Mohd Ariff Fadzil

Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients.

OBJECTIVE The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia. METHODS A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively. RESULTS A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score. CONCLUSION The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.

Relationship between coping styles and lipid profile among public university staff

BackgroundThe scarcity of data about coping styles with a biochemical marker namely lipid profile, potentially associated with cardiovascular risk factors is most striking among professionals working in public university. Hence, this research aimed to investigate the relationship between coping styles and lipid profile comprising total cholesterol (TC), triglyceride (TG), HDL-cholesterol (high density lipoprotein-cholesterol) and LDL-cholesterol (Low density lipoprotein-cholesterol) among this group of professionals.MethodsA cross sectional survey was conducted among staff from a tertiary education centre. Subjects were contacted to ascertain their medical history. A total of 320 subjects were interviewed and 195 subjects were eligible and subsequently recruited on a suitable date for taking blood and administration of the questionnaires. The subjects completed questionnaires pertaining to demographic details and coping styles. Pearson’s correlation coefficient was used to measure the strength of association between lipid profile and coping styles.ResultsMajority of the subjects were non-academic staff (60.0%), female (67.2%), Malay (91.8%), married (52.3%) and educated until Diploma level (34.9%). Academic staff scored significantly higher mean scores in task-oriented coping styles (Mean = 64.12). Non-academic staff scored significantly higher mean scores in emotion (Mean = 48.05) and avoidance-oriented coping styles (Mean = 57.61). Malay subjects had significantly higher mean scores in emotion (Mean = 47.14) and avoidance-oriented coping styles (Mean = 55.23). Non-malay subjects (Mean = 66.00) attained significantly higher mean scores in task-oriented coping styles. Single/divorced/widowed individuals scored significantly higher mean scores in emotion (Mean = 48.13) and avoidance-oriented coping styles (Mean = 56.86). There was a significant negative correlation between TC (r = −0.162) and LDL (r = −0.168) with avoidance-oriented coping styles (p = 0.023, p = 0.019 respectively).ConclusionAvoidance-oriented coping style was more likely to engender favourable lipid profile. Hence, assessment of coping styles would certainly assist health care practitioners in predicting subjects who would be at a greater risk of developing cardiovascular diseases.

[PP.LB02.09] UTILISING PULSE WAVE VELOCITY IN ASSESSING ARTERIAL STIFFNESS IN PATIENTS WITH MILD-TO-MODERATE RENAL IMPAIRMENT

Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease stage 2 to 4 and normal renal function. Design and method: Patients with confirmed chronic kidney disease stage 2 to 4 were recruited from various clinics in the Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia from 1st August 2015 until 31th January 2016. Sociodemographic and anthropometric indices were recorded at recruitment. Each patient underwent a carotid-femoral (aortic) PWV measurement to determine the arterial stiffness. Results: We studied a cohort of 174 patients: 87 patients with chronic kidney disease stage 2–4 and 87 control patients. The mean age was 47 ± 5.4 years. CKD patients had a higher mean PWV (7.8 ± 1.7) than healthy controls (5.6 ± 1.0) (p < 0.001, 95% CI −2.59,−1.77). There is significant difference of mean PWV between control (5.6 m/s ± 1.0) and CKD stage 2 (7.6 ± 1.5) (p < 0.001, 95% CI −2.40,−1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p < 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, ± 1.5) and stage 4 (9.0 m/s, ± 0.8) was 1.43 (p < 0.001, 95% CI −2.50, −0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s ± 1.8) and non-DM (7.3 m/s ± 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI −1.50,−0.12). There was a significant positive asssociation between DM and PWV (&bgr; = 0.81, r2 = 0.06, p = 0.022). However, no significant association was found on the multivariate analysis beween DM and PWV. Mutiple linear regression analysis showed only age (&bgr; = 0.078, p = 0.014), mean arterial pressure (MAP) (&bgr; = 0.031,p = 0.007) and diuretics usage as the combination antihypertensive medication (&bgr; = 0.839,p = 0.018) were independently associated with PWV (r2 = 0.249, p < 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population.

Support for a Campus Tobacco-Free Policy among Non-Smokers: Findings from a Developing Country

BACKGROUND A tobacco-free workplace policy is identified as an effective means to reduce tobacco use and protect people from second-hand smoke; however, the number of tobacco-free policies (TFP) remains very low in workplaces in Malaysia. This study explored the factors affecting support for a tobacco-free policy on two healthcare campuses in Malaysia, prior to the implementation of TFP. MATERIALS AND METHODS This cross- sectional study was conducted among 286 non-smokers from two healthcare training centres and two nearby colleges in Malaysia from January 2015 to April 2015. A standardized questionnaire was administered via staff and student emails. The questionnaire collected information on sociodemographic characteristics, support for a tobacco-free policy and perceived respiratory and sensory symptoms due to tobacco exposure. Bivariate and multivariate logistic regression analyses were performed to estimate the independent effects of supporting a tobacco-free campus. RESULTS The percentage of individuals supporting completely tobacco-free facilities was 83.2% (N=238), as opposed to 16.7% (N=48) in support of partially tobacco-free facilities. Compared to the supporters of partially tobacco-free facilities, non-smokers who supported completely tobacco-free health facilities were more likely to be female, have higher education levels, to be very concerned about the effects of other people smoking on their health and to perceive a tobacco-free policy as very important. In addition, they perceived that tobacco smoke bothered them at work by causing headaches and coughs and, in the past 4 weeks, had experienced difficulty breathing. In the multivariate model, after adjusting for sociodemographic characteristics and other factors, only experiencing coughs and headaches increased the odds of supporting a completely tobacco-free campus, up to 2.5- and 1.9-fold, respectively. CONCLUSIONS Coughs and headaches due to other people smoking at work enhances support for a completely tobacco-free campus among non-smokers.

Factors associated with anxiety among elderly hypertensive in primary care setting

Abstract Background: There is increasing evidence showing that anxiety is associated with morbidity in the older age group. Factors contributing to anxiety may vary among different diseases and settings. Aims: The aim of this study was to determine the factors associated with anxiety symptoms among elderly hypertensive at the primary care level. Methods: A cross-sectional study and face-to-face interviews using Hospital Anxiety and Depression Scale (HADS) were conducted among elderly hypertensive. Results: The mean (SD) age of subjects was 68.8 (6.76) years and comprised of 49.5% and 50.5% of males and females, respectively. The majority of respondents were Malays (76.1%), followed by Chinese (14.3%), and Indians (9.5%). The mean (SD) duration of hypertension was 8.44 (7.29) years and the prevalence of anxiety symptoms was 13.3% (95% CI: 9.9, 16.7). Multiple logistic regression analysis showed that elderly hypertensive with a past history of stroke (adjusted OR: 4.472; 95% CI: 1.754, 11.405; p = 0.002) and depression (adjusted OR: 3.715; 95% CI: 2.009, 6.872; p < 0.001) was significantly associated with the factors for anxiety. Conclusion: Elderly hypertensive with a history of stroke and having depressive symptoms are susceptible to get the anxiety. Therefore, screenings of risk factors and early intervention may improve the quality of life among elderly.

663 RISK FACTORS ASSOCIATED WITH THE PROGRESSION OF PREHYPERTENSION TO HYPERTENSION AMONG MALAY SUBJECTS IN A RURAL MALAYSIAN COMMUNITY: A 17 YEAR FOLLOW-UP STUDY

Background: Prehypertension (PHT), defined as systolic blood pressure (SBP) 120–139 mmHg and/or diastolic blood pressure (DBP) 80–89 mmHg, has been known to increase the risk of cardiovascular disease (CVD). However, reliable data with regards to the risk factors associated with the progression of hypertension (HT) from PHT is still lacking in developing countries such as Malaysia. Methodology: A follow-up study of 290 subjects, first recruited and evaluated in 1993, were re-evaluated in 2010 in the rural community of Raub, Pahang in Malaysia. The risk factors associated with the progression from PHT to HT state of the subjects were determined. Results: The mean age of PHT subjects in this study increased from 46.70 ± 11.19 to 63.93 ± 11.51 years. Out of the 290 subjects, 96 (33.0%) were PHT. A total of 76 (79.2%) PHT subjects later progressed to HT. The prevalence of diabetes mellitus, hypercholesterolemia and obesity showed significant increase from 9.0%, 22.2%, 6.8% to 23.6%, 56.3% and 19.5% respectively. Subjects with dyslipidemia also showed significant increase from 72.9% to 94.5%. However, the proportion of subjects with normal high density lipoprotein (HDL) level and smoking status showed no significant difference. Conclusions: This study showed that the progression from PHT to HT state were associated with significant increase in the prevalence rate of other CVD risk factor such as diabetes, hypercholesterolemia and obesity. It provides insight to the importance of these risk factors that need to be considered in the prevention and control of CVD diseases in developing countries.

909 SOCIODEMOGRAPHIC AND PSYCHOLOGICAL CORRELATES ASSOCIATED WITH ERECTILE DYSFUNCTION AMONG HYPERTENSIVE PATIENTS

Background: Erectile dysfunction (ED) is highly prevalent among patients with cardiovascular disease. However no study has been done among hypertensive patients from rural multiethnic community in Malaysia. Objective: To estimate the prevalence of ED and the associated sociodemographic and psychological correlates among hypertensive patients. Methods: A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The sociodemographic, health characteritics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of Erectile Function-5(IIEF-5) questionnaire and the Depession, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress respectively. Results: A total of 257 hypertensive patients participted in this study comprising 178 (69%) Malays, 56 (22%) Chinese and 18 (7%) Indians. Mean age was 61 ± 10.9 years. Overall, the prevalence rate of ED was 62%; 90 (35%) with moderate and 69 (27%) with severe ED. Higher proportion was found among Chinese (79%) compared to Malays (60%) and Indians (50%), p = 0.021. Patients with concomitant diabetes mellitus had significantly higher prevalence of ED (71%) compared to those with hypertension only (57%), p = 0.026. Age had negative correlation with IIEF-5 score (r = −0.347, p < 0.001) and the frequency of sexual intercourse (r = −0.340, p < 0.001). However no significant correlation was found between depression, anxiety and stress scores with IIEF-5 score. Conclusions: The prevalence rate of ED among hypertensive patients was high. It was associated with chinese ethnicity, having concomitant diabetes mellitus and increasing age. ED and the associated factors should be assessed and managed in hypertensive patients.

316 SEVENTEEN-YEAR TRANSITION IN CARDIOVASCULAR RISK FACTORS IN A COHORT OF A RURAL MALAYSIAN COMMUNITY

Background: Cardiovascular disease is currently the leading cause of death and disability in developed nations and is increasing rapidly in the developing world. Cardiovascular mortality is increasing in the developing countries such as Malaysia but reliable data regarding the determinants of these changes from its rural community are limited. Methodology: In 1993, 290 participants from the rural community of Raub, Pahang in Malaysia took part in a cardiovascular risk factors survey. In 2010, a follow-up survey was conducted and changes in levels of cardiovascular risk factors over 17 years were analysed. Results: The 1993 survey recruited 290 participants (average age 45.19 ± 11.64 years) of whom 56% were females. In 2010, the study participants were resurveyed and their vital status determined. The mean levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), total cholesterol (TC), and low density lipoprotein (LDL) cholesterol all increased over the 17-year period. Over the same period, the prevalence of hypertension, diabetes mellitus, hypercholesterolemia and obesity were significantly increased from 21.2%, 6.0%, 22.2% and 16.5% to 60.0%, 19.9%, 51.5% and 24.0% respectively. However, smoking prevalence showed no significant difference. Conclusions: The levels of cardiovascular risk factors worsened over the 17-year period between 1993 and 2010 in this rural community. More widespread implementation of community-based initiative inclusive of rural population directed at stemming the increasing burden of cardiovascular morbidity and mortality is required to reverse the impending epidemic of cardiovascular disease, diabetes and obesity in developing nations.

Knowledge and treatment preferences for erectile dysfunction among Malaysian hypertensives

Erectile dysfunction (ED) is commonly associated with hypertension. However, little is known about the preva- lence, knowledge, treatment preferences and experience for erection difficulties among hypertensive Malay - sian men. This cross-sectional study involved 264 hypertensive patients who attended outpatient clinics. Their socio-demo- graphic characteristics and detailed medical history were recorded. The blood pressure of all participants was measured through standardised method. The Malay version of International Index of Erectile Function-5 (IIEF-5) was used to assess ED. Their knowledge regarding hypertension and ED and their treatment preferences were assessed. Out of 264 who con- sented to participate, 77.7% experienced ED. Only 40.5 % seek treatment for erectile difficulty with the majority (92.5%) prefer traditional or complimentary medicine (TCM).