The Dual Burden of Hypertension and Dyslipidemia in Yemeni Diabetics: Prevalence, Microvascular Impact, and the Mediating Role of Hyperglycemia-Induced Hypertension
Description
In a retrospective cross-sectional study of 91 patients at a cardiac clinic in Ibb, Yemen, we analyzed a subcohort of 53 diabetic adults. Dyslipidemia was defined as total cholesterol >200 mg/dL or triglycerides >150 mg/dL; hypertension was defined as systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg. Primary outcomes included proteinuria (≥1+ on dipstick) and diabetic retinopathy. We employed multivariable logistic regression to identify predictors of microvascular complications and formal mediation analysis to explore pathways between hyperglycemia, blood pressure, and organ damage.
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Participant Selection Patients aged 18 years and older who attended the clinic during the study period and were diagnosed with hypertension, diabetes mellitus, or both were eligible for inclusion. Hypertension was defined according to current clinical guidelines as systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥80 mmHg, or documented use of antihypertensive medication. Diabetes mellitus diagnosis was established via fasting blood glucose ≥126 mg/dL, HbA1c ≥6.5%, or current use of antidiabetic drugs. Patients with incomplete clinical or laboratory records, or those presenting with acute illnesses, were excluded from the study. Data Collection and Definitions Data were extracted from medical records including demographics, anthropometric measures, clinical variables, laboratory values, and behavioral factors such as khat chewing. Body mass index was calculated as weight in kilograms divided by height in meters squared. Proteinuria was assessed using urine dipstick analysis, with a reading of 1+ or higher considered positive. Duration of disease was computed from the time of diagnosis. Diabetic retinopathy status was obtained from ophthalmology records when available. Cardiovascular risk phenotypes were categorized based on the presence of hypertension and/or dyslipidemia, defined by total cholesterol >200 mg/dL or triglycerides >150 mg/dL. Definition of Cardiovascular Risk Phenotypes Cardiovascular risk phenotypes were defined on the basis of the presence or absence of hypertension and dyslipidemia. Dyslipidemia was deemed present if total cholesterol exceeded 200 mg/dL or triglycerides were greater than 150 mg/dL. Patients were categorized into four groups: dual burden (both hypertension and dyslipidemia), dyslipidemia only, hypertension only, and diabetes only without these comorbidities. Outcomes The primary renal outcome was proteinuria status. Secondary outcomes included presence and grade of diabetic retinopathy. Additional composite risk scores were calculated based on weighted sums of standardized clinical variables to stratify risk among diabetic patients.
Institutions
- Ibb University