Control of Modifiable Atherosclerosis Risk Factors after Acute Coronary Syndrome in Black African: Prospective Study on 152 Cases in Lomé (Togo)

Objective: The objective is to assess the level of control of modifiable atherosclerosis risk factors and its determinants after acute coronary syndrome, in our patients in sub-Saharan Africa.

Patients and Methods: It is actually a prospective multicenter study, carried out in the Cardiology Services of the University Hospital Centres Sylvanus Olympio and Campus of Lomé, and the Saint-Esprit Medical Office from January, 1st 2017 to December, 31st 2019. We had selected patients followed-up for acute coronary syndrome for at least six months. All risk factors for modifiable atherosclerosis (high blood pressure, diabetes, dyslipidemia, overweight, sedentary lifestyle, smoking) were identified. To assess their level of control, patients were periodically reviewed for blood pressure, weight, waist circumference, LDL-cholesterol, and glycate hemoglobin. Smoking cessation and physical activity were also assessed. The data were analyzed using EPI INFO 6.0 software.

Results: We had retained 152 patients including 44 women and 108 men. The average age was 55±16.3 years. At admission, modifiable risk factors for atherosclerosis were represented by physical inactivity (92%), hypertension (64.5%), dyslipidemia (42.6%), obesity (41%), diabetes (31.2%) and smoking (21%). At follow-up beyond 6 months, blood pressure was normal in (48%) of hypertensive patients with a level of control positively correlated with age >70 years (p=0.011) and adherence to therapy (p=0.021). The diabetes control rate was 46.3%. It was negatively correlated with the high cost of treatment (p=0.04). In 48.1% of cases, LDL-cholesterol levels were at the therapeutic target, with control positively correlated with the dose of Atorvastatin (p=0.03). Smoking cessation was noted in 90% of smokers. The reduction in obesity remained low even after one year of follow-up.

Conclusion: Our study shows a low-level control of modifiable atherosclerosis risk factors during follow-up after Acute Coronary Syndrome. This requires better care improvement and intensification especially through therapeutic education so as to get rid of any reoccurrences and complications.

Keywords: Acute coronary syndrome, modifiable risk factors, sub-Saharan Africa.