Investigation of Electrocardiographic Changes in Individuals with Three or More Cardiovascular Risk Factors on Santiago Island—The Cross-Sectional PrevCardio.CV Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Type of Study
2.2. Participants
- Location and sample:
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- The sample was proportionally distributed among the various municipalities on Santiago Island, with the data collection procedure being performed randomly and at home.
- ○
- The study sample was calculated based on the demographic projections for Cabo Verde from 2010 to 2030, which showed that there were 317,238 individuals on Santiago Island in 2021.
- ○
- For the sample calculation, an estimated prevalence of 50%, a 95% confidence interval, and a 4% standard error were considered. The sample size is 599 individuals distributed across the nine municipalities on the island under study.
- Inclusion and exclusion criteria:
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- Inclusion criteria: individuals over 18 years old, of both sexes, residing on Santiago Island, and who agreed to participate in the study by signing the informed consent.
- ○
- Exclusion criteria: Cabo Verdean nationals who had been abroad for more than a year and had returned to Santiago Island less than 30 days before the start of the study. Also excluded were individuals with any disability that might have prevented them from participating in the study.
2.3. Variables
- Data collect:
- ○
- The individuals were invited to participate after reading the informed consent form, with all procedures explained. The households were selected by random sampling, and contact with the individuals began with an index house, from which nearby residences were surveyed, alternating three or more houses in any direction whenever possible. In residences where more than one individual met the inclusion criteria, data collection procedures were applied to all.
- ○
- A cardiovascular risk factors assessment questionnaire was applied.
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- The collected data included: age, sex, race, weight, height, presence of diabetes, dyslipidemia, family history, physical activity, alcoholism, smoking habits, history of cardiovascular events, weight and blood pressure monitoring habits.
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- Physical exercise: quantified by frequency (number of days per week) and duration (minutes/hours) of activity.
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- Smoking habits: assessed by the number of cigarettes smoked daily and the number of years of use.
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- Alcohol consumption: quantified by the number of glasses consumed per day, during and/or outside of meals.
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- History of cardiovascular conditions: participants were asked if they had experienced myocardial infarction (MI), stroke, or transient ischemic attack (TIA).
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- Family history: participants were inquired about the existence of any relatives with known heart disease.
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- Monitoring habits: participants were asked about their habits of monitoring blood pressure and weight and how frequently they did so.
2.4. Measurements
- Weight and height:
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- Weight was measured using a SECA® digital scale (Hamburg, Germany) with participants instructed to stand on the scale barefoot, with empty pockets, upright posture, and arms along the body.
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- Height was measured using a SECA® portable stadiometer (Hamburg, Germany) placed on a flat surface. Participants were instructed to remove any objects from their head that might interfere with the measurement, to stand with their back to the stadiometer, legs and feet parallel and arms along their sides.
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- BMI: categorized according to the WHO guidelines, using the formula BMI = weight/(height)2 [15].
- Blood pressure:
- ○
- Blood pressure assessment was carried out following the protocol of the Beira Baixa Blood Pressure Program (PPABB) using an automatic OMRON M3® device (Kyoto, Japan). Three readings were taken, with additional readings if the first two measurements varied by more than 10 mmHg. Blood pressure values were classified according to the 2023 European Society of Cardiology Guidelines [16].
- Diabetes:
- ○
- The presence of diabetes was verified through capillary blood glucose measurement conducted at the time of the questionnaire, using a manual glucose meter with test strips from the FreeStyle® brand (Abbott Park, IL, USA). The values were analyzed according to data from the Portuguese Diabetes Protection Association [17].
- Lipid sheet:
- ○
- Assessed through a questionnaire regarding knowledge of cholesterol levels, triglycerides, and history of medication use for cholesterol reduction.
- Electrocardiographic evaluation:
- ○
- The electrocardiographic evaluation was performed on participants who presented three or more associated risk factors, using the Schiller® electrocardiograph model AT101 (Baar, Switzerland). A 12-lead ECG was performed, with the individuals remaining at rest for at least 3 min, lying on a bed, in the supine position, with their muscles relaxed, arms stretched along the body and legs extended. Monitoring was performed in the conventional manner, using 4 peripheral electrodes placed on the participants’ limbs, namely, R—right arm, L—left arm, F—left leg, N—right leg (neutral). The precordial electrodes were placed in the precordial region, with V1 in the fourth intercostal space on the right margin of the sternum, V2 in the fourth intercostal space on the left border of the sternum, V3 in the middle between electrodes V2 and V4, V4 in the fifth left intercostal space on the midclavicular line, V5 at the same level as electrode V4 on the anterior axillary line, and V6 at the same level as electrodes V4 and V5 on the midaxillary line. After all electrodes were placed and checked, the electrocardiographic recording was started with a graph paper speed of 25 mm/s and amplitude of 1 mV per 10 mm. The analyses of the electrocardiographic recordings were performed based on the recommendations or the standardization and interpretation of the electrocardiogram guidelines (75–78). The electrocardiographic parameters were analyzed according to normality requirements, namely, heart rate (50–100 bpm); heart rhythm; electrical axis (from −30° to 90° normal axis, −30° to −90° axis deviated to the left, 90° to 180° axis deviated to the right, −90° and −180° extreme deviation of the electrical axis); P wave (positive or biphasic polarity), amplitude (≤2.5 mm), and duration (0.08 and 0.12 s); QT interval (350 ms to 450 ms); PQ segment duration (0.12 to 0.20 s); QRS complex duration (≤0.120 s), and amplitude (≤25 mm). The existence of alterations in the ST segment was analyzed, being normal when isoelectric. It was also verified whether the T wave was positive in all leads except aVR and the existence of a pathological Q wave.
2.5. Statistical Analysis
- Software and tests used:
- ○
- The data were analyzed using the IBM SPSS Statistics® software (Statistical Package for the Social Sciences), version 20.
- ○
- To assess the normal distribution of the sample, the Kolmogorov–Smirnov normality test was applied.
- ○
- Associations between variables were examined using the chi-square test, with a significance level of p ≤ 0.05 and a 95% confidence interval.
Assessment for eligibility | Evaluated | Excludes |
599 | 0 | |
Selection of participants | Eligible Participants | Participants who agreed and were included |
599 | 599 | |
Data collect | Participants who completed data collection | Participants who did not complete data collection |
599 | 0 | |
Data analysis | Included in the final analysis | Excluded in the final analysis |
599 | 0 | |
Consort diagram. |
3. Results
4. Discussion
5. Conclusions
6. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Distribution RF | n | Total (%) | Sex M (%) | Sex F (%) | Predominance AG |
---|---|---|---|---|---|
None RF | 56 | 9.3 | 58.9 | 41.1 | 18–27 |
One RF | 165 | 27.5 | 47.3 | 52.7 | 18–27 |
Two RF | 217 | 36.2 | 45.2 | 54.8 | 38–47 |
Three or more RF | 161 | 26.9 | 38.6 | 61.4 | 58–67 |
Heart Rate | n | Total (%) | Sex F (%) | Sex M (%) |
---|---|---|---|---|
Bradycardia (<50 bpm) | 3 | 1.9 | 33.3 | 66.7 |
Normal (50–100 bpm) | 153 | 95 | 62.1 | 37.9 |
Tachycardia (>100 bpm) | 5 | 3.1 | 60 | 40 |
Electrical Axis | n | Total (%) | Sex F (%) | Sex M (%) |
---|---|---|---|---|
Normal (−30° to 90°) | 151 | 93.8 | 80 | 20 |
Left Axis Deviation (−30° to −90°) | 8 | 5 | 75 | 25 |
Right Axis Deviation (90° to 180°) | 2 | 12 | 0 | 100 |
Electrocardiographic Changes | n | Total (%) | Predominant Sex |
---|---|---|---|
Ventricular Repolarization Changes | 26 | 26.8 | Female |
Nonspecific Repolarization Changes | 13 | 13.4 | Female |
Early Repolarization | 12 | 12.4 | Male |
First atrioventricular | 8 | 8.2 | Female |
Big T-wave | 7 | 7.2 | Female |
Intraventricular disturbance | 7 | 7.2 | Female |
Atrial hypertrophy | 6 | 6.2 | Female |
Sinus tachycardia | 4 | 4.1 | Same |
Ventricular extrasystole | 3 | 3.1 | Male |
Left ventricular hypertrophy | 2 | 2.1 | Same |
Atrial tachycardia | 2 | 2.1 | Male |
Supraventricular extrasystole | 1 | 1.0 | Female |
Other Changes | 6 | 6.2 | Male |
Risk Factors | p |
---|---|
Sex | 0.028 |
BMI ≥ 25 kg/m2 | <0.001 |
Sedentary Lifestyle | <0.001 |
Alcoholism | 0.027 |
Smoking | 0.352 |
Hypercholesterolemia | <0.001 |
Hypertriglyceridemia | <0.023 |
Family history of CCVD | <0.001 |
Hypertension | <0.001 |
Diabetes | <0.001 |
History of CCVD | 0.007 |
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Share and Cite
Coelho, P.; Mascarenhas, K.; Rodrigues, J.; Rodrigues, F. Investigation of Electrocardiographic Changes in Individuals with Three or More Cardiovascular Risk Factors on Santiago Island—The Cross-Sectional PrevCardio.CV Study. J. Pers. Med. 2024, 14, 876. https://doi.org/10.3390/jpm14080876
Coelho P, Mascarenhas K, Rodrigues J, Rodrigues F. Investigation of Electrocardiographic Changes in Individuals with Three or More Cardiovascular Risk Factors on Santiago Island—The Cross-Sectional PrevCardio.CV Study. Journal of Personalized Medicine. 2024; 14(8):876. https://doi.org/10.3390/jpm14080876
Chicago/Turabian StyleCoelho, Patrícia, Kelly Mascarenhas, Júlio Rodrigues, and Francisco Rodrigues. 2024. "Investigation of Electrocardiographic Changes in Individuals with Three or More Cardiovascular Risk Factors on Santiago Island—The Cross-Sectional PrevCardio.CV Study" Journal of Personalized Medicine 14, no. 8: 876. https://doi.org/10.3390/jpm14080876