Hashem Jaddou

Hypertension among 1000 patients with type 2 diabetes attending a national diabetes center in Jordan

BACKGROUND AND OBJECTIVES In Jordan, there is a paucity of research on hypertension and its risk factors among patients with type 2 diabetes mellitus. This study was designed to assess the prevalence of hypertension, risk factors, and the level of awareness and control of hypertension among outpatients with type 2 diabetes. SUBJECTS AND METHODS A cross-sectional study was carried out on a sample of 1000 patients with type 2 diabetes who were attending the National Center for Diabetes, Endocrine and Genetic Diseases for follow-up during the period of June to December 2006. Data were collected from medical records and through a structured interview questionnaire. Logistic regression analysis was used to assess the independent effect of variables on hypertension. RESULTS The prevalence of hypertension (BP >130/80 or on medication for high blood pressure) was 72.4% (70.9% of males and 73.9% of females). The logistic regression indicated that hypertension was positively associated with age (P=.001), body mass index (P=.001), and duration of diabetes (P=.001). About one-half of patients who were aware of having hypertension failed to keep their blood pressure under control. CONCLUSION Hypertension is a common co-morbidity among diabetic patients. Despite a high rate of awareness of hypertension among study subjects (93%), hypertension was not controlled to the recommended levels of blood pressure in about one-half (50.4%) of patients.

Vitamin B12 deficiency in Jordan: a population-based study.

Background: Vitamin B12 deficiency is highly prevalent worldwide and has been linked to hematologic, neurologic and psychiatric diseases. There are a few studies regarding vitamin B12 deficiency in developing countries in general and in Jordan in particular. Objectives: The aims of the present study were to assess the vitamin B12 status of Jordanians at national level and to identify population groups at high risk for vitamin B12 deficiency. Methods: Vitamin B12 status was assessed in a national sample of 5,640 subjects aged >8 years. The study involved interviews, laboratory measurements of vitamin B12 and other parameters, and physical measurements. The present report deals exclusively with subjects aged >18 years (n = 2,847). Results: The percentages of subjects with low (<200 pg/ml, n = 857), borderline (201-350 pg/ml, n = 382) and normal vitamin B12 level (>350 pg/ml, n = 1,608) were 30.1, 13.4 and 56.5%, respectively. Of the 382 subjects who had borderline vitamin B12 level, 61 subjects had both increased total homocysteine (tHcy; >13 µmol/l) and low holocobalamin (<35 pmol/l). Since elevated tHcy also indicates folate deficiency, the overall prevalence of vitamin B12 deficiency reached 32.2% (31.9% among males and 32.4% among females) after adding those 61 subjects to the 857 subjects with low vitamin B12 level. Conclusion: In conclusion, our study showed that almost one third of Jordanian adults have vitamin B12 deficiency with no gender differences. Intake of vitamin B complex and multivitamins seems to protect from vitamin B12 deficiency. An in-depth study of the dietary and eating habits of Jordanians may be needed to explain the observed age and regional differences in vitamin B12 deficiency in the study population.

Peripheral arterial disease in diabetic Jordanian patients and the agreement between ankle brachial index and toe brachial index

This study aims to screen patients with type 2 diabetes mellitus for peripheral arterial disease (PAD) and to determine the agreement between ankle brachial index (ABI) and toe brachial index (TBI). A total of 182 diabetic patients at 40 years of age or older were assessed using both ABI and TBI. Mean age was 60.5 (SD ±8.1) years. PAD was present in 28.9% and 5.4% of patients according to TBI and ABI definitions respectively. The prevalence of high ABI (ABI > 1.3) was 16.5%. The agreement between TBI and ABI results was fair. Current smoking was associated with low ABI whereas age was inversely associated with TBI. We strongly suggest using both the ABI and TBI as screening tests for PAD because the agreement between these tests was fair, they complement each other in most instances and they detect PAD at different anatomical levels.

Prevalence of Myopathy in Subjects on Statin Therapy Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan

Objective: This study aims to find the prevalence and risk factors of myopathy in subjects on statin therapy. Methods: Cross sectional study was conducted on 1046 subjects on statin therapy for dyslipidemia who were attending the National center for Diabetes, Endocrinology and Genetics [NCDEG] in Jordan between Sep. and Dec. 2012. Questionnaire was used to collect demographic data, medical history and muscular symptoms. Results: The prevalence of muscular symptoms among subjects taking statin was 27.9%, when subjects referred their muscular symptoms to statin the prevalence drop to 16.4%. Bivariate and multivariate analyses showed significant association between muscular symptoms and hypothyroidism, taking medication or substances that are known to interact with statin treatment [Fibrates, Verapamil, Amiodarone, Warfarin, Digoxin or Grapefruit juice [>1 quart/day]], and allopurinol therapy. Conclusions: Statin use is significantly associated with high prevalence of musculoskeletal pain [27.9%]. Although many clinicians perceive myalgia as a minor adverse effect, its clinical significance should not be underestimated, as myalgia could be a major obstacle to treatment adherence.

Comparison of Plasma Levels of Natural Anticoagulants (Protein C and Protein S) among Jordanian Smokers and Non-Smokers

Background: Protein C (PC) with its cofactor free protein S (FPS) are important anticoagulants. Any defect in the PC system is a risk factor for venous thrombosis. Aims: To assess the effect of intensity of smoking, and the dose-response for the number of cigarettes smoked on PC and FPS plasma levels. Methods: A comparative study was designed and carried out on a convenient sample of 50 healthy non-smokers and 150 non-symptomatic Jordanian male smokers. PC and FPS levels were measured using an automated system (Stago Analyzer, USA). Results: The plasma level of PC among smokers was 7.2% lower than that among non-smokers (p = 0.02). Moreover, smokers had 15.6% lower circulating FPS than non-smokers (p = 0.001). Furthermore, data showed significant negative correlations between both PC and FPS levels and the intensity of smoking (r = –0.21%, r = –0.23%, respectively; p = 0.01) and the period of smoking (r = –0.15%, r = –0.23%, respectively; p = 0.01, 0.12, respectively). Conclusions: The PC and FPS plasma levels were significantly lower in smokers than non-smokers. Both PC and FPS levels correlated inversely with the period and intensity of smoking, and FPS was more sensitive to smoking than PC.

The Prevalence of Dyslipidemia among Jordanians

Background Dyslipidemia is one of the major modifiable risk factors for the development of cardiovascular disease and type two diabetes mellitus. Knowing the current prevalence of dyslipidemia is an important step for increasing awareness of the problem and for proper planning of health programs for prevention of its negative clinical effects. Methods A national population based household sample was selected from north, middle, and south regions of Jordan in 2017. A total sample of 4,056 aged between 18 and 90 years were included. Selected individuals were interviewed using a structured questionnaire and fasting blood samples were collected for biochemical measurements. Results The prevalence rates of hypercholesterolemia, hypertriglyceridemia, high LDL, and low HDL were 44.3%, 41.9% 75.9%, and 59.5%, respectively. Hypercholesterolemia in Jordan almost doubled from 23.0% in 1994 to 44.3% in 2017, and hypertriglyceridemia increased from 23.8% in 1994 to 41.9% in 2017. All lipid abnormalities decreased after the age of 60 years. Hypertension, diabetes, and obesity were all independently associated with hypercholesterolemia and hypertriglyceridemia. Conclusions Results of this study show that dyslipidemia is a widely prevalent health problem among adult Jordanian population and that the problem has substantially increased since 1994. Encouraging healthy lifestyle and healthy diet are the basis for prevention of dyslipidemia.