLOGO
Lucie Valérie Adélaide NEBIE
Nobila Valentin YAMEOGO
Koudnoaga André SAMADOULOUGOU
ZABSONRE Patrice

Abstract

Objective: Study the association between anti-ischemic chemoprophylaxis (ACE inhibitor, statin, and antiplatelet agent) and the reduced risk of the occurrence of silent myocardial ischemia in hypertensive diabetic subjects.


Methodology: This was an observational, retrospective, prospective case-control study conducted from January 1 to November 30, 2018. It involved 94 patients distributed into 47 cases and 47 controls following the result of the exercise stress test performed in the cardiology department of Yalgado Ouédraogo Teaching Hospital in Ouagadougou, Burkina Faso.


Results: The average age of the cases was 55.98 ± 8.6 years against 56.11 ± 7.57 years for the controls; the sex ratio was in favor of women in both groups. Anti-ischemic chemoprophylaxis was found in 25% of cases and 15% of controls. The assessment of the cardiovascular risk showed a high cardiovascular risk level in 34% of cases, against to 35% of controls; an intermediate risk level in 34% of cases, against 41% in controls. Risk factors such as age, dyslipidemia, smoking, and hyperuricemia were not associated with silent myocardial ischemia. Multivariate analysis revealed an association (odds ratio = 0.29; p = 0.048) between chemoprophylaxis and reduction of 71% of the risk of silent myocardial ischemia.


Conclusion: Our work highlights the importance of pharmacological treatment of hypertensive diabetic patients as a primary cardiovascular prevention.

Article Details

KOLOGO, K. J., TALL-THIAM, A., KABORE-BENON, L. E., MILLOGO, G. R. C., KAMBIRE, Y., KAGAMBEGA, L. J., … Patrice, Z. (2025). Study of factors associated with silent myocardial ischemia in hypertensive diabetic patients followed-up in the cardiology department of Yalgado Ouédraogo Teaching Hospital . Journal of Cardiology and Cardiovascular Medicine, 10(5), 106–112. https://doi.org/10.29328/journal.jccm.1001217
Research Articles

Copyright (c) 2025 Kologo KJ, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

1. World Health Organization (WHO). Global report on diabetes. Geneva; 2016;86. Available from: https://iris.who.int/handle/10665/254648

2. Ministry of Health, Burkina Faso. National survey report on the prevalence of major common risk factors for non-communicable diseases in Burkina Faso. 2013;104. Available from: https://cdn.who.int/media/docs/default-source/ncds/ncd-surveillance/data-reporting/burkina-faso/steps/burkinafaso-2013-steps-report.pdf

3. Chironi G, Simon A. Cardiovascular risk factors and prevention. Rev Prat. 2010;(60):1303–9. Available from: https://www.researchgate.net/publication/49843374_Cardiovascular_risk_factors_and_prevention

4. Kolte D, Aronow WS, Banach M. Polypills for the prevention of cardiovascular diseases. Expert Opin Investig Drugs. 2016;25(11):1255–64.

5. Arroyo-Rodríguez C, Brito-Zurita OR, Sandoval-Navarrete S, Solis-Vásquez R, Ornelas-Aguirre JM, Olea-Hernández C, et al. Risk factors for three-vessel coronary artery disease in patients of Northwest Mexico. Arch Cardiol Mex. 2018;88(5):423–31. Available from: https://doi.org/10.1016/j.acmx.2018.02.009

6. Moutakiallah Y, Aithoussa M, Atmani N, Amahzoune B, Hatim A, Drissi M, et al. Coronary surgery under cardiopulmonary bypass in patients with diabetes. Pan Afr Med J. 2014;17:199. Available from: https://www.panafrican-med-journal.com/content/article/17/199/full/

7. Cauderc R, Bonnefont RD, Paul JL, Therond P. Lipid profile 2017. Ann Biol Clin. 2017:646–52. Available from: https://doi.org/10.1684/abc.2017.1303

8. Ferrières J. The 2016 European Society of Cardiology Recommendations on the Management of Dyslipidemia. Presse Med. 2017;46(7-8):688–96. Available from: https://www.em-consulte.com/article/1138465/les-recommandations-de-2016-de-la-societe-europeen

9. Leriverend H, Clere N, Faure S. Kidney failure and drug-induced nephrotoxicity. 2016;23–30. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0515370016301744

10. Kirk JK, Bertoni AG, Case D, Bell RA, Goff DC, Narayan KMV. Predicted risk of coronary heart disease among persons with type 2 diabetes. Coron Artery Dis. 2007;18(8):595–600. Available from: https://doi.org/10.1097/mca.0b013e3282f0902b

11. Purifine Ake-Tano SO, Ekou FK, Konan YE, Tetchi EO, Kpebo DO, Sable SP, et al. Dietary habits among type 2 diabetic patients attending the Abidjan Diabetes Centre de Santé Publique. 2017 Jul 10;423–30. Available from: https://pubmed.ncbi.nlm.nih.gov/28737363/

12. Mbaye A, Yaméogo NV, Ndiaye MB, Kane AD, Diack B, Dioum M, et al. Screening of silent myocardial ischaemia by dobutamine stress echocardiography among type 2 diabetics at high cardiovascular risk in Senegal. Ann Cardiol Angeiol (Paris). 2011;60(2):67–70. Available from: https://doi.org/10.1016/j.ancard.2010.07.001

13. Koo BK, Kim YG, Park KS, Moon MK. Asymptomatic subjects with diabetes have a comparable risk of coronary artery disease to non-diabetic subjects presenting chest pain: a 4-year community-based prospective study. BMC Cardiovasc Disord. 2013 Oct 18;13:87. Available from: https://doi.org/10.1186/1471-2261-13-87

14. ACCORD Study Group, Buse JB, Bigger JT, Byington RP, Cooper LS, Cushman WC, et al. Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol. 2007 Jun 18;99(12A):21i–33i. Available from: https://doi.org/10.1016/j.amjcard.2007.03.003

15. Yaméogo TM, Kyelem CG, Ouédraogo MS, Lankoandé D, Rouamba M-M, Cruz ME, et al. Clinical characteristics of diabetes screening volunteers: insights for prevention in Burkina Faso. Health Sci Dis. 2014;15(1). Available from: https://doi.org/10.5281/hsd.v15i1.328

16. Ntyonga-Pono M-P. Adherence to antidiabetic treatment among diabetic patients in Gabon: preliminary data. Med Mal Metab. 2015;9(2):198–202. Available from: https://www.scirp.org/reference/referencespapers?referenceid=3664326

17. Vernstrøm L, Funck KL, Grove EL, Laugesen E, Baier JM, Hvas A-M, et al. Antiplatelet effect of aspirin during 24h in patients with type 2 diabetes without cardiovascular disease. Thromb Res. 2018;161:1–6. Available from: https://doi.org/10.1016/j.thromres.2017.11.013

18. Vigili de Kreutzenberg S, Solini A, Vitolo E, Boi A, Bacci S, Cocozza S, et al. Silent coronary heart disease in patients with type 2 diabetes: application of a screening approach in a follow-up study. J Diabetes Complications. 2017;952–7. Available from: https://doi.org/10.1016/j.jdiacomp.2017.03.014

19. Gu A, Kamat S, Argulian E. Trends and disparities in statin use and low-density lipoprotein cholesterol levels among US patients with diabetes 1999–2014. Diabetes Res Clin Pract. 2018;139:1–10. Available from: https://doi.org/10.1016/j.diabres.2018.02.019

20. Institut National de la Statistique et de la Démographie (INSD). Statistical yearbook [Internet]. 2016.

21. Diyane K, Ansari NE, Mghari GE, Anzid K, Cherkaoui M. Characteristics of the association between type 2 diabetes and hypertension in subjects aged 65 and older. Pan Afr Med J. 2013;14. Available from: https://doi.org/10.11604/pamj.2013.14.100.1880

22. Ferrières J. Cardiovascular risk assessment. Arch Cardiovasc Dis Suppl. 2012;4(4):248–58. Available from: https://pubmed.ncbi.nlm.nih.gov/15724421/

23. Hirayama S, Rinsho B. Secondary dyslipidemia: diagnosis of drug-induced dyslipidemia. Jpn J Clin Pathol. 2016;64(5). Available from: https://pubmed.ncbi.nlm.nih.gov/30695363/

24. Singh R, Devi S, Gollen R. Role of free radicals in atherosclerosis, diabetes and dyslipidemia: larger-than-life. Diabetes Metab Res Rev. 2015;31(2):113–26. Available from: https://doi.org/10.1002/dmrr.2558

25. Ouédraogo T. Screening for silent myocardial ischemia in type 2 diabetics at Yalgado Ouédraogo University Hospital: contribution of the stress test [Thesis]. Ouagadougou: Université Ouaga 1: Joseph Ki Zerbo; 2017.

26. Taskinen M-R, Borén J. New insights into the pathophysiology of dyslipidemia in type 2 diabetes. Atherosclerosis. 2015;239(2):483–95. Available from: https://doi.org/10.1016/j.atherosclerosis.2015.01.039

27. Chait A, Goldberg I. Treatment of dyslipidemia in diabetes: recent advances and remaining questions. Curr Diab Rep. 2017 Nov;17(11). Available from: https://doi.org/10.1007/s11892-017-0942-8

28. Michel F. Dyslipidemia in diabetics. In: Expressions santé SAS. Diabetes and obesity. Paris. 2011;170–5.

29. Halimi S. What to remember and how to apply it in practice? A hope and confirmation of medical common sense. Lettre du Cardiologue. (243):20–4.

30. Netgen. Therapeutic impact of screening for silent myocardial ischemia in type 2 diabetic patients. Switzerland. 2008;(4):1800–4.

31. Puel J, Valensi P, Vanzetto G, Lassmann-Vague V, Monin JL, Moulin P, et al. Société Française de Cardiologie (SFC); Association de Langue Française pour l’Étude du Diabète et des Maladies Métaboliques (ALFEDIAM). Identifying myocardial ischaemia in diabetics. SFC/ALFEDIAM joint recommendations. Arch Mal Coeur Vaiss. 2004;97(4):338–57. Available from: https://pubmed.ncbi.nlm.nih.gov/15182078/

32. Goff D, Gerstein HC, Ginsberg HN, Cushman WC, Margolis KL, Byington RP, et al. Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current knowledge and rationale for the ACCORD trial. Am J Cardiol. 2007;99(12 Suppl):S4–20. Available from: https://doi.org/10.1016/j.amjcard.2007.03.002

33. Scognamiglio R, Negut C, Ramondo A, Tiengo A, Avogaro A. Detection of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus. J Am Coll Cardiol. 2006 Jan 3;47(1):65–71. Available from: https://doi.org/10.1016/j.jacc.2005.10.008

34. Jackson G, Padley S. Erectile dysfunction and silent coronary artery disease: abnormal CT coronary angiogram despite normal exercise ECGs. J Clin Pract. 2008;62(6):973–6. Available from: https://doi.org/10.1111/j.1742-1241.2008.01788.x

35. Coca A, Agabiti-Rosei E, Cifkova R, Manolis AJ, Redón J, Mancia G. The polypill in cardiovascular prevention: evidence, limitations and perspectives – position paper of the European Society of Hypertension. J Hypertens. 2017;35(8):1546–53. Available from: https://doi.org/10.1097/hjh.0000000000001390

36. Skolnik N, Jaffa FM, Kalyani RR, Johnson E, Shubrook JH. Reducing cardiovascular risk in diabetes: An ADA update. J Fam Pract. 2017;66(5):300–8. Available from: https://www.mdedge.com/jfponline/article/136327/diabetes/reducing-cvrisk-diabetes-ada-update

37. Malekzadeh F, Marshall T, Pourshams A, Gharravi M, Aslani A, Nateghi A, et al. A pilot double-blind randomized placebo-controlled trial of fixed-dose combination therapy (polypill) on cardiovascular risk factors. J Clin Pract. 2010;64(9):1220–7. Available from: https://doi.org/10.1111/j.1742-1241.2010.02412.x

38. ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529–39. Available from: https://doi.org/10.1056/nejmoa1804988

39. Pavlovic J, Greenland P, Deckers JW, Brugts JJ, Kavousi M, Dhana K, et al. Comparison of ACC/AHA and ESC guideline recommendations following trial evidence for statin use in primary prevention: results from the Rotterdam Study. JAMA Cardiol. 2016;1(6):708. Available from: https://doi.org/10.1001/jamacardio.2016.1577

40. Belaid R, Oueslati I, Jallouli H, Trabelsi R, Ajili M, Chihaoui M, et al. Diet and cardiovascular risk in type 2 diabetes. Ann Endocrinol (Paris). 2018;79(5):490. Available from: https://doi.org/10.1016/j.ando.2018.06.977