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Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited.The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria.This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension 33 mm/mOverall, 45 (18.7%) patients died during follow-up. Maternal age 20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF 25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF 25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study.This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery.

Background: There are indications that prehypertension precedes hypertension. Like hypertension, it is associated with increased cardiovascular risk. Objective: To determine the prevalence, awareness and correlates of prehypertension and hypertension among adults in Delta State, Nigeria. Methods: This was a cross-sectional study. We recruited adults aged ≥18 years from two communities in Delta State, Nigeria, using the multi-stage sampling technique. The study instrument was a modified WHO-STEPS questionnaire.Prehypertension and hypertension were defined using the JNC-7 criteria. Ethical approval was obtained before the recruitment of participants. Results: Of the 852 adults studied, the mean (±SD) age was 42.64 (±16.07) years, females (55.9%) and urban dwellers (55.8%). The prevalence of prehypertension and hypertension were 42.5% and 29.3%, respectively; both were higheramong urban dwellers. The peak age-group for prehypertension and hypertension were 25-34 and 35-44 years, respectively.Awareness of hypertension was low; 12.0% (102/852). Blood pressure category significantly correlated with age, body mass index, place of residence, level of education, employment status and fruit intake. Conclusion: The prevalence of prehypertension and hypertension in this study were high. Based on the premise that prehypertension is a precursor of hypertension and occurred more among youths, the higher prevalence of prehypertensiongives an inkling to rising prevalence of hypertension. Keywords: Prehypertension, hypertension, adults, Nigeria, WHO STEPS Funding: Nil

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones.This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.

Rheumatic valvular heart disease (RVHD) is one of the foremost causes of heart failure (HF) in our population, particularly among young adults, but a decline in the prevalence of RVHD has been observed. The effect of this decline on the relevance of RVHD among other causes of HF is not established in our setting.To determine whether RVHD is still a leading cause of HF in our population or not.This was a retrospective study of HF patients hospitalized between August 2018 and June 2020. The demographic features, blood pressure, aetiology of HF and ejection fraction were retrieved from the unit's HF register. Data were presented as frequencies and medians. Associations were tested as appropriate.RVHD accounted for 78 (35.5%) of HF, with a median age of 47 years. The young and middle- aged subgroups were 10(12.8%) and 48(61.6%), respectively. The affected valves were all regurgitant and 68 (77.2%) had definite RVHD. Isolated mitral valve, combined mitral and aortic valves were affected in 40 (51.3%) and 22 (28.2%), respectively. The median systolic blood pressure and ejection fraction were 110mmHg and 26% respectively. RVHD was associated with HF with reduced ejection fraction. (P value0.001).RVHD remains one of the leading causes of HF (35.5%) among adults in our population. Young adults are now in the minority and most patients present late in the course of the disease. Valve surgery should be made readily accessible. Primary and secondary prevention of acute rheumatic fever should be reinforced.La cardiopathie valvulaire rhumatismale (RVHD) est l'une des principales causes d'arrete cardiaque (IC) dans notre population, en particulier chez les jeunes adultes, mais une baisse de la prévalence du RVHD a été observée. L'effet de ceci le déclin de la pertinence de la RVHD parmi les autres causes d'IC est pas établi dans notre environnement.Déterminer si ou non la RVHD est toujours un cause de l'IC dans notre population.Il s'agissait d'une étude rétrospective de patients atteints d'IC hospitalisé entre août 2018 et juin 2020. Le caractéristiques démographiques, tension artérielle, étiologie de l'IC et les fractions d’éjection ont été extraites du registre HF de l’unité. Les données ont été présentées sous forme de fréquences et de médianes. Les associations ont été testés le cas échéant.Le RVHD représentait 78 (35,5%) de l'IC, avec une médiane âge de 47 ans. Les sous-groupes jeunes et d'âge moyen étaient 10 (12,8%) et 48 (61,6%), respectivement. Les valves affectées étaient tous régurgitants et 68 (77,2%) avaient un RVHD défini. La valve mitrale isolée, les valves mitrale et aortique combinées étaient touchés dans 40 (51,3%) et 22 (28,2%), respectivement. Le la pression artérielle systolique médiane et la fraction d'éjection étaient 110 mmHg et 26% respectivement. Le RVHD était associé à HF avec fraction d'éjection réduite. (Valeur P0,001).Le RVHD reste l'une des principales causes de HF (35,5%) chez les adultes de notre population. Les jeunes adultes sont maintenant dans la minorité et la plupart des patients se présentent tard dans le cours de la maladie. La chirurgie valvulaire doit être rendue facilement accessible. Prévention primaire et secondaire de la fièvre rhumatismale aiguë devrait être renforcée.Arrete cardiaque, étiologie, cœur valvulaire rhumatismal maladie.

Aims The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North‐West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. Methods and results Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow‐up, relative to baseline status, were assessed by echocardiography. During median 17 months follow‐up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all‐cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (

Background Peripartum cardiomyopathy (PPCM) seems to have varied epidemiology within and between countries. We recently reported that Kano (North-West Nigeria) has the highest known incidence of PPCM in the world, but the clinical profiles of the patients by regions have not been previously reported. In this study, we aimed to describe the regional differences (if any) in the clinical profiles of patients with PPCM in Nigeria. Methods We consecutively recruited 244 PPCM patients over 9 months from 3 hospitals in Kano (n=199; 81.6%) and from 11 hospitals spread across the North-Central, South-West, South-East and South-South zones (n=45; 18.4%) of Nigeria. Results The baseline characteristics of the patients are summarised in Table 1. 35 (17.6%) patients in Kano and 10 (23.2%) patients in other zones died (p=0.0523) after a median of 17 months. Conclusion PPCM patients in Kano were younger, had lower socio-economic status, presented to hospitals later, were less symptomatic, had larger sizes of cardiac chambers, worse right ventricular systolic function, higher pulmonary artery systolic pressure and were receiving less treatment at enrolment, than those in other zones in Nigeria. This information will be used for advocacy and interactions with healthcare providers. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Dantata Group of Companies (Nigeria). Ammasco International Ltd. (Nigeria). Fortune Oil Mills Nigeria Ltd.

Introduction: There is substantial clinical evidence that monotherapy with beta-blockers are less effective in reducing blood pressure among hypertensive Black patients compared to Whites. The highly selective beta-1 agents like nebivolol and bisoprolol have, however, been reported to be effective in reducing blood pressure in African Americans. However, results in African Americans cannot be extrapolated to native Africans because of genetic admixture and gene-environment interaction. There is, therefore, the need for us to generate data that are applicable to Africans residing in sub-Saharan Africa. We therefore decided to evaluate the efficacy and tolerability of highly selective beta-1 agent nebivolol in hypertensive Black patients residing in sub-Saharan Africa.Materials and Methods: The nebivolol study was a multicenter, prospective, observational program among hypertensive patients with 4- and 8-week follow up which was conducted in 5 cities in Nigeria of Abuja, Calabar, Enugu, Oghara, and Port Harcourt. Dosages of nebivolol used in keeping with local prescribing information were 5 and 10 mg once daily each. The effectiveness of treatment was assessed by change from baseline in mean office systolic and diastolic blood pressures, and the proportion of patients achieving the therapeutic goal of Results: We report the results of the 140 patients studied. The mean age and body mass index were 46.9 ± 7.3 years and 22.3 ± 5.8 kg/m2, respectively, and 57.1% were female. Nebivolol reduced SBP and DBP by 7.6 and 6.6 mmHg, respectively, in 4 weeks, and by 11.1 and 8.0 mm Hg, respectively, in 8 weeks. Blood pressure control was achieved in 54.8% of the patients in 4 weeks and increased to 60.4% in 8 weeks. There was no change in metabolic profile between randomization and at 8 weeks, and erectile dysfunction occurred in 1.3% of the study population.Conclusions: Nebivolol 5 and 10 mg appear efficacious in Nigerian Africans with no negative metabolic effect and minimal side effect profile.Clinical Trial Registration:www.ClinicalTrials.gov, Study Identification: NCT 03598673.

Background: The proliferation of heart-unhealthy lifestyles may in part be responsible for the unabated scourge from heart disease. Assessments of knowledge and perception are key factors in curbing lifestyle-related diseases. Aims: The aim of the study is to determine the prevalence of heart-unhealthy lifestyles and its association with knowledge and perception of heart disease among young adults in Delta State, Nigeria. Settings and Design: A cross-sectional observational study conducted in Oghara, Nigeria. Materials and Methods: Three hundred healthy adults aged 18–35 years were recruited using the multistage sampling technique. The study instrument was a modified structured interviewer-administered questionnaire. Ethical approval was obtained before conducting the survey. Statistical Analysis Used: Obtained data were summarized and analyzed using SPSS version 22.0 software. Results: The response rate was 98% (294/300): 103 males and 191 females. The mean and median age of the respondents was 27 years. Majority of the respondents had at least 6 years of formal education. Heart-unhealthy lifestyles were prevalent: lack of exercise (71.4%), inadequate fruit intake (46.9%), alcohol consumption (26.5%), and tobacco smoking (19%). The mean knowledge score for heart disease was 39.49%. Using a score of 50% as the benchmark for good knowledge, 59% of the respondents had poor knowledge. Majority of the respondents did not perceive that they were at risk of heart disease. Conclusion: Heart-unhealthy lifestyles are common among young Nigerian adults. Knowledge of and self-perceived susceptibility to heart disease were poor in this study. There is a need for increased and refocused heart-health education at all ecological levels from early on in life.

Excess accumulation of body fat results in increased body size and shape change. Ethnic variations in the phenotypic expression of body size are not unrelated to genetic factors and lifestyle-related choices. Anthropometric indices are useful surrogates to assess adiposity. Body mass index and waist circumference assess general and central obesity, respectively. The World Health Organization (WHO) set sex-specific cut-off values for anthropometric indices using Caucasian-based data. However, there are ethnic differences in percentage body fat and obesity-related risks. Compared to Caucasians, Asians have a smaller body frame but higher percentage of body fat and increased cardiometabolic risks. The task to ascertain the level of adiposity at which health becomes threatened is on-going. Although, the calls for ethnic-specific obesity cut-off values are not without controversies, the WHO has redefined Asian-specific obesity cut-off values. Sub-Saharan Africans, Arabs, and Pacific-Islanders need to provide more convincing evidence to justify the need for ethnic-specific obesity cut-off values.

Peripheral artery disease (PAD), an important component of the cardiovascular triad, has been linked with obesity as one of the risk factors for its development. The risk posed by obesity however varies depending on the indices measured.We compared the relationship of measures of central and visceral obesity (waist circumference (WC) and waist-hip ratio (WHR) versus that of general obesity (body mass index (BMI) in the development of PAD among Nigerians with hypertension and/or diabetes mellitus. PAD was diagnosed when Ankle Brachial Index (ABI) was0.9 in either limb.A total of 541 patients (194 males and 347 females) were studied with a mean age of 58.4(±0.46)years. The mean BMI, WC and WHR were 27.8 (±0.222)kg/m2, 96.8 (±0.515)cm and 0.941 (±0.003) respectively. Although the mean BMI, WC and WHR were higher in patients with PAD than those without PAD, the difference was only statistically significant for WC and WHR (p=0.003 and p=0.016) but not BMI (p=0.151). However, the difference in mean BMI was statistically significant in patients60 years (p=0.015) but not in those60 years (p=0.953).This study has shown that in Nigerian Africans measures of central and visceral obesity were more related to the development of PAD than BMI which is a measure of general obesity and that this lack of significance is probably due to the fact that PAD occurred more in older people as there was a significant relationship with PAD in people younger than 60 years old.

8 p., Background Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTERCHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. Methods We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative contribution of each level of adjustment to the risk of death. Findings We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. Interpretation Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are needed. Funding The study was supported by Novartis.

Background: Transthoracic echocardiography (TTE) is a useful diagnostic tool in cardiology practice. The information provided by the requesting physician is a helpful guide in the interpretation of findings. This study aimed to audit echocardiography request forms (ECFs). Methods: A 3-year retrospective audit of echocardiography request forms (ERFs) received at a community-based echocardiography centre in Delta State, Nigeria. Delta State University Teaching Hospital Health Research Ethics Committee granted ethical approval to conduct this study. Data extracted from the ERFs were patients' name, age, sex, address and indication/background clinical information, the name and signature of requesting physician, name of referring hospital and date of the request. Evaluation of the appropriateness of the indications for echocardiography was done using 2011 Revised American College of Cardiology Foundation's appropriate use criteria (AUC). The corresponding echocardiograms were coded as normal or abnormal reports. Data were anonymised and analysed using the SPSS software version 23. Results: All the 412 ERFs audited had the names of the patients. The patients' age, sex and address were missing in 22.6%, 11.4% and 92.5% of the ERFs, respectively. A total of 119 (28.9%) ERFs lacked indication/clinical information and thus unclassifiable using the 2011 AUC. Of the remaining ERFs, the AUC was appropriate, inappropriate and uncertain in 259 (88.4%), 26 (8.9%) and 8 (2.7%), respectively. Majority of the ERFs with uncertain indications had normal echocardiograms. The echocardiograms of 78% (93/119) of the patients whose ERFs lacked indication/clinical information were abnormal. Conclusion: In this study, ERFs were inadequately filled. However, majority of the stated indications/clinical information for TTE were classified as appropriate.

Background: Knowledge gaps and misperception of heart disease and its risk factors are significant roadblocks to effective prevention and control of cardiovascular diseases (CVD). This study aims to assess the knowledge and perception of heart disease and its risk factors among adults in Delta State, Nigeria. Method: Cross-sectional study of adults recruited from Jesse and Warri, Delta State, Nigeria. The study questionnaire was adapted from the heart disease fact questionnaire (HDFQ). Respondents with knowledge scores

Nigeria has the highest burden of PPCM in the world. The condition occurs in one out of every hundred deliveries in the western axis of Northern Nigeria. It is relative uncommon in the southern part of the country. The aim of the paper is to summarise the historical aspect of PPCM report and care in Nigeria.

Background: Globally, women are not exempt from the menace of cardiovascular diseases. Methods: This cross-sectional study assessed the 10-year cardiovascular risk (CVR) for stroke or myocardial infarction of women aged ≥18 years attending opportunistic medical screening programs in two suburban communities in Delta State, Nigeria. Consenting women were consecutively recruited for the study, and the study instrument was the World Health Organization/International Society of Hypertension prediction chart for Africa (AFR D) without blood cholesterol. Total CVR was graded as low ( 40 years, 9.9% had never married, and 39.9% had a secondary level of education. The mean body mass index (29 vs. 27 kg/m2), systolic blood pressure (140 vs. 121 mmHg), diastolic blood pressure (87 vs. 77 mmHg), and blood glucose (104 vs. 92 mg/dl) were significantly higher among women aged ≥40 years. Smoking, hyperglycemia, and hypertension were noted in 0.0%, 7.0%, and 34.4% of the women, respectively. The 10-year risk of stroke or myocardial infarction was low in 87.7%, moderate in 7.2%, and high in 5.0% of the women. All the respondents with high CVR were aged ≥40 years. Among respondents aged

The global COVID-19 pandemic has created in its wake an urgent need for a clear guide for managing cardiovascular diseases and the complications it causes on the cardiovascular system. In this regard, the Executive Council of the Nigerian Cardiac Society constituted a committee to develop guidelines on management of Coronavirus Disease 2019 (COVID 19) and Cardiovascular Diseases. These guidelines have been written to provide a simple approach to managing cardiovascular diseases among COVID 19 patients in Nigeria. It will also provide information about potential cardiac implications of COVID 19 based on evidence and offer early clinical guidance on the management, given the current uncertainty of COVID 19. We have intended that this brief write up and set of recommendations be useful not only for primary care physicians, residents and medical students, but also for all professionals who work as hands-on practitioners.

Objective: To describe the prevalence and rural-urban differences in lifestyle-related cardiovascular risk factors. Method: A cross-sectional survey of apparently healthy adults in an urban and a rural community in Delta State, Nigeria using the WHO STEPS questionnaire. Ethical approval was granted by the Delta State University Teaching Hospital. Results: Of the 866 respondents, 56% were urban dwellers and 44% were males. The mean age was 42.5(±16.05) years. The prevalence of current smokers was 13.6%. It was significantly higher among rural dwellers (22.3% vs 6.8%, p

Introduction: Peripheral artery disease (PAD) is a common but underdiagnosed arm of the cardiovascular triad. Reliance on the presence of skin manifestations of chronic lower limb ischemia may result in clinical inertia in the diagnosis of PAD. Objective: Literature on the skin manifestations of PAD is limited. This paper aims to determine the prevalence and diagnostic value of skin manifestations of PAD. Methods: This was a cross-sectional descriptive study of consecutive adults with hypertension and diabetes attending the consultant medical outpatient department, University of Benin Teaching Hospital, Benin-city, Nigeria. Physical examination of the skin of the lower limbs for features suggestive of PAD and ankle-brachial index (ABI) were performed. A diagnosis of PAD was made if ABI < 0.9. Results: Of the 541 participants, 115 (21.3%) had skin changes suggestive of PAD, and 182 (33.6%) had low ABI < 0.9. Among participants with PAD, 65 (35.7%) had skin manifestations suggestive of PAD. The association between PAD and skin manifestations suggestive of PAD was significant (χ2 = 34.248,P < 0.001). The sensitivity, specificity, positive, and negative predictive values of the presence of skin manifestations as a diagnostic tool for PAD compared with low ABI was 35.7%, 86.1%, 56.5%, and 72.5%, respectively. Conclusion: Among participants with PAD, the prevalence of skin manifestations of suggestive of PAD was 35.7%. Reliance on the presence of skin changes for diagnosis of PAD may result in missed or delayed diagnosis because of its low sensitivity and positive predictive value.

>Introduction: Urbanization has been linked to increasing prevalence of obesity.Objective: To determine the rural–urban differences in the prevalence and sociodemographic correlates of obesity/overweight.Materials and Methods: A cross-sectional, descriptive study of adults in Jesse (rural) and Warri (urban). Weight and height were measured, and body mass index (BMI) was calculated.Results: A total of 866 respondents, 44.0% (rural) and 56.0% (urban) with a male: female ratio of 1:1 and 1:1.5; mean age (± standard deviation [SD]) was 47.1 (±19.0) years and 38.9 (±12.2) years, and mean BMI (±SD) was 22.64 (±3.52) kg/m2 and 24.89 (±5.14) kg for rural and urban populations, respectively. The overall prevalence of obesity and overweight was 10.9% and 20.9%, respectively, with urban (15.7% and 23.9%) being higher than rural (4.7% and 17.1%).Female respondents in both settings had a higher prevalence rate of overweight of 26.5% versus 19.9% (urban) and 17.3% versus 16.8% (rural) for females and males, respectively. The prevalence of obesity is highest among middle-aged (40–64 years) respondents in both settings. The difference in high BMI (≥25 kg/m2) between urban and rural setting in this age group was statistically significant (Chi-square [χ2] = 22.055, df = 1, P < 0.001). The urban–rural differences in the association between educational status and prevalence of obesity and overweight was significant (≤primary: χ2 = 18.970, df = 1, P < 0.001; secondary: χ2 = 9.064, df = 1, P = 0.003).Conclusion: The prevalence of obesity and overweight is high, being higher in the urban population. Obesity and overweight are more prevalent among females and middle-aged persons in both settings. The odds of having high BMI (≥25kg/m2) are highest among urban dwellers with a lower level of education.

Background: The population of elderly persons with diabetes mellitus is increasing worldwide. However, there is scarcity of data on this subgroup of diabetic subjects in our locale. Objective: To study the clinical and biochemical characteristics of elderly diabetic subjects who developed DM at the age of 65 years and above. Subjects and Methods: Hospital records of all persons with type 2 DM seen at a Diabetes Clinic in Benin City, Nigeria who were diagnosed at the age of 65 years and above were retrieved for the study. Data on patient's age, sex, duration of diabetes mellitus, body mass index, waist circumference, blood pressure, fasting plasma glucose, glycosylated hemoglobin A1c (HbA1c), and fasting lipid profile were extracted. Medical records of clinic patients with DM who were diagnosed before the age of 65 years served as controls. Results: Sixty-three patients who developed DM at the age of 65 years and above were included as study subjects while 398 who developed DM before the age of 65 years served as controls. The study subjects consisted of 33 (52.4%) females and 30 (47.6%) males. The mean ± SEM age of study subjects was 73.40 ± 0.72 years (min-max, 66-92 years). Thirty-three (52.4%) of the study subjects had concurrent DM and hypertension. Hypertension and generalized obesity were found in 30 (47.6%) and 8 (12.7%) subjects, respectively. Abdominal obesity was found in 28 (44.4%) of female and in 12 (19%) of male study subjects. The mean body mass index (BMI) was significantly larger in the controls than in the study subjects (28.76 ± 0.45 vs. 26.64 ± 0.72; P = 0.016). The mean systolic and diastolic blood pressures and lipid profile were comparable in study subjects and the controls. Conclusion: Hypertension and dyslipidemia were more common in our elderly study subjects but generalized obesity was less common.

Cor triatriatum dextrum is an exceptionally rare congenital heart disease, in which the right atrium is partitioned into two chambers by a membrane to form a triatrial heart. It is caused by persistence of the right valve of sinus venosus. The aim of presenting this case is to highlight that cor triatriatum dextrum though rare can result in right heart failure, mimicking other common causes of heart failure such as mitral valve disease. 2D-echocardiography is an important tool in making early and accurate diagnosis. We report a case of an adult Nigerian with cor triatriatum dextrum presenting with pulmonary hypertension in heart failure that was initially misdiagnosed as pulmonary tuberculosis with right heart failure at the referring center, and then mixed mitral valve disease clinically by us prior to echocardiographic assessment.