In Ghana, type 2 diabetes and hypertension prevalence rates have recorded a steady increase over the years [1] [2] . Obesity and dyslipidaemia are mostly associated with people presenting with type 2 diabetes and hypertension [3] [4] . Disordered body fat distribution and plasma lipid levels promote atherosclerosis, a major risk factor for cardiovascular diseases (CVD) such as stroke, coronary artery disease and peripheral vascular disease [4] [5] . In diabetes mellitus and hypertension, the process of atherosclerosis is even more aggressive, thus rapidly predisposing these individuals to a greater risk for CVD [5] [6] . Studies in the Ghanaian populations regarding obesity and dyslipidaemia have mainly been carried out in urban and peri-urban settings [5] [6] [7] [8] . There is therefore a paucity of literature with respect to studies in rural settings like Battor in the Volta Region. This study therefore seeks to determine the relationship between anthropometric, dyslipidaemic parameters and ascertain using the Framingham percentage risk for heart disease, the relative risk of developing CVD in ten years among type 2 diabetes and hypertension patients under clinical management at the Battor Catholic Hospital.

Out of the study population of 187, participants classified as control were 62 (33.2%) and the rest as case presenting with diabetes, hypertension or both 125 (66.8%). As can be seen from Table 1, majority of the participants were females 130 (69.5%). In general, significantly higher levels of education were reported among the controls, the inverse was however observed among the case group. Majority of the respondents worked between one (1) to eight (8) hours a day, though longer working hours were recorded among the case group in comparison to the control (p-0.0415). Dietary salt, sugar and fat intake as well as alcohol intake were predominantly moderate among the study group, with consumption significantly higher toward the controls. Casual participation in exercise was recorded among respondents; however, majority of the case group do not engage at all in exercise 67 (54.0%) (see Table 1).

The average age of the respondents in this study was 48.2 ± 14.2 years. In general, the anthropometric parameters of the case group were significantly

Data is presented as figure with percentage in parenthesis. p is significant at 0.05. n: number, H: Hypertension, Diabetes, H/D: Both Hypertension and Diabetes.

higher compared to the controls, the exception though was found in the height of participants where though not statistically significant the controls were averagely 0.1 meter taller than the cases. Significantly higher systolic and diastolic blood pressures values were observed among the cases compared to the controls. Among the biochemical markers assayed, higher glycaemic and atherogenic lipid levels were observed among the cases (see Table 2).

Significant intra group age differences were observed among the cases, with the mean age increasing from those presenting with only diabetes [48.3 ± 13.9] through those presenting with only hypertension [57 ± 12.5] to participants presenting with both conditions [58.2 ± 12.3]. Significant differences were also observed among the case group with respect to both waist and hip circumference, presenting a trend as afore mentioned for age. The highest average fasting blood glucose concentration was reported among the diabetes only group [12.4 ± 4.4] followed by those with both chronic conditions [11.9 ± 2.7]. Lipid indices assayed in this study were found to be comparable across the case group with the exception of VLDL-C (see Table 3).

Continuous data is presented as means ± standard deviation of the mean. Continuous data were compared using unpaired t-test. p is significant at 0.05. VLDL-C: Very Low Density Lipoprotein-Cholesterol, LDL-C: Low Density Lipoprotein-Cholesterol, HDL-C: High Density Lipoprotein, TC: Total Cholesterol, TG: Triglycerides, FBG: Fasting Blood Glucose, WHR: Waist-to-Hip Ratio, BMI: Body Mass Index, WC: Waist Circumference, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure.

Data is presented as means ± standard deviation of the mean. p is significant at 0.05. Continuous data were compared using one-way ANOVA with a Bonferroni posttest. Ht: Hypertensives, VLDL-C: Very Low Density Lipoprotein-Cholesterol, LDL-C: Low Density Lipoprotein-Cholesterol, HDL-C: High Density Lipoprotein, TC: Total Cholesterol, TG: Triglycerides, FBG: Fasting Blood Glucose, WHR: Waist-to-Hip Ratio, BMI: Body Mass Index, WC: Waist Circumference, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure, p: compares all three, ^acompares control with any, *compares hypertensives or diabetic/hypertensive with diabetics, ¥compares hypertensives and diabetic/hypertensive.

In the control group, the study revealed no significant correlation among the anthropometric variables with the atherogenic indices, as well as glycaemic indices. An observed increase in waist circumference corresponded to an increase in both the systolic and diastolic blood pressure. Among the case group an increase in any of the anthropometric indices (BMI, WC, HC, and WHR) was associated with a corresponding increase in the haemodynamic parameters measured (SBP and DBP). Waist circumference was associated with all the atherogenic indices assayed. The haemodynamic parameters of the case group were found to be positively associated with glycaemia, TC and LDL. Also among the cases a positive relationship was found between glycaemic levels and TC as well as LDL (see Table 4).

Among the general study population, it was observed that 26.2% of the participants had a high risk of developing coronary heart disease over the next ten years. A further 26.2% were estimated to have a moderate risk of developing co-

VLDL-C: Very Low Density Lipoprotein-Cholesterol, LDL-C: Low BMI: Body Mass Index, WC: Waist Circumference, HC: Hip Circumference, WHR: Waist-to-Hip Ratio, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure,, FBG: Fasting Blood Glucose , TC: Total Cholesterol, TG: Triglycerides, HDL: High Density Lipoprotein, LDL: Low Density Lipoprotein-Cholesterol, VLDL: *.Correlation is significant at the 0.05 level (2-tailed), **.Correlation is significant at the 0.01 level (2-tailed), ***.Correlation is significant at the 0.001 level (2-tailed).

ronary heart disease within the next ten years. As shown in Figure 1(a), significantly all the study participants classified as having high risk of developing coronary heart disease were of the case group 49 (39.2%). Additionally, 41(32.8%) of the case group was estimated to carry a moderate risk of developing coronary heart disease compared to 11.3% of the control group. The odds of developing coronary heart disease in ten years was 4.5 times higher among the case group compared to the controls. Gender variations in percentage ten-year risk estimations was observed, with significantly greater number of female participants than male exhibiting high risk profile and the reverse observed at the moderate risk cluster (see Figure 1(a) & Figure 1(b), Figure 2(a) & Figure 2(b)).

Essentially, age is a risk factor for the development of type 2 diabetes and cardiovascular morbidity; the risk of heart disease is observed to increase about 3-fold with each advancing decade [14] . In developing countries, majority of people with diabetes are between the ages of 45 and 64 years [15] . Older age is reportedly associated with heart disease after age 55 and 45 years for women and men respectively [14] . In this study, the average age of the respondents was 48.2 ± 14.2 years. However, among the case group significant intra group age differences were observed, with the mean age increasing from persons presenting with diabetes [48.3 ± 13.9] through those presenting with hypertension [57.1 ± 12.5] to participants presenting with both conditions [58.2 ± 12.3] (see Table 3).

In general, the anthropometric parameters of the case group were significantly higher compared to the controls, the exception though was found in the height of participants where though not statistically significant the control group was averagely 0.1 meter taller than the cases. Significant intra group differences were observed among the case population with respect to both waist and hip circumferences, presenting a trend aforementioned for age. In conformity with the results of this study, earlier studies have reported significantly higher measures of obesity in type 2 diabetes and hypertension [4] [7] [16] [17] [18] . Among the case group an increase in any of the anthropometric indices (BMI, WC, HC, WHR) was associated with a corresponding increase in the haemodynamic parameters measured (SBP and DBP). Findings from previous studies have reported similar observations, a prospective study to examine the relationship between body fat distribution and 2-year incidence of hypertension and stroke demonstrated a relationship between hypertension and abdominal adiposity in a cohort of 41,837 study participants [19] . We [7] , in a Pentecostal population in the Kumasi metropolis recorded a close association between hypertension and central obesity (waist circumference). Though mechanisms linking obesity to haemodynamic dysregulation are not fully understood, Kotsis, et al. [20] posited that during the early phases of obesity, there is sodium retention resulting from an increase in renal tubular re-absorption leading to expansion of extracellular-fluid volume; the kidney-fluid apparatus resets to a hypertensive level consistent with a model of hypertension due to volume overload.

Dyslipidaemia contributes to the process of arteriosclerosis, which develops even faster in the presence of hypertension and diabetes mellitus [6] . In the current study, with the exception of HDL-C, higher levels of unfavourable lipid profiles were recorded in type 2 diabetes and hypertension group. Our results conform to findings from studies conducted among different populations [21] [22] [23] [24] [25] . On the levels of HDL-C among the study population, the findings of the present study are consistent with three previous studies in the Ghanaian and Nigerian populations, which recorded significantly higher mean levels of HDL-C among the disease group in comparison to their control peers [8] [22] [26] . High density lipoprotein cholesterol had been considered to be cardio-protective, with efforts directed at increasing HDL-C levels to reduce the risk in those with increased risk of atherosclerosis [27] . However, emerging evidence shows that higher HDL-C levels may not necessarily result in decreased risk of cardiovascular disease but rather the functional quality of HDL-C [27] [28] . In diabetes, the functional quality of HDL-C has been found to be lower than that of healthy individuals, thus in diabetes HDL-C is unable to reverse- transport cholesterol, has impaired anti-inflammatory and anti-oxidative properties and may even be pro-arteriogenic [27] [29] . In explaining the occurrence of a better lipid profile (high HDL-C levels) among hypertensives, Owusu, et al. [8] suggested, higher mortality among hypertensives with unfavorable lipid profiles, leading to a lower percentage of diabetes survivors with dyslipidaemia.

The association between hypertensive parameters and glycaemia, TC and LDL-C observed in this study were reported previously among Ghanaian diabetes mellitus patients under clinical management at the Tamale Teaching Hospital in the Northern Region of Ghana [30] . The fundamental defect in these patients is their resistance to insulin action which appears to cause hyperinsulinemia, enhanced hepatic gluconeogenesis and glucose output, reduced suppression of lipolysis in adipose tissue leading to a high free fatty acid influx and increased hepatic VLDL secretion causing hypertriglyceridemia and reduced plasma levels of HDL-C [31] .

This study also sought to determine the relative risk of developing future cardiovascular events among different groups within the study population using the Framingham Risk Score [13] . All the study participants classified as having high risk of developing coronary heart disease were of the case group 49 (39.2%) (see Figure 1(a)). The odds of developing coronary heart disease in ten years was 4.5 times higher among the case group compared to the controls. In the STARNet study, Parchman, et al. [32] found 16.2% of type 2 diabetic population recording a high risk of coronary heart disease in ten years. The observed difference in the percentage ten-year coronary risk between the current study and that of the STARNet could be explained by the difference in population characteristics. Whereas the case participants in this study included type 2 diabetes and hypertension individuals, the STARNet study consisted of only persons presenting with type 2 diabetes.

The high coronary risk observed among the case group in this study could be attributable to the major unfavourable cardio-metabolic risk profiles (dyslipidaemia and hyperglycaemia) exhibited by these individuals compared to the controls [33] . The presence of these classic and putative risk factors may affect the heart (coronary artery disease), the central nervous system (cerebrovascular disease) and the lower limbs (peripheral vascular disease) [34] .

Gender variations in percentage ten-year risk estimations were observed to be significantly tilted towards the female subpopulation (p < 0.0030) (Figure 1(b), Figure 2(a) & Figure 2(b)). In a meta-analysis of 37 prospective cohort studies, Huxley, et al. [35] observed a significantly higher risk for fatal coronary heart disease associated with diabetes in women than in men. Women were more likely to exhibit unfavourable cardiovascular risk profiles than men [35] [36] [37] . Within the diabetes population, the female have been reported to exhibit significantly higher levels of blood pressure and lipids than their male counterparts, whiles the difference in these parameters among the female diabetes and non-diabetes population have been observed to be significantly greater than those observed for the male with diabetes and non- diabetes [35] .

Our study demonstrates a significant association with obesity, dyslipidaemia with Ghanaian Type 2 diabetes and hypertensives. The risk of developing future cardiovascular event was high among the case participants. The preponderance of developing future cardiovascular events was higher among the female, a phenomenon which may be mediated by body adiposity and dyslipidaemia.

Our gratitude goes to the management, staff and participants at the Battor Catholic Hospital for their assistance and participation during the study period.

Authors have declared that no conflict of interests exists.

This work was carried out in collaboration between all authors. Authors WKBAO, SYL, JOY, CO and MTAF conceptualized and designed the study. Authors JOY and SYL recruited the study participants. Authors JOY, SYL and CO generated the data. Authors JOY, SYL and WKBAO analyzed the data and drafted the manuscript. Authors WKBAO, SYL, JOY, CO and MTAF reviewed the manuscript for intellectual content and each author approved the final manuscript.

Lokpo, S.Y., Owiredu, W.K.B.A., Osei-Yeboah, J., Obiriko- rang, C. and Agyei-Frempong, M.T. (2017) Association between Anthropometry, Dysli- pidaemia and the Ten-Year Relative Risk of Cardiovascular Disease in Ghanaians with Type 2 Diabetes and Hypertension at the Battor Catholic Hospital. Open Access Li- brary Journal, 4: e3379. https://doi.org/10.4236/oalib.1103379